Net costs of dementia in Sweden – An Incidence Based 10 Year Simulation Study.

Net costs of dementia in Sweden – An Incidence Based 10 Year Simulation Study.

Int J Geriatr Psychiatry. 2012 Feb 1;

Authors: Sköldunger A, Wimo A, Johnell K

Abstract

BACKGROUND: Aging of the population results in increasing number people suffering from dementia, and this will have a great impact on costs for the society. Because of the long duration of dementia disorders, it is difficult to collect empirical data for the whole survival period of incident cases. Therefore, modeling approaches are frequently used. The purpose of this study was to describe the costs of an incident dementia cohort with progression modeling. METHODS: Epidemiological data indicated that the incidence of dementia in Sweden was 24,000 people in 2005. Thus, incident cases were run in a Markov model for 10 cycles of 1 year each. Severity state specific costs were used and defined by Clinical Dementia Rating scale. RESULTS: Total cost for the cohort was 27.24 billion Swedish Krona (SEK). The mean cost per person and year was 269,558 SEK. Total cost for long-term institutional care was 21 billion SEK during the modeled period. CONCLUSION: Cost of long-term institutional care is the major cost driver, even in mild dementia. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22298311 [PubMed - as supplied by publisher]

 

Semantic memory and language dysfunction in early Alzheimer’s disease: a review.

Semantic memory and language dysfunction in early Alzheimer’s disease: a review.

Int J Geriatr Psychiatry. 2012 Feb 1;

Authors: Verma M, Howard RJ

Abstract

BACKGROUND: Language impairment in Alzheimer’s disease occurs early, and language function deteriorates with progression of the illness to cause significant disability. This review focuses on language dysfunction in Alzheimer’s disease and the contribution of semantic memory impairment. METHODS: Electronic publication databases were searched for literature relevant to the review. Additionally, individual references were examined to elicit further studies not found by online search. RESULTS: Language impairment in Alzheimer’s disease initially affects verbal fluency and naming before breakdown in other facets. Naming and fluency require integrity of semantic concepts, and dysfunction may be a marker of primary semantic memory impairment rather than overall cognitive decline. Research suggests the presence of semantic loss several years prior to diagnosis. Imaging studies indicate an altered connectivity state with respect to language networks, and this is associated with potential semantic failure. This state may also be present in individuals with established risk factors for Alzheimer’s disease. Compensatory recruitment of alternative cortical areas to supplement language function appears to occur and may be a target for future intervention. CONCLUSIONS: Identifying and classifying the nature and degree of language impairment more closely could aid in developing targeted therapies. Treatments already established in other aphasic states, such as post-stroke, may be especially relevant. The nature of these and the protective nature of cognitive reserve are potential therapeutic avenues. Copyright © 2012 John Wiley & Sons, Ltd.

PMID: 22298328 [PubMed - as supplied by publisher]

 



Unmarried Boomers Confront Old Age: A National Portrait.

Unmarried Boomers Confront Old Age: A National Portrait.

Gerontologist. 2012 Jan 31;

Authors: Lin IF, Brown SL

Abstract

Purpose of the Study:Our study provides a national portrait of the Baby Boom generation, paying particular attention to the heterogeneity among unmarried Boomers and whether it operates similarly among women versus men. DESIGN AND METHODS: We used the 1980, 1990, and 2000 Census 5% samples and the 2009 American Community Survey (ACS) to document the trends in the share and marital status composition of the unmarried population during midlife. Using the 2009 ACS, we developed a sociodemographic portrait of Baby Boomers according to marital status. RESULTS: One in three Baby Boomers was unmarried. The vast majority of these unmarried Boomers were either divorced or never-married; just 10% were widowed. Unmarried Boomers faced greater economic, health, and social vulnerabilities compared to married Boomers. Divorced Boomers had more economic resources and better health than widowed and never-married Boomers. Widows appeared to be the most disadvantaged among Boomer women, whereas never-marrieds were the least advantaged among Boomer men. IMPLICATIONS: The rise in unmarrieds at midlife leaves Baby Boomers vulnerable to the vagaries of aging. Health care and social service providers as well as policy makers must recognize the various risk profiles of different unmarried Boomers to ensure that all Boomers age well and that society is able to provide adequate services to all Boomers, regardless of marital status.

PMID: 22298744 [PubMed - as supplied by publisher]

 

Baby Boom Caregivers: Care in the Age of Individualization.

Baby Boom Caregivers: Care in the Age of Individualization.

Gerontologist. 2012 Jan 31;

Authors: Guberman N, Lavoie JP, Blein L, Olazabal I

Abstract

PURPOSE: Many Baby Boomers are faced with the care of aging parents, as well as that of disabled or ill spouses or children. This study examines how Baby Boomers in Quebec, Canada, perceive and play their role as caregivers and how this might differ from their parents’ generation. DESIGN AND METHODS: This was a qualitative and empirical study using an interpretive constructivist design. We interviewed 39 Baby Boomers caring for a family member with a semistructured guide that examined respondents’ identification with their social generation, their relationship to and values regarding caregiving, and the reality of the caregiving they offered. RESULTS: In contrast to our perceptions of previous generations, the majority of interviewees refuse to be confined to the sole identity of caregiver, as they work to juggle caregiving, work, family, and social commitments. To succeed in this juggling act, they have high expectations of support from services. Based on this new approach to caregiving, we advance the idea of a “denaturalization” of care, no longer seen as a “natural” destiny or “normal” family responsibility. IMPLICATIONS: The new conception of caregiving as work that can and should be shared with services is in direct opposition to public policy that is based on the assumption of family care as the cornerstone of long-term care. Can the healthcare system adapt to the new expectations of the Baby Boom generation or will these caregivers be forced to take on elements of caregiving they no longer consider legitimate?

PMID: 22298745 [PubMed - as supplied by publisher]

 

Out of the Closet and Into the Trenches: Gay Male Baby Boomers, Aging, and HIV/AIDS.

Out of the Closet and Into the Trenches: Gay Male Baby Boomers, Aging, and HIV/AIDS.

Gerontologist. 2012 Jan 31;

Authors: Rosenfeld D, Bartlam B, Smith RD

Abstract

Regardless of HIV status, all gay male Baby Boomers are aging in a context strongly shaped by HIV/AIDS. For this subcohort within the Baby Boom generation, the disproportionately high volume of AIDS deaths among gay men aged 25-44 years at the epidemic’s peak (1987-1996) created a cohort effect, decimating their social networks and shaping their personal and social lives during the epidemic, throughout their life course, and into later years. But despite these lasting effects on an entire cohort of gay men, relevant scholarship narrowly focuses on older HIV-positive gay men using clinical, psychological, and social network approaches. It thus makes inadequate use of the life course perspective, which, by attention to timing, agency, and interdependence, can uncover the myriad interlocking and longitudinal aspects of the epidemic that affect this group. This article argues for the application of this latter approach to research into the lasting impacts of HIV/AIDS on this cohort of gay men. We examine HIV/AIDS mortality within this cohort at the epidemic’s height, these deaths’ concentration in urban gay communities, and the growing and increasingly diverse population of HIV-positive gay men born in the Baby Boom Years. Our conclusion suggests that a fuller examination of the role of HIV/AIDS in the lives of gay male Baby Boomers, using a life course perspective, is critical to appreciating this generation’s heterogeneity and to expanding knowledge of how later life is shaped by the intersection between historical events, personal biography, and social and community ties.

PMID: 22298746 [PubMed - as supplied by publisher]

 



Cohort Differences in the Availability of Informal Caregivers: Are the Boomers at Risk?

Cohort Differences in the Availability of Informal Caregivers: Are the Boomers at Risk?

Gerontologist. 2012 Jan 31;

Authors: Ryan LH, Smith J, Antonucci TC, Jackson JS

Abstract

Purpose of the Study:We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age. DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles. RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby. IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.

PMID: 22298747 [PubMed - as supplied by publisher]

 

Prescribing patterns of low doses of antipsychotic medications in older Asian patients with schizophrenia, 2001-2009.

Prescribing patterns of low doses of antipsychotic medications in older Asian patients with schizophrenia, 2001-2009.

Int Psychogeriatr. 2012 Feb 3;:1-7

Authors: Xiang YT, Dickerson F, Kreyenbuhl J, Ungvari GS, Wang CY, Si TM, Lee EH, He YL, Chiu HF, Lai KY, Shinfuku N, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH

Abstract

ABSTRACTBackground: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001-2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.

PMID: 22300452 [PubMed - as supplied by publisher]

 

The validity of amnestic MCI and non-amnestic MCI at age 75 in the prediction of Alzheimer’s dementia and vascular dementia.

The validity of amnestic MCI and non-amnestic MCI at age 75 in the prediction of Alzheimer’s dementia and vascular dementia.

Int Psychogeriatr. 2012 Feb 3;:1-8

Authors: Jungwirth S, Zehetmayer S, Hinterberger M, Tragl KH, Fischer P

Abstract

ABSTRACTBackground: Clinical subtypes of mild cognitive impairment (MCI) were assigned as potential prodromes to various types of dementia. Amnestic MCI (aMCI) is said to have a high likelihood of progressing to Alzheimer’s dementia (AD) and non-amnestic MCI (naMCI) subtypes are assumed to have a higher likelihood of progressing to non-AD dementia. The aim of this study was to investigate the prognostic accuracy of aMCI and naMCI for the development of AD, vascular dementia (VaD), and mixed dementia.Methods: In this longitudinal study, 487 subjects without dementia (cognitively healthy: n = 387; MCI cases: n = 115) aged 75 years at baseline, who participated in a population-based cohort study (Vienna Transdanube Aging study), were available for analysis. The observation period was 90 months. The diagnoses of the clinical MCI subtypes were made according to common criteria. The outcome (AD, VaD, mixed dementia) was described for both MCI subtypes. Diagnostic values of aMCI and naMCI according to incident AD, VaD, and mixed dementia were determined.Results: AD was the most common type of dementia following both MCI subtypes. Participants with aMCI were more likely to progress to AD than participants with naMCI. The proportion of incident VaD and mixed dementia did not differ concerning the MCI subtypes. The positive predictive value for both MCI subtypes was low (range: 1%-46%), whereas the negative predictive value was high (range: 86%-99%).Conclusions: The increased risk of clinical MCI subtypes for a particular type of dementia could only be confirmed for aMCI and incident AD.

PMID: 22300486 [PubMed - as supplied by publisher]

 

When the profession becomes personal: dementia care practitioners as family caregivers.

When the profession becomes personal: dementia care practitioners as family caregivers.

Int Psychogeriatr. 2012 Feb 3;:1-9

Authors: Manthorpe J, Samsi K, Rapaport J

Abstract

ABSTRACTBackground: Little is known about the impact of caring experience on the practice of dementia care professionals. Few research studies covering dementia practice ask about personal experiences of providing care or having a family member with dementia. In England and Wales, the Mental Capacity Act (MCA) 2005 provided a new legal framework for planning and decision-making in the event of possible loss of capacity. Professional activities in this area include advice and assistance with arranging proxy decision-making, establishing wishes, and advance decisions. The aim of this paper is to present interview data from dementia care professionals with family experiences of dementia and their reflections on decision-making frameworks.Methods: A total of 123 dementia care professionals working in community and care home settings were interviewed (2007-2010) about their experiences and expectations of the MCA 2005. Additional questions covered experiences of being family members or carers of a person with dementia and any use of the planning and decision-making provisions of the MCA in personal and family contexts. Data were analyzed thematically.Results: Seventy practitioners had experience of family members with dementia and family caring. Decision-making and planning were viewed as easier under the MCA but tensions could arise around loss of decision-making capacity or family dispute. Empathy for caregiving situations and how things could have been different were reflected upon.Conclusions: Trainers, clinical supervisors, and researchers in dementia care may build upon personal experience of some practitioners to promote empathy with other family carers and the provision of timely information and advice.

PMID: 22300515 [PubMed - as supplied by publisher]

 

Neighborhood characteristics and depressive mood among older adults: an integrative review.

Neighborhood characteristics and depressive mood among older adults: an integrative review.

Int Psychogeriatr. 2012 Feb 3;:1-19

Authors: Julien D, Richard L, Gauvin L, Kestens Y

Abstract

ABSTRACTBackground: There is growing evidence that neighborhood environments are related to depressive mood in the general population. Older adults may be even more vulnerable to neighborhood factors than other adults. The aim of this paper is to review empirical findings on the relationships between neighborhood characteristics and depressive mood among older adults.Methods: A search of the literature was undertaken in PsycINFO and MEDLINE.Results: Nineteen studies were identified. Study designs were most often cross-sectional, included large sample sizes, and controlled for major individual characteristics. Mediational effects were not investigated. Statistical analysis strategies often included multilevel models. Spatial delimitations of neighborhood of residence were usually based on administrative and statistical spatial boundaries. Six neighborhood characteristics were assessed most often: neighborhood socioeconomic disadvantage, neighborhood poverty, affluence, racial/ethnic composition, residential stability, and elderly concentration. Selected neighborhood characteristics were associated with depressive mood after adjusting for individual variables. These associations were generally theoretically meaningful.Conclusions: Neighborhood variables seem to make a unique and significant contribution to the understanding of depressive mood among older adults. However, few studies investigated these associations and replication of results is needed. Several substantive neighborhood variables have been ignored or neglected in the literature. The implications of neighborhood effects for knowledge advancement and public health interventions remain unclear. Recommendations for future research are discussed.

PMID: 22300529 [PubMed - as supplied by publisher]