This document summarizes guidelines for communicating with and obtaining informed consent from elderly subjects, particularly those with frailty or dementia. It discusses definitions of elderly, frailty, and regulatory requirements. Sensory impairment, dementia, aphasia, and assessment tools are reviewed. Guidelines emphasize assessing a subject's ability to make a choice, understand information, appreciate the situation, manipulate information rationally, and remember their decision. Prospective studies find decision-making capacity varies between diagnostic groups and is predicted by cognitive deficits. Obtaining valid informed consent from elderly subjects requires thorough communication and capacity assessments.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Are Primary Care Clinicians Serving Low-Income Patients More Likely to Screen...asclepiuspdfs
Background: Women of all income levels experience domestic violence (DV). Primary health-care providers are able to screen women early and provide services or referrals; however, regular DV screening rarely occurs in the US. We investigated whether implicit bias based on patient population income level could be influencing provider practices in California. Methods: Data for this study were drawn from a self-administered survey conducted from October 2013 to March 2014. Providers (n = 152) were included if they worked in primary care and provided information on the predominant income of their patients. The survey included questions on provider demographics, screening practices, and number of female victims identified. Results: Providers serving low-income patient populations (LIPPs) or higher-income patient populations had equivalent training and knowledge about DV. However, DV screening practices (e.g., screening more often, at a younger age, and giving a screening question for DV) and outcomes (DV victims identified) varied significantly by patient population income level (P < 0.01). Working with low-income patients and engaging in universal screening practices both predicted more victim identification (P < 0.01). Conclusions: Implicit bias appears to influence clinicians’ screening practices, with those serving LIPPs being more likely to screen regardless of training or knowledge. If DV screening in primary care occurred more regularly, it would yield more detection of victims at all income levels. Training and self-reflection could combat implicit bias, as well as written policies and standardized procedures to encourage universal screening practices by clinicians irrespective of the income level of their patient populations.
Epidemiology is the study of patterns of disease and injury in populations. Epidemiologists conduct research to identify causes of disease and develop prevention strategies. Entry-level epidemiologists conduct studies, develop intervention programs, and communicate findings. Senior epidemiologists supervise others and lead large-scale studies and research programs. Epidemiology is important for monitoring health status, investigating health threats, and researching solutions.
Epidemiological studies in psychiatry in IndiaSujit Kumar Kar
Epidemiological studies in psychiatry have been conducted in India for over 60 years, starting with Dr. K.C. Dube's 1961 study in Agra. Initial studies found wide variation in prevalence rates of psychiatric disorders from 9.5 to 370 per 1000 population. Landmark international studies provided more standardized approaches. However, Indian studies were inadequate to assess non-psychotic disorders. Substance use epidemiological studies included the National Household Survey and Drug Abuse Monitoring System. The National Mental Health Survey was the largest nationwide survey and found treatment gaps of 73-85% for mental disorders. Ongoing national surveys continue to inform mental healthcare in India.
Introduction
Uses and aims of epidemiology
Qualification
Jobs included
List of skills
Role of epidemiologists
Specializations
Courses offered
Public health significance
1. Social and economic factors may have changed between the time periods studied, such as increases in unemployment, poverty, or family disruption, which could impact rates of psychiatric morbidity.
2. Changes may have occurred in how psychiatric disorders are diagnosed and classified between 1977 and 1985 that could influence prevalence findings.
3. Increased awareness, destigmatization of mental health issues, and expansion of treatment services between the periods may have impacted help-seeking behaviors and the proportion of cases identified.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Are Primary Care Clinicians Serving Low-Income Patients More Likely to Screen...asclepiuspdfs
Background: Women of all income levels experience domestic violence (DV). Primary health-care providers are able to screen women early and provide services or referrals; however, regular DV screening rarely occurs in the US. We investigated whether implicit bias based on patient population income level could be influencing provider practices in California. Methods: Data for this study were drawn from a self-administered survey conducted from October 2013 to March 2014. Providers (n = 152) were included if they worked in primary care and provided information on the predominant income of their patients. The survey included questions on provider demographics, screening practices, and number of female victims identified. Results: Providers serving low-income patient populations (LIPPs) or higher-income patient populations had equivalent training and knowledge about DV. However, DV screening practices (e.g., screening more often, at a younger age, and giving a screening question for DV) and outcomes (DV victims identified) varied significantly by patient population income level (P < 0.01). Working with low-income patients and engaging in universal screening practices both predicted more victim identification (P < 0.01). Conclusions: Implicit bias appears to influence clinicians’ screening practices, with those serving LIPPs being more likely to screen regardless of training or knowledge. If DV screening in primary care occurred more regularly, it would yield more detection of victims at all income levels. Training and self-reflection could combat implicit bias, as well as written policies and standardized procedures to encourage universal screening practices by clinicians irrespective of the income level of their patient populations.
Epidemiology is the study of patterns of disease and injury in populations. Epidemiologists conduct research to identify causes of disease and develop prevention strategies. Entry-level epidemiologists conduct studies, develop intervention programs, and communicate findings. Senior epidemiologists supervise others and lead large-scale studies and research programs. Epidemiology is important for monitoring health status, investigating health threats, and researching solutions.
Epidemiological studies in psychiatry in IndiaSujit Kumar Kar
Epidemiological studies in psychiatry have been conducted in India for over 60 years, starting with Dr. K.C. Dube's 1961 study in Agra. Initial studies found wide variation in prevalence rates of psychiatric disorders from 9.5 to 370 per 1000 population. Landmark international studies provided more standardized approaches. However, Indian studies were inadequate to assess non-psychotic disorders. Substance use epidemiological studies included the National Household Survey and Drug Abuse Monitoring System. The National Mental Health Survey was the largest nationwide survey and found treatment gaps of 73-85% for mental disorders. Ongoing national surveys continue to inform mental healthcare in India.
Introduction
Uses and aims of epidemiology
Qualification
Jobs included
List of skills
Role of epidemiologists
Specializations
Courses offered
Public health significance
1. Social and economic factors may have changed between the time periods studied, such as increases in unemployment, poverty, or family disruption, which could impact rates of psychiatric morbidity.
2. Changes may have occurred in how psychiatric disorders are diagnosed and classified between 1977 and 1985 that could influence prevalence findings.
3. Increased awareness, destigmatization of mental health issues, and expansion of treatment services between the periods may have impacted help-seeking behaviors and the proportion of cases identified.
This document discusses managing pain in older adults. It notes that around 53% of older adults experience bothersome pain every month, with women, obese people, and those with musculoskeletal conditions or depression reporting higher rates. Chronic pain is common in older adults and affects mobility, sleep, and quality of life. The types of pain older adults experience include osteoarthritis, musculoskeletal conditions, and pain from cardiac, respiratory or diabetic complications. Treatment considerations must account for how aging affects drug absorption and clearance as well as common comorbidities. Non-drug treatments and a multidisciplinary team approach can also help manage pain in older populations.
This document discusses modern aspects of homeopathy and the importance of diagnosis. It provides background on the author, Dr. Rajneesh Kumar Sharma, and his qualifications. It discusses Hahnemann's views on the value of diagnosis from the 6th and 7th editions of the Organon of Medicine. The document emphasizes that diagnosis is necessary for selecting the correct treatment, medicine, and management plan. It argues that homeopaths should be allowed to use necessary auxiliary measures like oxygen support and fluid administration when treating patients. The Central Council of Homoeopathy confirms homeopaths' right to use supplementation and diagnostic methods.
Not Only Depressed. A Pilot Study on Quality of Life of Women with Urinary In...inventionjournals
The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study – sample of 97 women with urinary incontinence - is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
This document discusses the role of epidemiology in public health. It begins by outlining the goals of public health as reducing disease, death and suffering. It then defines epidemiology as the study of disease distribution and the factors that influence distribution, making it the basic science of public health. The document goes on to discuss how epidemiology has expanded over time to study non-infectious diseases, the environment, health care delivery, and personal behaviors. It argues that epidemiology needs to consider broader social and political determinants of health like poverty, conflict, and human rights issues to fully understand population health.
This document discusses oral health need assessment. It defines key terms and classifications of need. It describes several methods to assess oral health need, including theoretical approaches, oral health-related quality of life indicators, using indices, and a new socio-dental approach. The document outlines a model for oral health need assessment and discusses assessing need at the population level using tools like questionnaires, clinical exams, and existing data. It emphasizes incorporating people's perceptions and propensity for health behaviors into a comprehensive needs assessment.
Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
1. Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems. Descriptive epidemiology aims to describe patterns of disease, while analytical epidemiology aims to identify risk factors.
2. Key approaches in epidemiology include observational studies like cross-sectional and case-control studies, as well as experimental studies like randomized controlled trials. Important concepts include rates, ratios, and proportions used to describe disease frequency and distribution.
Palliative care is about providing well-being and the highest quality of life to patients with serious, progressive, chronic life-limiting illness, including during the dying process.
Natural history of disease describes the typical course a disease takes from exposure to outcome without treatment intervention. It includes induction time, incubation period, latency, stages of subclinical and clinical disease, and possible outcomes of recovery, disability, or death. Spectrum of disease refers to the full range of manifestations a disease can take in a population from precursor to severe states depending on interactions between host, agent, and environment factors. Studying natural history and spectrum is important for disease prevention by identifying appropriate intervention stages.
Carle Palliative Care Journal Club for 7/3/18Mike Aref
Journal club review of "Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial" by D. Hui et. al. in JAMA. 2017 Sep 19;318(11):1047-1056.
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
preventive and social medicine presentationDHANPAL SINGH
1. An investigation was conducted into an epidemic of diarrhoeal diseases to determine its scope, contributing factors, and cause.
2. The investigation aimed to define the extent of the outbreak, identify the conditions and factors responsible, and determine the source of infection and mode of transmission in order to control the epidemic.
3. Standard methods of outbreak investigation were followed, including establishing a case definition, analyzing epidemiological data on time, place, and person, formulating and testing hypotheses, and making recommendations to prevent future outbreaks.
This document provides an overview of epidemiology, including its basic concepts, principles, scope, and measurement tools. Some key points:
- Epidemiology is the study of disease distribution and determinants in populations, and is used to prevent and control health problems. It describes disease patterns and identifies risk factors.
- Epidemiological principles are applied in various areas like clinical research, disease prevention, and health services evaluation. Measurement tools include rates, ratios, and proportions to quantify disease frequency and burden.
- The scope of epidemiology includes measuring mortality, morbidity, disability, births, risk factors, and assessing health needs in populations. Different study designs are used to investigate disease etiology and evaluate interventions.
This document provides definitions and explanations of key concepts in epidemiology. It discusses epidemiology as the study of health-related states and events in populations, including determinants, distribution, and health phenomena. It also defines important epidemiological terms like incidence, prevalence, outbreaks, transmission, and measures like rate, ratio and proportion used to quantify epidemiological data. The document aims to describe the scope and methodology of epidemiology as a public health discipline.
This document discusses concepts related to disease prevention, including the iceberg of disease model and levels of prevention. It explains that the iceberg model represents undiagnosed cases below the waterline and clinical cases above. It also outlines the goals of disease control as reducing incidence, duration, and complications. Finally, it describes the three levels of prevention - primary, secondary, and tertiary - including their goals and examples of interventions.
The possible adverse effects of long-term prednisolone use are:
- Susceptibility to infection
- Fluid retention
- Osteoporosis
- Muscle weakness and atrophy
- Delayed wound healing
Pathology is the study of disease and disease processes. It aims to determine the cause, understand the mechanisms, and describe the effects and progression of diseases. Pathology explains how diseases cause observed symptoms by detailing the steps from risk factors to physiological disruption to resulting body changes and responses. Understanding the pathology, epidemiology, etiology, pathogenesis, clinical manifestations, investigations, natural history, and management of a disease is important for pharmacy students to properly diagnose, treat, and communicate with patients and other healthcare professionals.
This document discusses concepts related to disease and causation, including:
1) The natural history of a disease describes its evolution over time from earliest stages to recovery, disability, or death without treatment.
2) Henle-Koch's postulates provide guidelines for establishing causation between a microbe and a disease.
3) The stages of a disease include pre-pathogenic, pathogenic, incubation period, prodromal, overt disease, defervescence, and convalescence phases.
Hanipsych, beni suef, elderly with depressionHani Hamed
This study examined depression among elderly individuals living in geriatric homes compared to those attending geriatric clubs in Beni Suef, Egypt. The researchers assessed 145 elderly individuals using questionnaires on socioeconomic factors, health conditions, and depression symptoms. They found that 89.7% of individuals in geriatric homes suffered from depression, while 56.7% in geriatric clubs were depressed. Risk factors for depression included being single, widowed or divorced. The study concluded that depression is highly prevalent among institutionalized elderly and recommended increased community awareness, healthcare worker training, and social support programs.
The document proposes a health promotion activity called "Bipolar disorder - the basics" to increase awareness and understanding of bipolar disorder (BD) and help prevent relapse. The activity would provide participants with information on what BD is, its types and symptoms, prevalence, comorbidities, stigma and effects of stigma. It would be delivered through a presentation facilitated by a trainer, followed by entry and exit surveys to measure knowledge increase and user satisfaction. The goal is to educate people, including those with BD, their families and professionals, by presenting information on BD in a clear and non-technical way while using technical terms when needed.
23 September 2010 - National Council for Palliative Care / National End of Life Care Programme / the neurological alliance 15 February 2013 - National End of Life Care Programme / Whole Systems Partnership
This document aims to set out an EoLC framework for implementation that speciï¬cally meets the needs of those with neurological conditions.
It covers:
Strategic context
End of life care tools
End of life care in neurological disease
Communication and advance care planning
Co-ordination and multidisciplinary approach to care
Management of physical symptoms
Holistic care - psychosocial and spiritual aspects
Care at the end of life
Carers
Workforce, education and training
Commissioning health and social care services
This document discusses managing pain in older adults. It notes that around 53% of older adults experience bothersome pain every month, with women, obese people, and those with musculoskeletal conditions or depression reporting higher rates. Chronic pain is common in older adults and affects mobility, sleep, and quality of life. The types of pain older adults experience include osteoarthritis, musculoskeletal conditions, and pain from cardiac, respiratory or diabetic complications. Treatment considerations must account for how aging affects drug absorption and clearance as well as common comorbidities. Non-drug treatments and a multidisciplinary team approach can also help manage pain in older populations.
This document discusses modern aspects of homeopathy and the importance of diagnosis. It provides background on the author, Dr. Rajneesh Kumar Sharma, and his qualifications. It discusses Hahnemann's views on the value of diagnosis from the 6th and 7th editions of the Organon of Medicine. The document emphasizes that diagnosis is necessary for selecting the correct treatment, medicine, and management plan. It argues that homeopaths should be allowed to use necessary auxiliary measures like oxygen support and fluid administration when treating patients. The Central Council of Homoeopathy confirms homeopaths' right to use supplementation and diagnostic methods.
Not Only Depressed. A Pilot Study on Quality of Life of Women with Urinary In...inventionjournals
The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study – sample of 97 women with urinary incontinence - is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
This document discusses the role of epidemiology in public health. It begins by outlining the goals of public health as reducing disease, death and suffering. It then defines epidemiology as the study of disease distribution and the factors that influence distribution, making it the basic science of public health. The document goes on to discuss how epidemiology has expanded over time to study non-infectious diseases, the environment, health care delivery, and personal behaviors. It argues that epidemiology needs to consider broader social and political determinants of health like poverty, conflict, and human rights issues to fully understand population health.
This document discusses oral health need assessment. It defines key terms and classifications of need. It describes several methods to assess oral health need, including theoretical approaches, oral health-related quality of life indicators, using indices, and a new socio-dental approach. The document outlines a model for oral health need assessment and discusses assessing need at the population level using tools like questionnaires, clinical exams, and existing data. It emphasizes incorporating people's perceptions and propensity for health behaviors into a comprehensive needs assessment.
Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
1. Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems. Descriptive epidemiology aims to describe patterns of disease, while analytical epidemiology aims to identify risk factors.
2. Key approaches in epidemiology include observational studies like cross-sectional and case-control studies, as well as experimental studies like randomized controlled trials. Important concepts include rates, ratios, and proportions used to describe disease frequency and distribution.
Palliative care is about providing well-being and the highest quality of life to patients with serious, progressive, chronic life-limiting illness, including during the dying process.
Natural history of disease describes the typical course a disease takes from exposure to outcome without treatment intervention. It includes induction time, incubation period, latency, stages of subclinical and clinical disease, and possible outcomes of recovery, disability, or death. Spectrum of disease refers to the full range of manifestations a disease can take in a population from precursor to severe states depending on interactions between host, agent, and environment factors. Studying natural history and spectrum is important for disease prevention by identifying appropriate intervention stages.
Carle Palliative Care Journal Club for 7/3/18Mike Aref
Journal club review of "Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial" by D. Hui et. al. in JAMA. 2017 Sep 19;318(11):1047-1056.
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
preventive and social medicine presentationDHANPAL SINGH
1. An investigation was conducted into an epidemic of diarrhoeal diseases to determine its scope, contributing factors, and cause.
2. The investigation aimed to define the extent of the outbreak, identify the conditions and factors responsible, and determine the source of infection and mode of transmission in order to control the epidemic.
3. Standard methods of outbreak investigation were followed, including establishing a case definition, analyzing epidemiological data on time, place, and person, formulating and testing hypotheses, and making recommendations to prevent future outbreaks.
This document provides an overview of epidemiology, including its basic concepts, principles, scope, and measurement tools. Some key points:
- Epidemiology is the study of disease distribution and determinants in populations, and is used to prevent and control health problems. It describes disease patterns and identifies risk factors.
- Epidemiological principles are applied in various areas like clinical research, disease prevention, and health services evaluation. Measurement tools include rates, ratios, and proportions to quantify disease frequency and burden.
- The scope of epidemiology includes measuring mortality, morbidity, disability, births, risk factors, and assessing health needs in populations. Different study designs are used to investigate disease etiology and evaluate interventions.
This document provides definitions and explanations of key concepts in epidemiology. It discusses epidemiology as the study of health-related states and events in populations, including determinants, distribution, and health phenomena. It also defines important epidemiological terms like incidence, prevalence, outbreaks, transmission, and measures like rate, ratio and proportion used to quantify epidemiological data. The document aims to describe the scope and methodology of epidemiology as a public health discipline.
This document discusses concepts related to disease prevention, including the iceberg of disease model and levels of prevention. It explains that the iceberg model represents undiagnosed cases below the waterline and clinical cases above. It also outlines the goals of disease control as reducing incidence, duration, and complications. Finally, it describes the three levels of prevention - primary, secondary, and tertiary - including their goals and examples of interventions.
The possible adverse effects of long-term prednisolone use are:
- Susceptibility to infection
- Fluid retention
- Osteoporosis
- Muscle weakness and atrophy
- Delayed wound healing
Pathology is the study of disease and disease processes. It aims to determine the cause, understand the mechanisms, and describe the effects and progression of diseases. Pathology explains how diseases cause observed symptoms by detailing the steps from risk factors to physiological disruption to resulting body changes and responses. Understanding the pathology, epidemiology, etiology, pathogenesis, clinical manifestations, investigations, natural history, and management of a disease is important for pharmacy students to properly diagnose, treat, and communicate with patients and other healthcare professionals.
This document discusses concepts related to disease and causation, including:
1) The natural history of a disease describes its evolution over time from earliest stages to recovery, disability, or death without treatment.
2) Henle-Koch's postulates provide guidelines for establishing causation between a microbe and a disease.
3) The stages of a disease include pre-pathogenic, pathogenic, incubation period, prodromal, overt disease, defervescence, and convalescence phases.
Hanipsych, beni suef, elderly with depressionHani Hamed
This study examined depression among elderly individuals living in geriatric homes compared to those attending geriatric clubs in Beni Suef, Egypt. The researchers assessed 145 elderly individuals using questionnaires on socioeconomic factors, health conditions, and depression symptoms. They found that 89.7% of individuals in geriatric homes suffered from depression, while 56.7% in geriatric clubs were depressed. Risk factors for depression included being single, widowed or divorced. The study concluded that depression is highly prevalent among institutionalized elderly and recommended increased community awareness, healthcare worker training, and social support programs.
The document proposes a health promotion activity called "Bipolar disorder - the basics" to increase awareness and understanding of bipolar disorder (BD) and help prevent relapse. The activity would provide participants with information on what BD is, its types and symptoms, prevalence, comorbidities, stigma and effects of stigma. It would be delivered through a presentation facilitated by a trainer, followed by entry and exit surveys to measure knowledge increase and user satisfaction. The goal is to educate people, including those with BD, their families and professionals, by presenting information on BD in a clear and non-technical way while using technical terms when needed.
23 September 2010 - National Council for Palliative Care / National End of Life Care Programme / the neurological alliance 15 February 2013 - National End of Life Care Programme / Whole Systems Partnership
This document aims to set out an EoLC framework for implementation that speciï¬cally meets the needs of those with neurological conditions.
It covers:
Strategic context
End of life care tools
End of life care in neurological disease
Communication and advance care planning
Co-ordination and multidisciplinary approach to care
Management of physical symptoms
Holistic care - psychosocial and spiritual aspects
Care at the end of life
Carers
Workforce, education and training
Commissioning health and social care services
The route to success in end of life care - achieving quality for people with learning disabilities
28 February 2011 - National End of Life Care Programme
This publication aims to provide a practical guide which supports anyone caring for people with learning disabilities to ensure that those who may be in the last months of their life receive high quality end of life care.
It may also be useful to health or social care professionals who come into contact with people with learning disabilities in clarifying what measures need to be taken to ensure that they can access appropriate care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
How treating psychological and social needs can improve the daily lives of the chronically ill, creating a new model for outpatient care, quality of life and aging, humanization of care, streamlining responsibilities of hospital staff and news around the world.
2015 geriatric pharma chapter 1 fundamentals of geriatric pharmacotherapyROBERTO CARLOS NIZAMA
This document discusses the challenges of caring for the geriatric population. It begins by noting there is no universally agreed upon definition of "geriatric," as age alone is an imperfect measure. The elderly population can be stratified by age, health status, and living environment to better understand individual needs and how clinical evidence applies. Healthcare for the elderly involves many providers across different settings, from independent living to nursing homes. Close scrutiny of a patient's individual characteristics is needed to ensure care is optimally tailored and potential issues addressed.
The document provides an introduction to gerontological nursing. It discusses key topics such as the definition and study of gerontology, common terminology, demographics of the aging population, leading causes of mortality and morbidity in older adults, theories of aging, and the roles and settings of gerontological nursing care. The summary focuses on the essential information presented across these topics in 3 sentences or less.
Gerontology is the scientific study of aging that examines biological, sociological, and other aspects of aging, and gerontological nursing focuses on providing care to and advocating for the older adult population. Key topics covered include the rising number of older adults globally, common health issues they face, theories to
This document provides an overview of a fundamentals of nursing practice course. The 3-credit lecture and 2-credit clinical course introduces nursing concepts and basic nursing skills. It covers concepts of holistic care for individuals, health promotion, and the nursing process. The course objectives are to learn nursing concepts and theories, introduce concepts of patient needs and safety, and demonstrate competency in basic nursing skills. Grading is based on quizzes, assignments, presentations, and exams. Early lessons cover concepts of humanity, health, illness, and factors influencing health. Models of health and wellness are also discussed.
A Review About The Impact Of Multiple Sclerosis On Health-Related Quality Of ...Scott Donald
This document reviews the impact of multiple sclerosis on health-related quality of life. It discusses how MS uniquely affects physiological functioning in many areas and is often diagnosed in young adults, negatively impacting productivity. The unpredictable course of MS makes it difficult for patients to feel in control. While clinicians focus on physical disability, patients identify role limitations, cognition, and emotions as most impacting their wellbeing. Several instruments have been developed to assess MS-specific health-related quality of life beyond just physical disability. Both generic and disease-specific questionnaires are now available to better understand treatment outcomes from the patient perspective.
Health related quality of life and multimorbidity in community-dwellingAlfredo Alday
Introduction
Multimorbidity is more common in the elderly population and negatively affects health-related quality of life (QoL). The aims of the study were to report the QoL of users of the Basque telecare public service (BTPS) and to establish its relationship with multimorbidity.
Methods
The EuroQol questionnaire was administered to 1125 users of the service. Their sociodemographic and healthcare characteristics were obtained from BTPS databases and the Basque healthcare service. Multiple regression analysis was performed on the overall questionnaire index to determine the effect of chronic diseases and sociodemographic. Moreover, the effects of the different diseases on specific dimensions of the test were explored by logistic regression.
Results
Of the users interviewed, 82% were women, 88% ≥75 years and 66% lived alone. The average of chronic pathologies was higher among men (5.3 vs. 4.6), for the lower age range and among those not living alone (P < 0.001).>< 0.001).
Conclusions
This study reveals that for the population covered by BTPS the impact of chronic pathologies, multimorbidity and their social context affects QoL very diversely. These diverse social and healthcare needs of community-dwelling elders allow the development and implementation of personalised services, such as telecare that facilitate them to remain at home.
Epidemiology is the study of the distribution and determinants of health-related states and events in specified populations, and the application of this study to control health problems. It involves describing disease occurrence, identifying risk factors and causes, and conducting analytical studies to test hypotheses. There are two main types of epidemiological studies - descriptive epidemiology which examines disease occurrence by time, place and person, and analytical epidemiology which tests hypotheses about risk factors. Observational studies include cohort studies, case-control studies and cross-sectional studies, while experimental studies involve determining exposure in a controlled manner. The ultimate goal of epidemiology is to improve disease prevention and control to enhance quality and duration of life.
This document summarizes a study that assessed the quality of life of 100 glaucoma patients using the WHOQOL-Bref questionnaire. The study found that glaucoma patients had significantly lower quality of life scores than healthy controls in the physical, mental, social, and environmental domains. Among socio-demographic factors, quality of life was lower in older patients and those with lower socioeconomic status. Several clinical factors, such as severity of glaucoma, were also associated with lower quality of life. The study concludes that glaucoma significantly impacts patients' quality of life and that socio-demographic and clinical factors should be considered in glaucoma management.
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by impairments in social communication and interaction, as well as restrictive and repetitive behaviors. The worldwide prevalence of autism is estimated to be around 1%, though estimates are higher in high-resource countries. While no clear brain pathology defines autism, neuroimaging and postmortem studies have observed subtle anatomical and functional brain differences. Genetic findings have applied mainly to heterogeneous groups rather than specific subtypes. Early intervention can improve social and language skills and may reduce symptom severity, but more research is needed on long-term outcomes and treatments. Families are often the primary source of support for individuals with autism throughout life.
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This document provides an overview of a paper on the social determinants of mental health produced by the World Health Organization and Calouste Gulbenkian Foundation. It discusses the background, methods, findings, and key concepts around how social, economic, and environmental factors impact mental health across the lifespan. The paper takes a life course approach and finds that factors like socioeconomic status, gender, education level, employment conditions, and community support influence mental health outcomes. It provides a framework for understanding these determinants and pursuing multi-sectoral actions and policies to promote mental well-being at all stages of life.
A CALL FOR ACTION TO STRENGTHEN HEALTHCARE FOR HEARING LOSSJimena Kerszenblat
This document calls for action to strengthen healthcare for hearing loss. It summarizes that hearing loss is a major global health issue affecting over 360 million people worldwide. If left untreated, hearing loss in children can lead to delays in language development and cognitive ability. In adults, hearing loss is associated with increased risks of dementia and disability. The document recommends a global effort across five key areas: 1) Improve healthcare provision for hearing loss prevention and treatment. 2) Ensure public health measures address the main causes of hearing loss. 3) Address hearing loss in both children and adults. 4) Address broader societal and education needs. 5) Establish research and innovation programs targeted at hearing loss priorities. A concerted effort is needed across many
ental health has been hidden behind a curtain of stigma and discrimination for too long. It is time to bring it out into
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We need to enhance our investment in mental health substantially and we need to do it now.
Systematic assessment of early symptoms of unspecified dementias in people wi...Premier Publishers
Researchers have shown that individuals with mental retardation or with developmental disabilities are at a greater risk of developing health problems and among others dementia than the general population. As the literature points out, dementia is characterized by progressive loss of cognitive functions, until the individual has lost all independency and ability in daily life. It is therefore necessary to carry out a systematic assessment throughout the developmental phases at the beginning of these signs. The purpose of this paper is to present the importance of systematic assessment of early symptoms of unspecified dementias in people with developmental disabilities. The methodology is based on the pre-dementia analysis of two study cases followed by a 2-year period. In conclusion, it can be argued that the diagnosis of dementia in people with developmental disabilities, in the early stages, has become difficult because of the lack of reliable and standardized criteria and diagnostic procedures and difficulties to investigate cognitive decline versus an already vulnerable developmental disability base. Therefore, in people with developmental disabilities, a diagnosis of dementia needs to be done based on changes in mental status from basic functioning. This helps a clinician to determine an accurate diagnosis in later years as hypothetically results from two case studies with later subcortical dementia. However, this endeavour remains to be discussed widely by mental health specialists, public health and cognitive neuroscience in order to determine whether this contribution provided actually has the power of explanation understandable or is understandable by the part of interest.
This study will evaluate the use of a connected health platform to support people with dementia and their caregivers. The study will have two groups - a connected health group and a control group. The connected health group will use monitoring devices, a tablet, and online portal to connect caregivers, doctors, nurses regarding daily health metrics. Assessments will be done at baseline and several follow-ups. The control group will not use the technology but receive the same care. The goal is to see if the connected health model improves information sharing and supports keeping patients at home longer. Ethics approval is still needed before starting participant recruitment.
1. The document provides an overview of key concepts in pathophysiology including homeostasis, mechanisms of disease, levels of prevention, and medical terminology.
2. Key aspects covered include how normal structure and function relate to disease signs and symptoms, and how disordered physiology leads to specific disease presentations.
3. Maintaining knowledge of pathophysiology helps physicians understand medical histories, develop treatment plans, and integrate various diagnostic findings and tests.
Running head ALZHEIMER’S DISEASE RESEARCH FINAL1ALZHEIMER’S DI.docxhealdkathaleen
Running head: ALZHEIMER’S DISEASE RESEARCH FINAL 1
ALZHEIMER’S DISEASE RESEARCH FINAL 22
Alzheimer’s Disease Research Final
Dalia Catalan
Florida National University
Alzheimer’s Disease Research Final
Phase one
Introduction
Alzheimer's disease tends to be a progressive, irreversible ailment that impacts the normal functioning of the brain slowly destroying the thinking and memory-related skills and as it progresses it limits the patient the ability to conduct simple tasks ("What Is Alzheimer's Disease?," 2020). Researchers suggest that approximately 6 million American citizens older than 65 years of age have dementia which is caused by Alzheimer's disease. In most patients, the symptoms of this condition begin to be identified when they are in their mid- the 60s. This condition is often ranked as one of the top ten causes of death in the United States, but following a recent investigation, the condition has climbed the ladder and it is currently ranked as the top five leading cause of death in the United States. Often the disease is categorized with cancer and heart disease as the main cause of death among the older population. This paper will focus on planning research that is focused on understanding Alzheimer's disease, its causes symptoms and its impact on the older population.
Problem identification
Alzheimer's disease tends to be the most common cause of dementia among the older population around the world. The condition impacts the normal functioning of the brain hence causing the loss of cognitive functioning such as reasoning, remembering and thinking. Also, it impacts behavioral abilities to the extent of the victim not being able to conduct various daily essential activities ("What Is Alzheimer's Disease?," 2020). The severity of the brain damage from the mildest stage where the normal function of a person is impact and it progresses to a most severe stage and the victim must be dependent on the people around him or her for basic activities related to daily living. The condition is most popular among the older population and its estimated that the condition has impacted about 6 million senior American citizens' normal function and also it is a leading cause of death among this population ("Alzheimer's Disease Fact Sheet," 2020).
Significance of the Problem to Nursing
With a significant population estimated to be victims of Alzheimer's disease in the United States, it is most likely that individuals in the nursing practice will encounter patients suffering from this condition either in their personal lives on in their careers. Thus, it is essential for the nurses to be able to understand and recognize the Alzheimer's Disease symptoms, treatment approaches, and options as well as learn how to effectively interact with this vulnerable population ("Update on Alzheimer’s: What Nurses Should Know," 2020).
To be able to provide quality health care services the nurse practitioner needs to underst ...
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Communicating with the Elderly: Decision Making and Informed Consent in
Subjects with Frailty or Dementia
Article · September 2007
DOI: 10.1177/174701610700300309
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3. has not been univocally defined, although chronic
conditions, co-morbidity and physical dependency,
possibly together with social and environmental con-
ditions, have a part to play in the definition. Any
future modification to the ICH-E7 text will have to be
aware of, and take into account, this sub-group.
Regulatory requirement for clinical
research and trials
There is no particular European regulatory framework
which specifically covers physiological or patho-phys-
iological research. Each Member State has its own
approach which may cover all or only a part of the
range of necessary requirements for recruitment.
Medicinal products and medical devices are, how-
ever, covered by their own directives. Directive
2001/20/EC on clinical trials on medicinal products,
and specifically article 5, ‘clinical trials in incapacitat-
ed adults not able to give informed legal consent’ [3]
includes the following:
• The person not able to give informed legal consent
has received information according to his/her
capacity of understanding regarding the trial, the
risks and the benefits.
• The explicit wish of a subject who is capable of
forming an opinion and assessing the information
to refuse participation in, or to be withdrawn from,
the clinical trial at any time is to be considered by
the investigator or where appropriate the principle
investigator.
For the elderly and the frail to participate in
research there is therefore a clear requirement to be
able to assess their understanding and capacity for
consent.
Communication assessment in the elderly
The assessment and approach to the decision-making
capacity of any individual consists of three main parts:
1. Participation should be entirely voluntary and
assessment should be able to provide evidence that
the individual can make a choice;
2. Information to the subjects should be relevant,
simple and clear enough to be understood in
his/her own language and this understanding
should be assessed;
3. The validity of the subjects’ decision depends over-
all on their ability to communicate and it is impor-
tant that this should also be evaluated.
In practice it is not usually difficult to determine
whether a person lacks all ability to make decisions.
In the elderly, during normal ageing, the ability to
communicate and understand is not impaired; how-
ever, communication may be impaired by pathologi-
cal situations which may, or may not, be associated
with the ageing process [4]. There may therefore on
the one hand be a general sensory impairment or a
frailty aggravated by social or environmental condi-
tions and on the other hand discrete disease patholo-
gy such as dementia, depression or an aphasia follow-
ing a stroke.
Sensory impairment
Sensory abilities [4] have to be assessed before provid-
ing any information to elderly subjects because ageing
is associated with impairment in sensory capabilities.
There are clear changes in the evolution of vision
with age with a decreased sensitivity to light, a
reduced ‘smoothness’ to colours and a decreasing
amplitude of accommodation, all of which have start-
ed by the age of 20 years. There is also a progressive,
bilateral symmetrical hearing loss (presbyacusia)
which occurs with age.
Dementia
When the diagnosis of dementia has been made
according to recognised procedures (eg the
Diagnostic and Statistical Manual of Mental Disorders
sourcebook [5] or the NINCSD-ADRDA [6] criteria)
it has to be recognized that the natural history of
these dementias varies from a subject to another, and
therefore the decision-making ability of individuals
will be impaired to a variable degree according to the
stage of the disease and the pathology (eg Alzheimer’s
disease, fronto-temporal dementia, Lewy body
dementia, or vascular dementia).
The most widely used tool to assess the stage of
the disease in Alzheimer’s disease is the Mini Mental
State (MMS) examination [7]. This is a short global
cognitive 30 items test, assessing several intellectual
functions:
Laurence Hugonot-Diener and Jean-Marc Husson98
Age (years) Percentage of French population Number
65 - 74
75 - 79
80 - 84
85 - 100
over 100
15.9
7
4
1.5
9.5 million
4.2 million
2.4 million
900 000
13 000 (estimate)
Table 1: Stratification of the French population (total 65 million people) over the age of 65 years.
RER Vol 3.3_inners.qxd:RER Vol 3.3_inners.qxd 3/8/07 16:38 Page 34
4. • Spatial and temporal orientation (5 + 5)
• Attention (5)
• Memory (3 + 3)
• Language (8)
• Constructional praxis (1)
Figure 1 represents the natural history of Alzheimer’s
disease based on the MMS from which it can be seen
that the average judgment impairment occurs at a
moderately severe stage of the disease, ie under an
MMS total score of 15/30.
In other types of dementia assessment of these abil-
ities requires more focussed psychometric tests than
the MMS with the inclusion of assessment on ‘logical
test or problem solving’, ‘agnosia’, and ‘language com-
prehension’ (semantic or category deficit of under-
standing) as well as specific communication abilities.
Taking into account all factors referred to above
the following comprehensive geriatric assessment
(Figure 2) using a range of different tools and param-
eters has been proposed [8].
It should be clear that researchers must be aware
of the different abilities involved in decision making
in order to ensure that elderly volunteer subjects
understand the relevant information, and appreciate
the research study and its consequences for them as
individuals, as well as be able to manipulate informa-
tion rationally.
Aphasia
Aphasia, which often follows a stroke, is a particular
condition where communication is impaired. Clinical
and psychometric assessment is made to classify the
type of aphasia with classification of the aphasic syn-
dromes being based on fluency, auditory comprehen-
sion and the ability to repeat verbal material.
Comprehension is preserved in some fluent aphasia
as well as in non-fluent aphasia.
Figure 3 shows such a classification [9].
Evaluation guidelines
There are several guidelines for assessing the ‘decision-
making capabilities’ [10-12] of potential research sub-
jects with cognitive impairment. In these the subject
must demonstrate to a doctor or a nurse that he/she has
capabilities to make a decision and this includes:
1. Ability to make a choice. This is the less stringent
component. Subjects may fail to demonstrate this
ability either because they demonstrate that they
are unable to reach a decision, or to make their
wishes known. Investigators have to ensure that
the subject ‘appreciates’ and understands that
he/she has the right to make a choice.
99Communicating with the elderly: decision making and informed consent in subjects with frailty or dementia
Figure 1: The natural history of Alzheimer’s disease.
Evolution of mean patients’ decline on MMS cognitive
function (with and without treatment).
Figure 2: A proposed comprehensive geriatric assessment for dementia using different tools and parameters.
RER Vol 3.3_inners.qxd:RER Vol 3.3_inners.qxd 3/8/07 16:38 Page 35
5. Laurence Hugonot-Diener and Jean-Marc Husson100
2. Ability to understand relevant information. That
the subject understands the decision he/she is
being asked to take and nature of the consequences
of ‘participation’ in order to give an informed con-
sent (or refusal). Information should be presented
in short, simple sentences.
After each ‘input’ of information, it is necessary
to ask the subject to tell the professional health in
his/her own words what was just said. It is neces-
sary to listen for accuracy of the recalled informa-
tion; the subject does not have to use medical ‘jar-
gon’. The investigator has to assist the subject in
considering what he/she thinks will be the benefit
and/or burden to him/her of each treatment option
(or refusal). For example what would be the likely
outcome of the tests/interventions according to the
individuals personal goals, interests, life-style,
comfort, longevity, anxiety reduction, etc.
3. Ability to appreciate the situation and its likely
consequences. That the subject can communicate
his/her decisions and explain in his/her own words
why a particular decision was made. Denial, delu-
sion, and psychotic levels of distortion can impair
appreciation, as can any condition that limits
understanding.
4. Ability to manipulate information rationally. This
component focuses on a subject’s ability to
employ rational thought processes to compare the
risks and the benefits of the options which they
are facing.
5. Ability to remember his/her decision. The subject’s
decision must be stable and consistent over a peri-
od of time.
The University of California San Diego (UCSD)
task force decisional tree (Figure 4) is a good tool to
evaluate ‘decision-making capabilities’ [12].
It is important that the process for determining
capacity to understand information and subsequently
obtaining informed consent should not be rushed. In
practice many healthcare decisions are not made with
individual patients but involve family members (or
care providers). In this situation the authentic wishes
of an elderly person with dementia should be respect-
ed and not over-ruled in the interests of what the fam-
ily or care staff feels is best for them.
Prospective studies about decision-
making and elderly
There are a small number of published studies
which consider decision-making and the elderly and
this is an area which should be subject to further
research. The following is a brief summary of the
recent studies in this area.
• A prospective study by Elena Paillaud and co-
workers [13] sought to determine the preferences
of elderly in-patients concerning the provision of
medical information, in relation to life threatening
situations, either to themselves or to a designated
surrogate.
A questionnaire and the MMS (to select subjects
without any cognitive impairment) was completed
by 426 French elderly inpatients, aged 70 years or
over, by two geriatricians within the week following
admission to one of three geriatric units. The
results showed that 32.6% wanted to receive com-
plete information, 77% wished to be informed if
there were a life-threatening situation; 28% had
designated a surrogate.
Figure 3: Classification of the aphasic syndromes,
based on fluency, auditory, comprehension, and
ability to repeat verbal material.
Figure 4: Decision tree for evaluation of ‘decision-
making capabilities’.
IRB = institutional review board (ethics committee)
TCS transcortical sensory aphasia
TCM transcortical motor aphasia
RER Vol 3.3_inners.qxd:RER Vol 3.3_inners.qxd 3/8/07 16:38 Page 36
6. The authors concluded that the MMS total score,
physical disability, a low level of confidence in med-
icine and the presence of family members, specifi-
cally children, are independent determinants of a
high level of information expectation.
• Barton W, Palmer et al. [14] conducted a prospec-
tive study to compare decisional capacity among 3
different diagnostic groups; patients with schizo-
phrenia (n=35), with Alzheimer’s disease (n=30) or
with diabetes mellitus (n=36), and had examined
the degree to which impaired understanding can be
detected using a brief set of screening questions.
Results showed that decisional capacity differed
among the THREE groups. The diabetic group
showed the best capacity, followed by the schizo-
phrenic patients, and then those with Alzheimer’s
disease. There was, however, a considerable hetero-
geneity within each group.
The authors conclusion was that level of cogni-
tive deficit, assessed by MMS, is a potential marker
of those who should receive comprehensive capac-
ity evaluations (particularly in the understanding
component) as this was the best predictor of deci-
sional capacity.
• Williams B. et al [15] have conducted a ‘follow up
study’ of people living in Tayside Scotland, who
opted out of a cross-sectional survey. 887 people,
aged 65-84 years, were invited to take part in a
home-based cross sectional survey and of these 471
(54%) refused to take part. Permission was
obtained to follow up the refusers with information
subsequently being obtained from 417.
Demographic characteristics of people who had
refused to take part in the original cross sectional
survey and the reasons they gave for not taking part
were collected. The authors concluded that an
expression of non-consent does not necessarily
mean that a fully informed evaluation of the pros
and cons of participation or non-participation of
subjects has taken place. The meaningfulness of
expressions of non-consent may therefore be a
cause for concern and should be subject to further
research.
Conclusion
Procedures to determine decisional capacity in elder-
ly people participating in research protocols needs to
be reviewed in order to achieve a European consen-
sus. The decision tree from the UCSD task force
(Figure 4, [10]) should be considered as a good start-
ing point for further discussion. As the next step a
European workshop is to be convened in order to
work towards the validation of European tools for the
assessment of decisional capacity in the elderly.
References
1. International Conference on Harmonization /ICH - E7. Studies in
support of special populations: geriatrics, 1994. Available at
www.fda.gov/cder/Guidance/iche7.pdf.
2. EMEA- CHMP document (Ref EMEA/498920/2006): Adequacy of
guidance on the Elderly regarding medicinal products for human
use; 14 December 2006. Available at www.emea.europa.eu/pdfs/
human/opiniongen/49892006en.pdf.
3. Directive 2001/20/EC on clinical trials on medicinal products –
article 5: clinical trials in incapacitated adults not able to give
informed consent. Available at europa.eu/eur-lex/pri/en/oj/dat/
2001/l_121/l_12120010501en00340044.pdf.
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8. Hugonot-Diener L. La consultation en Gériatrie. Paris: Masson,
2001.
9. Cummings JL. The Neuropsychiatry of Alzheimer’s disease and
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10. Roth LH, Meisel A, Lidz CW. Tests of competency to consent to
treatment. American J Psychiatry 1997;134; 28-35.
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decision-making capacities. Am J Psychiatry 1998; 155: 11
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12. Decision making capacity guidelines. The University of California
San Diego (UCSD), 2003. Available at http://irb.ucsd.edu/deci-
sional.shtml.
13. Paillaud E, Ferrand E, Lejonc JL, Henry O, Bouillane O,
Montagne O. Medical information and surrogate designation:
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& Ageing 2007; 36: 274-279.
14. Palmer BW, Dunn AB, Appelbaum PS, Mudaliar S, Thai L, Henry
R, Golsham S, Jeste DV. Assesment of capacity to consent to
research among older subjects with schizophrenia, Alzheimer dis-
ease, or diabetes mellitus. Arch Gen Psychiatry 2005; 62: 726-733.
15. Williams B, Irvine L, McGinnis A, Mcmurdo ME, Crombie IK.
When‘no’ might not quite mean ‘no’. The importance of informed
and meaningful non consent. BMC Health Services research 2007;
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101Communicating with the elderly: decision making and informed consent in subjects with frailty or dementia
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