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Differences in suicidal idea and behavior according to cognitive function in elderly people
S638 P3-381
Poster Presentations P3 DIFFERENCES IN SUICIDAL IDEA AND BEHAVIOR ACCORDING TO COGNITIVE FUNCTION IN ELDERLY PEOPLE
Jaenam Bae1, Young-Soo Lee2, Daham Cho3, Byungsoo Kim4, SungMan Chang5, Dong Woo Lee6, Maeng-Je Cho7, 1Inha hospital, Incheon, South Korea; 2In-Ha university, Incheon, South Korea; 3Inha university hospital, Incheon, South Korea; 4National Cancer Center, Goyang-si Gyeonggi-do, South Korea; 5Kyungpook university hospital, Daegu, South Korea; 6Inje university Sanggye Paik hospital, Seoul, South Korea; 7Seoul National University Hospital, Seoul, South Korea. Background: The risk factors of the suicidal attempt in the aged population are known to be depression, health problem. Also, there is a doctrine that says the impaired cognitive function may be the risk factor of the suicidal attempt in the elderly people. So we did a comparative study on the frequency of suicidal idea and behavior between the general aged group, dementia group and MCI group. Methods: Face-to-face household survey was conducted in five different regions of Korea from June 2008 to August 2008. There were 3,074 subjects, aged more than 65. Number of respondents was 2007 people. Cognitive function was evaluated using the Korean version of the CERAD Neuropsychological Assessment Battery. The participants are categorized into the normal group, dementia group and MCI group and the suicidal idea and behavior were compared. The data was adjusted according to the age, sex, educational background, alcohol consumption, smoking history and GDS. Results: 2007 subjects were analyzed: 1552 were classified as normal aging group, 391 as MCI, and 64 as dementia. Comparing between the normal and dementia groups, the rate of suicidal idea of the dementia group was 4.8 %, which was lower than the normal group’s 14.8% (OR 0.28, p < 0.001). It was still lower when adjusted by the age, sex, educational background, alcohol consumption, smoking history and GDS (OR 0.33, p¼0.001). However, comparing between the normal and MCI group, the rate of suicidal idea MCI group 19.4%, normal group 14.8%, OR 1.38, p< 0.001) and behavior (MCI group 12.0%, normal group 8.9%, OR 1.41, p< 0.001) was statistically significantly higher in the MCI group. After the adjustment, both suicidal idea and behavior were higher in the MCI group. Conclusions: In this research, there is a significant difference of suicidal idea and behavior depending on the impairment of cognitive function. More aggressive psychiatric intervention for suicidal attempts is necessary for the MCI group considering the fact that the mildly cognitive impaired patients shows the higher frequency of both suicidal idea and behavior compared to the normal group. P3-382
QUALITY OF LIFE IN DEMENTIA PATIENTS IN A DEVELOPING COUNTRY: COMPARISON OF THREE APPROACHES
R. P. Bhandari*1, Sanjit Raj Joshi2, 1CHES.Nepal, KTMq, Nepal; 2Tri Chandra Campus, KTM, Nepal. Background: Aging related health problems are increasing in developing country like Nepal. To compare ratings of quality of life in patients with established dementia patients in both subjective and objective view points and between patients’ and relatives’ ratings. Methods: Subjective and objective quality of life was assessed in 38 patients with dementia patients using the Quality of Life Interview - Brief Version and WHO Quality of Life - Bref scale. Key family members were also interviewed using the same scales. Results: Subjective and objective quality of life are moderately well correlated (r ¼ 0.43) and similar agreement was found between patients and relatives (r ¼ 0.46). Conclusions: Although quality of life is characteristically measured with subjects, the use of objective measures of quality of life and key informants of patients provide useful proxy measures. Support, care and treatment center should be established in different community to improve the quality of life of patients in developing country like Nepal. P3-383
WHAT IS REQUIRED TO ENSURE QUALITY DEMENTIA CARE IN RURAL SETTINGS?
Dorothy Forbes1, Catherine Blake2, Elina Salonen3, Sara Finkelstein2, Debra Morgan4, Maureen Markle-Reid5, Maggie Gibson6, Ivan Culum2,
Christine Leskovar3, Betsy Little3, 1University of Alberta, Edmonton, Alberta, Canada; 2University of Western Ontario, London, Ontario, Canada; 3Alzheimer Society London & Middlesex, London, Ontario, Canada; 4University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 5 McMaster University, Hamilton, Ontario, Canada; 6Parkwood Hospital, St. Joseph’s Health Care London, London, Ontario, Canada. Background: Although many Canadian rural communities are experiencing declining populations, they are also experiencing a faster growing proportion of seniors than in urban areas. Thirty-three per cent of seniors reside in predominantly rural regions, with proportions of seniors and persons with dementia (PWD) increasing as the distance from urban centres increases. Community health care providers may be the only contact PWD and their family caregivers have with the health care system. However, many providers report that they lack dementia care knowledge and skills. Methods: The overarching aim of this research was to enhance the use of evidence-informed dementia care in rural settings through a richer understanding of the diverse types of evidence and knowledge used and needed by rural PWD, their caregivers, and their community health care providers. A Qualitative Interpretive Descriptive approach was used. A thematic approach was used to analyze data collected from a convenience sample selected through our study collaborators: Alzheimer Society of London Middlesex (ASLM), Oneida Nation of the Thames, and the South West Community Care Access Centre. Face-to-face interviews were conducted with 10 dementia care networks (two from Oneida Nation) that included five PWD; 14 family caregivers (six spouses, five children, two grandchildren and one nephew); and 14 community health care providers (nurses, personal support workers, social workers, physicians, and administrators). Results: The overarching theme was identified as ‘relationships’: relationships that changed as the symptoms of dementia progressed and those that endured as trusting partnering relationships. Relationships among the health care provider, PWD, and their family caregivers were essential for the health care provider to navigate and ‘be there’ for PWD and family caregivers through their dementia journey. Only then could the reciprocal exchange of knowledge occur. Health care providers identified strategies that would enhance their access to research-based evidence and were more likely to contribute evidence from empirical research, knowledge from clinical practice, and “how to” knowledge, while caregivers were more likely to contribute experiential and contextual knowledge and information about the PWD to the knowledge exchange process. The resulting care decisions reflected the challenging, complex and changing nature of dementia care (e.g., how to manage daily activities, behavioral challenges, sleep-wake disturbances, communication and eating difficulties, being depressed, and decisions about placement in long-term care facilities). Conclusions: Rural community health care providers must take an active role in ensuring that family members are equipped with the knowledge they need to provide quality care to the PWD and be willing to advocate for their clients. Knowledge exchange is not merely passing on information. Rather, it is important for care partners to have an opportunity to develop trusting relationships, to learn from each other, and to engage in conversations about how the new information might apply to their own lives. P3-384
FORMER ALCOHOLICS SHOW DEFICITS IN MEMORY
Emilio Herrera Junior, Fabio Limonte, Jessica Rodrigues, Gustavo A. Herrera, Faculty of Medicine of Catanduva, Catanduva, Brazil. Background: Chronic alcoholism leads to a progressive reduction of memory that induces Korsakoff’s psychosis. Previously studies about alcoholism effects focus on the cognitive activities has interest in clinical research because the specificity of the symptoms and possible reversal or permanent dysfunction of the same during the different period of abstinence. This study aim to evaluate the memory and the abstract reasoning in individuals after a long period of alcohol abstinence. Methods: Sixty male individuals were interviewed by a standard questionnaire in the city of Catanduva-SP/Brazil. The former alcoholics (n¼30; mean age MA¼56years) had a prolonged use of alcohol (at least 20years) and remained in the abstinence time for 5years. The control group (n¼30; MA¼56)non-alcoholics volunteers from the general population. The memory was measured by Mini-Mental State Examination (mini-mental) and a learning test whit a list of 10words (CERAD;
Poster Presentations P3 DIFFERENCES IN SUICIDAL IDEA AND BEHAVIOR ACCORDING TO COGNITIVE FUNCTION IN ELDERLY PEOPLE
Jaenam Bae1, Young-Soo Lee2, Daham Cho3, Byungsoo Kim4, SungMan Chang5, Dong Woo Lee6, Maeng-Je Cho7, 1Inha hospital, Incheon, South Korea; 2In-Ha university, Incheon, South Korea; 3Inha university hospital, Incheon, South Korea; 4National Cancer Center, Goyang-si Gyeonggi-do, South Korea; 5Kyungpook university hospital, Daegu, South Korea; 6Inje university Sanggye Paik hospital, Seoul, South Korea; 7Seoul National University Hospital, Seoul, South Korea. Background: The risk factors of the suicidal attempt in the aged population are known to be depression, health problem. Also, there is a doctrine that says the impaired cognitive function may be the risk factor of the suicidal attempt in the elderly people. So we did a comparative study on the frequency of suicidal idea and behavior between the general aged group, dementia group and MCI group. Methods: Face-to-face household survey was conducted in five different regions of Korea from June 2008 to August 2008. There were 3,074 subjects, aged more than 65. Number of respondents was 2007 people. Cognitive function was evaluated using the Korean version of the CERAD Neuropsychological Assessment Battery. The participants are categorized into the normal group, dementia group and MCI group and the suicidal idea and behavior were compared. The data was adjusted according to the age, sex, educational background, alcohol consumption, smoking history and GDS. Results: 2007 subjects were analyzed: 1552 were classified as normal aging group, 391 as MCI, and 64 as dementia. Comparing between the normal and dementia groups, the rate of suicidal idea of the dementia group was 4.8 %, which was lower than the normal group’s 14.8% (OR 0.28, p < 0.001). It was still lower when adjusted by the age, sex, educational background, alcohol consumption, smoking history and GDS (OR 0.33, p¼0.001). However, comparing between the normal and MCI group, the rate of suicidal idea MCI group 19.4%, normal group 14.8%, OR 1.38, p< 0.001) and behavior (MCI group 12.0%, normal group 8.9%, OR 1.41, p< 0.001) was statistically significantly higher in the MCI group. After the adjustment, both suicidal idea and behavior were higher in the MCI group. Conclusions: In this research, there is a significant difference of suicidal idea and behavior depending on the impairment of cognitive function. More aggressive psychiatric intervention for suicidal attempts is necessary for the MCI group considering the fact that the mildly cognitive impaired patients shows the higher frequency of both suicidal idea and behavior compared to the normal group. P3-382
QUALITY OF LIFE IN DEMENTIA PATIENTS IN A DEVELOPING COUNTRY: COMPARISON OF THREE APPROACHES
R. P. Bhandari*1, Sanjit Raj Joshi2, 1CHES.Nepal, KTMq, Nepal; 2Tri Chandra Campus, KTM, Nepal. Background: Aging related health problems are increasing in developing country like Nepal. To compare ratings of quality of life in patients with established dementia patients in both subjective and objective view points and between patients’ and relatives’ ratings. Methods: Subjective and objective quality of life was assessed in 38 patients with dementia patients using the Quality of Life Interview - Brief Version and WHO Quality of Life - Bref scale. Key family members were also interviewed using the same scales. Results: Subjective and objective quality of life are moderately well correlated (r ¼ 0.43) and similar agreement was found between patients and relatives (r ¼ 0.46). Conclusions: Although quality of life is characteristically measured with subjects, the use of objective measures of quality of life and key informants of patients provide useful proxy measures. Support, care and treatment center should be established in different community to improve the quality of life of patients in developing country like Nepal. P3-383
WHAT IS REQUIRED TO ENSURE QUALITY DEMENTIA CARE IN RURAL SETTINGS?
Dorothy Forbes1, Catherine Blake2, Elina Salonen3, Sara Finkelstein2, Debra Morgan4, Maureen Markle-Reid5, Maggie Gibson6, Ivan Culum2,
Christine Leskovar3, Betsy Little3, 1University of Alberta, Edmonton, Alberta, Canada; 2University of Western Ontario, London, Ontario, Canada; 3Alzheimer Society London & Middlesex, London, Ontario, Canada; 4University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 5 McMaster University, Hamilton, Ontario, Canada; 6Parkwood Hospital, St. Joseph’s Health Care London, London, Ontario, Canada. Background: Although many Canadian rural communities are experiencing declining populations, they are also experiencing a faster growing proportion of seniors than in urban areas. Thirty-three per cent of seniors reside in predominantly rural regions, with proportions of seniors and persons with dementia (PWD) increasing as the distance from urban centres increases. Community health care providers may be the only contact PWD and their family caregivers have with the health care system. However, many providers report that they lack dementia care knowledge and skills. Methods: The overarching aim of this research was to enhance the use of evidence-informed dementia care in rural settings through a richer understanding of the diverse types of evidence and knowledge used and needed by rural PWD, their caregivers, and their community health care providers. A Qualitative Interpretive Descriptive approach was used. A thematic approach was used to analyze data collected from a convenience sample selected through our study collaborators: Alzheimer Society of London Middlesex (ASLM), Oneida Nation of the Thames, and the South West Community Care Access Centre. Face-to-face interviews were conducted with 10 dementia care networks (two from Oneida Nation) that included five PWD; 14 family caregivers (six spouses, five children, two grandchildren and one nephew); and 14 community health care providers (nurses, personal support workers, social workers, physicians, and administrators). Results: The overarching theme was identified as ‘relationships’: relationships that changed as the symptoms of dementia progressed and those that endured as trusting partnering relationships. Relationships among the health care provider, PWD, and their family caregivers were essential for the health care provider to navigate and ‘be there’ for PWD and family caregivers through their dementia journey. Only then could the reciprocal exchange of knowledge occur. Health care providers identified strategies that would enhance their access to research-based evidence and were more likely to contribute evidence from empirical research, knowledge from clinical practice, and “how to” knowledge, while caregivers were more likely to contribute experiential and contextual knowledge and information about the PWD to the knowledge exchange process. The resulting care decisions reflected the challenging, complex and changing nature of dementia care (e.g., how to manage daily activities, behavioral challenges, sleep-wake disturbances, communication and eating difficulties, being depressed, and decisions about placement in long-term care facilities). Conclusions: Rural community health care providers must take an active role in ensuring that family members are equipped with the knowledge they need to provide quality care to the PWD and be willing to advocate for their clients. Knowledge exchange is not merely passing on information. Rather, it is important for care partners to have an opportunity to develop trusting relationships, to learn from each other, and to engage in conversations about how the new information might apply to their own lives. P3-384
FORMER ALCOHOLICS SHOW DEFICITS IN MEMORY
Emilio Herrera Junior, Fabio Limonte, Jessica Rodrigues, Gustavo A. Herrera, Faculty of Medicine of Catanduva, Catanduva, Brazil. Background: Chronic alcoholism leads to a progressive reduction of memory that induces Korsakoff’s psychosis. Previously studies about alcoholism effects focus on the cognitive activities has interest in clinical research because the specificity of the symptoms and possible reversal or permanent dysfunction of the same during the different period of abstinence. This study aim to evaluate the memory and the abstract reasoning in individuals after a long period of alcohol abstinence. Methods: Sixty male individuals were interviewed by a standard questionnaire in the city of Catanduva-SP/Brazil. The former alcoholics (n¼30; mean age MA¼56years) had a prolonged use of alcohol (at least 20years) and remained in the abstinence time for 5years. The control group (n¼30; MA¼56)non-alcoholics volunteers from the general population. The memory was measured by Mini-Mental State Examination (mini-mental) and a learning test whit a list of 10words (CERAD;