Enhancing Quality in Psychiatry with Psychiatrists (EQUIPP)--results from a pilot study.

Objectives: To pilot a pharmacist-led, patient centered medication management program.

Design: Prospective, single arm trial.

Setting: Academic geriatric psychiatry outpatient clinic.

Systematic review: Effective characteristics of nursing homes and other residential long-term care settings for people with dementia.

Objectives: In response to the need for an evidence-based review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes.

Design: Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia.

Results: Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial.

Practice-based interventions addressing concomitant depression and chronic medical conditions in the primary care setting: a systematic review and meta-analysis.

Background: Depression concomitant with chronic medical conditions is common and burdensome in primary care.

Objective: To assess the effectiveness of practice-based interventions for improving depression and chronic medical outcomes.

Data Sources: MEDLINE, Embase, the Cochrane Library, CINAHL, and PsycINFO from inception to June 11, 2012.

Performance of Medometer visual tool for measuring medication adherence and comparison with other measures.

Objectives: To measure adherence in older adults with the use of a novel visual scale screening tool and to compare this adherence measurement with other adherence measures.

Design: Noncontrolled prospective intervention trial.

Setting: Geriatric psychiatry clinic in North Carolina between February 2008 and July 2009.

Identifying priorities for patient-centered outcomes research for serious mental illness.

Objective: The purpose of this project was to engage a diverse group of stakeholders (N=38) to help establish priorities to guide patient-centered outcomes research (PCOR) in serious mental illness.

Methods: Three meetings, two Web-based and one on site, were held to generate and prioritize an initial list of topics. Topics were then sorted and organized into common themes.

Perceptions of depression among dementia caregivers: findings from the CATIE-AD trial.

Objective: For patients with Alzheimer's disease complicated by behavioral disturbances, to use single questions about perceived depression and assess patient and caregiver accuracy in recognizing patient depression.

Methods: Cross-sectional interviews from the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD). Patients were asked 'Do you believe you are depressed?' Caregivers were asked 'Do you believe the patient is depressed?' and 'Do you believe you (caregiver) are depressed?' These responses were compared to the patient's score on the Cornell Scale for Depression in Dementia (CSDD), and to the caregiver's score on the Beck Depression Inventory (BDI) using screening test characteristics.

Methodology of a pilot study to improve the quality of medication use in older adults: Enhancing Quality in Psychiatry Using Pharmacists (EQUIPP).

Background: Medication-related problems are prevalent in older adults, contributing to increased harm and health care costs and negatively impacting quality of care. Older adults with psychiatric disease are at an increased risk because of their underlying disease and types of medications prescribed. Efforts to improve the quality of medication use often focus on select medication-related problems, select diagnoses, or predefined quality indicators; however, such an approach fails to consider the potential for multiple coexisting problems within individuals.

Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses.

Objective: To test the accuracy of five practical depression screening strategies in older adults residing in residential care/assisted living (RC/AL).

Design: Cross-sectional screening study.

Setting: Four RC/AL communities in North Carolina.

Depression in assisted living is common and related to physical burden.

Objective: The objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland.

Method: One hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians.

Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities.

Background: Individualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life.

Methods: Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities.

Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey.

Background: Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy.

Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults.

Background: Many medications present special risks when used by older adults (ie, those aged > or = 65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults.

Characteristics associated with depression in long-term care residents with dementia.

We describe the prevalence, assessment, and treatment of, as well as characteristics associated with, depression in residential care/assisted living and nursing home residents with dementia. Overall, 25% of the participants were depressed. Depression was related to severe cognitive impairment, behavioral symptoms, pain, and for-profit nursing home residence.

Asking family about memory loss. Is it helpful?

Objective: To compare a family informant's report of memory loss in an older family member to standardized clinical diagnoses of cognitive impairment.

Setting: Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), a 10-year longitudinal study of community dwellers aged 65 and greater in five counties of North Carolina.

Participants: A stratified random sample of potentially demented participants was selected from the second wave of the Duke EPESE using responses to a brief cognitive screen.

Can we trust depression screening instruments in healthy 'old-old' adults?

Objective: Despite a growing understanding of late-life depression, few studies focus on the old-old, those 75 years and over. We wished to characterize depressive symptoms and determine the accuracy of two common screening instruments for major and minor depression in a population of old-old retirees.

Methods: Participants lived independently in one of two Continuing Care Retirement Communities and volunteered for an in-home interview about cancer screening attitudes.

Screening accuracy for late-life depression in primary care: a systematic review.

Objective: To determine the accuracy of depression screening instruments for older adults in primary care.

Study Design: Systematic review.

Data Sources: MEDLINE, PsycINFO (search dates 1966 to January 2002), and the Cochrane database on depression, anxiety and neurosis.

Depression in assisted living: results from a four-state study.

Objective: Assisted living is a rapidly-growing sector of long-term care, but little research has been done on depression in this setting. Using data from a large sample of assisted-living residents, the authors sought to 1) describe the prevalence of depression and depressive symptoms; 2) identify resident characteristics associated with depression; and 3) examine the relationship between depression and the rate of nursing home placement and mortality.

Methods: A group of 2,078 residents age 65 and older were enrolled from 193 assisted-living facilities across four states (Florida, Maryland, New Jersey, and North Carolina).

New onset of neuropsychiatric symptoms in the elderly: possible primary hyperparathyroidism.

Primary hyperparathyroidism is a disorder of calcium homeostasis that occurs most commonly in older adults. Resultant hypercalcemia may be accompanied by neuropsychiatric symptoms, ranging from mild depression and cognitive changes to extreme agitation and psychosis. Surgical intervention almost invariably reverses these symptoms.