Repetition priming and change in functional ability in older persons without dementia.

Adverse consequences such as institutionalization and death are associated with compromised activities of daily living in aging, yet there is little known about risk factors for the development and progression of functional disability. Using generalized linear models, the authors examined the association between the ability to benefit from repetition and rate of change in functional ability in 160 nondemented elders participating in the Religious Orders Study. Three single-word repetition priming tasks were administered that varied in the degree to which visual-perceptual or conceptual processing was invoked. Decline in functional ability was less rapid, during follow-up of up to 10 years, in persons with better baseline priming performance on a task known to draw on both visual-perceptual and conceptual processing (word-stem completion). By contrast, change in functional ability was not associated with priming on tasks that are known to draw primarily on either visual-perceptual (threshold word-identification) or conceptual (category exemplar production) processing. The results are discussed in terms of a common biological substrate in the inferotemporal neocortex, supporting efficient processing of meaningful visual-perceptual experience and proficient performance of activities of daily living. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the social climate of congregate residences for older people: Sheltered Care Environment Scale.

We developed the Sheltered Care Environment Scale (SCES) to provide researchers and practitioners with a practical means of assessing the social climate in congregate residential settings for the elderly. The SCES, a 63-item yes/no questionnaire that can be completed by residents and staff members of a facility, taps their perceptions of seven dimensions of the social environment. These dimensions concern the quality of relationships, the personal growth orientation present in the facility, and maintenance and change of the social system. The SCES discriminates among settings, has moderate to high internal consistency and split-half reliability, and is sensitive to environmental change against a backdrop of relative stability over time. The SCES reflects actual, agreed-on qualities of a setting and is relatively unaffected by characteristics of the respondent. Normative data are available from a national sample of 244 facilities representing the variety of residential settings available to the elderly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychologist as front-line mental health consultant in a general hospital.

Describes the experiences and diverse functions of a psychologist who acts as an independent mental health consultant in a general hospital. Particular attention is paid to problems that arise when psyche and soma interface, because these problems require knowledge of biology as well as of psychology. The appropriateness of this role for the psychologist and its acceptability to referring physicians are examined. The particular strengths of the psychologist as a behavioral scientist and the need for continuing education in differential diagnosis when psychological and physiological factors interact are also explored. Professional boundaries and role relations between psychology and related professions are reviewed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Excess mortality in general hospital patients with delirium: a 5-year follow-up of 519 patients seen in psychiatric consultation

Mortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess mortality ratio varied from 6.2 for patients with malignancies to 2.1 for patients with motor system disease. After hospital discharge the 5-yr cumulative mortality was 51%. As compared to the general population excess mortality was noted in most, but not in all diagnostic subgroups. The age and sex adjusted excess mortality ratio varied from 14.1 for malignancies to 1.3 for motor system disease. The figures underline a general notion that delirium may be an indicator of disorders of grave prognosis, but mortality appears to depend more on the medical condition than on the presence of delirium.     

The role of psychology and psychiatry in general hospital settings in Alabama.

Investigated the availability of psychiatric units in general hospitals, the variety of staff personnel employed, and the range of treatment methods utilized in Alabama. 36% of the responding hospitals provided inpatient psychiatric services. Larger hospitals were more apt to provide these services. The type of staff employed and treatment utilized were similar for both psychiatric institutions and general community hospitals. 89% of the hospitals providing psychiatric services employed psychologists (PhDs and/or MAs). Findings are discussed with reference to the expanding role of psychology at the community level. Emphasis is given to the need for training programs at general hospitals. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preferences and life evaluations of older adults with and without dementia: Reliability, stability, and proxy knowledge.

This study assessed the reliability and stability of care preferences and life evaluations among older adults with and without dementia. The study also examined spouse proxy predictions of partner responses. Test-retest reliability over 1 week, stability over 1 year, and proxy knowledge were all moderate to good, but lower for people with dementia. In all 3 areas, however, there was broad interindividual variability. People with dementia may become less reliable and stable in their self-reports, and some spouse proxies may have flawed knowledge about their partner, but dementia status alone is not sufficient to presume poor reliability or knowledge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The realism in older people's confidence judgments of answers to general knowledge questions.

The study investigated 2 aspects of the accuracy (i.e., realism) of confidence judgments of persons age 60–93 years (N = 1,384) regarding their answers to general knowledge questions. These aspects are the level of confidence (calibration) in relation to the proportion of correct answers and the ability to discriminate between correct and incorrect answers by means of confidence judgments. No age differences were found for either of the 2 aspects. Gender differences were found for proportion of correct answers and confidence but not for the realism in the confidence judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The informed consent process in older patients who developed delirium: a clinical epidemiologic study

PURPOSE: Delirium, defined as an acute, fluctuating disorder of attention and cognition, is a serious and increasingly common problem for hospitalized older persons. Delirium poses unique ethical challenges for the informed consent process, notably the preservation of patient autonomy in the face of potentially fluctuating decision-making capacity. To clarify these issues, we examined the informed consent process in a group of hospitalized older patients who developed delirium. PATIENTS: Eighty-four hospitalized patients aged >70 years who developed delirium during hospitalization at a large urban teaching hospital. METHODS: We conducted a clinical epidemiologic investigation of informed consent in 173 medical and surgical procedures performed in 84 patients. Clinical researchers carried out detailed cognitive evaluation of patients on or near the consent date. A separate blinded researcher extracted medical record information on the procedures and informed consent process variables. RESULTS: Of 173 procedures, 33 (19%) had no documentation of any consent, and 34 (20%) used surrogate consent. There were no documented assessments of competency/ decisional capacity; cognitive assessments were done in 7 (4%) cases, and legal consults in 2 (1%) cases. Discussion of potential risks of the procedure with patient or surrogate were documented in 61 (35%) cases. In multivariable analysis, independent predictors for failure to obtain consent were presence of delirium (adjusted odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.3, 5.3) and less invasive procedure (OR = 5.0, CI 2.0, 12.8). Although cognitive impairment predicted surrogate use, we found that 47% of cases with substantial impairment did not involve use of a surrogate, whereas surrogates signed for 4% of cases with normal mental status near the time of consent. CONCLUSIONS: Our results highlight the ethical challenges that delirium poses for the informed consent process, including the high rate of no consent, lack of cognitive and decisional capacity assessment, and inconsistent surrogate use.     

Sex differences in the sensitivity of two self-report depression scales in older depressed inpatients.

Both the Geriatric Depression Scale (J. A. Yesavage et al; see record 1984-02939-001) and the Beck Depression Inventory were less effective in identifying depressed men than women in a sample of 191 geriatric psychiatric inpatients with major unipolar depression. From one quarter to one half of the men were missed cases, depending on the cutoff score used. Separate cutoff scores for older men and women on depression screening instruments may be appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-concept changes of depressive patients in general hospital treatment.

This study used the semantic differential to investigate the rating behavior on the Real and Ideal Self of 37 neurotic-depressive, 37 paranoid, and 67 other patients in hospital treatment, on admission and prior to discharge. Of 5 diagnostic groupings, only depressives moved from very low to relatively high Real Self rating and exhibited a positive correlation between Real Self and improvement. On the Ideal Self none of the groups showed any significant rating change during hospital stay. The results suggested that enhanced Real Self rating as a function of improved adjustment is not confined to client-centered therapy, since it also occurs with depressives in hospital treatment and without prolonged psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation and services in a general medical hospital.

When psychologists need to see patients who have been admitted to a general medical hospital or are asked to see a patient in a general medical hospital, they must be aware of, and in compliance with, the rules governing consultation, privileging, and privacy. Psychological treatment for patients is an important part of the treatment of patients with medical conditions that may be exacerbated by psychosocial stressors, preexisting anxiety, or depressive symptoms. The role of the psychologist is to have an integrated role with the medical team and work with the patient in effectively managing these symptoms. Models for promoting psychological services to all patients, especially those who are medically ill, have emerged as one of the few growth areas in psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor Validation of the Addiction Severity Index Scale Structure in Persons With Concurrent Disorders.

Confirmatory factor analysis was used to test the scale structure of the Addiction Severity Index (ASI) in a sample of 1,802 substance abusers (43% alcohol dependent) with a concurrent psychiatric disorder (46% with mood disorders). The fit of the original composite score model based on the work of P. L. McGahan, J. A. Griffith, R. Parente, & A. T. McLellan (1990) was compared with the evaluation indices (EIs) developed by A. I. Alterman et al. (1998). The 5-dimensional model based on the EIs was an overall better fit to the data. Internal consistency (Cronbach's alpha) for the EIs ranged from .66 (family domain) to .75 (legal domain). The 5 EIs were moderately correlated (rs = .42-.72) with the interviewer severity ratings from the ASI. Evaluation studies involving concurrent disordered substance abusers should use the EIs as summary measures of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia Aging Study

OBJECTIVE: To determine prevalence of dementia and its subtypes in Japanese-American men and compare these findings with rates reported for populations in Japan and elsewhere. DESIGN AND SETTING: The Honolulu Heart Program is a prospective population-based study of cardiovascular disease established in 1965. Prevalence estimates were computed from cases identified at the 1991 to 1993 examination. Cognitive performance was assessed using standardized methods, instruments, and diagnostic criteria. PARTICIPANTS: Subjects were 3734 Japanese-American men (80% of surviving cohort) aged 71 through 93 years, living in the community or in institutions. MAIN OUTCOME MEASURES: Age-specific, age-standardized, and cohort prevalence estimates were computed for dementia (all cause) defined by 2 sets of diagnostic criteria and 4 levels of severity. Prevalence levels for Alzheimer disease and vascular dementia were also estimated. RESULTS: Dementia prevalence by Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised ranged from 2.1% in men aged 71 through 74 years to 33.4% in men aged 85 through 93 years. Age-standardized prevalence was 7.6%. Prevalence estimates for the cohort were 9.3% for dementia (all cause), 5.4% for Alzheimer disease (primary or contributing), and 4.2% for vascular dementia (primary or contributing). More than 1 possible cause was found in 26% of cases. The Alzheimer disease/vascular dementia ratio was 1.5 for cases attributed primarily to Alzheimer disease or vascular dementia. CONCLUSIONS: Prevalence of Alzheimer disease in older Japanese-American men in Hawaii appears to be higher than in Japan but similar to European-ancestry populations. Prevalence of vascular dementia appears to be slightly lower than in Japan, but higher than in European-ancestry populations. Further cross-national research with emphasis on standardized diagnostic methods is needed.     

Measuring transactive memory systems in the field: Scale development and validation.

This study describes the development and validity testing of a field measure of transactive memory systems. Transactive memory systems are especially important for teams designed to leverage members' expertise, but field research has lagged because there are no adequate measures of the construct. The author developed and tested a 15-item scale in a laboratory sample of 124 teams, a field sample of 64 Master of Business Administration consulting teams, and a field sample of 27 teams from technology companies. Results from the present study demonstrate that the scale is internally consistent, related to alternative measures and hypothesized causes and effects, and unrelated to theoretically distinct constructs, providing evidence of convergent, criterion-related, and discriminant validity. Suggestions for improving the scale, future validity testing, and possible boundary conditions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recognition by familiarity is preserved in Parkinson's without dementia and Lewy-Body disease.

Objective: The retrieval deficit hypothesis states that the lack of deficit in recognition often observed in patients with Parkinson's disease is because of the low retrieval requirements of the task, given that these patients have retrieval and not encoding deficits. To test this hypothesis we investigated recognition memory by familiarity in Parkinson's patients and in patients with Lewy Bodies disease and Parkinson with dementia. Method: We analyzed to what extent the experimental groups were able to recognize by familiarity in a typical yes/no recognition memory task. The experimental groups were patients with early nondemented Parkinson's disease, advanced nondemented Parkinson's disease, demented Parkinson's patients, and patients with dementia with Lewy Bodies. We compared their performance with a group of young and another group of old healthy participants. The estimation of familiarity was made by analyzing recognition of word targets and distractors consisting of combinations of different letters in comparison with a condition in which targets and distractors were composed of similar letters, even though subjects were unaware of the independent variable. Results: The results indicate that familiarity was used at the same level by controls, patients with early Parkinson's disease and patients with dementia with Lewy Bodies. Although late Parkinson patients also used familiarity, its effect was only marginally significant. Patients with Parkinson's disease and dementia were not capable of using familiarity in recognition memory. Conclusions: Our results support the retrieval deficit hypothesis as Parkinson's patients without dementia show no deficit in a situation in which the retrieval requirements are minimal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical psychology in general hospital settings: Issues in interprofessional relationships.

We suggest that the involvement of clinical psychologists in health care teams may not necessarily improve health care. The position of clinical psychology with regard to medical theory and practice is examined. Then issues arising from multidisciplinary teamwork, with particular emphasis on consultation–liaison work, are discussed. We conclude that professional power structures in hospital settings have a profound influence on clinical psychological practice and that these issues need to be explicitly addressed before health care can benefit from the expertise of clinical psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A demonstration of dual-task performance without interference in some older adults.

Highly efficient dual-task processing is demonstrated when reaction time to each of two tasks does not differ between the dual-task situation and the single-task situation. This has been demonstrated reliably in younger adults; nevertheless, the two extant studies of extensive dual-task training did not find evidence for it in any elderly adult. The origins of age-related differences after training were explored in a study in which the stimuli for the two tasks were perfectly redundant although two distinct responses were required. The dual-task situation thus greatly reduced the demands of stimulus categorization while still requiring two response selections and two response executions. After only limited training 8 of 8 younger adults and 5 of 8 older adults showed performance consistent with highly efficient processing. Three older adults failed to show this even after 12 training sessions. The results implicate stimulus categorization more than response selection as an important locus of inefficient dual-task processing, particularly for older adults. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Neuropsychological functioning in older insomniacs with or without obstructive sleep apnea.

The relationships between neuropsychological functioning and sleep loss, sleep apnea, and hypoxemia were examined. Forty-five older insomniacs (M age?=?64.6 yrs) with or without sleep apnea were administered neuropsychological tests after 1 night of nocturnal monitoring in a sleep laboratory. The results showed few differences on cognitive and psychomotor performance between individuals with sleep disruptions alone compared with those whose insomnia was associated with sleep apnea and hypoxemia. There were no significant relationships between nocturnal sleep and respiratory variables and daytime functioning. Furthermore, cognitive and psychomotor performance in older insomniacs with or without sleep apnea revealed minimal impairment compared with age-matched normative data. The results suggest that when the severity of sleep disruptions is controlled, there are minimal differences in neuropsychological functioning of older adults with mild to moderate sleep apnea compared with those without apnea. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring the impact of sessions in process€xperiential therapy of depression: The Session Impacts Scale.

The Session Impacts Scale (SIS) is a brief client-report measure of the experienced impacts of therapy sessions. Data were collected from depressed clients seen in short-term process-experiential treatment. Factor analyses were consistent with the expected hierarchical structure of the measure (Helpful Impacts and Hindering Impacts, with Helpful Impacts divided into Task Impacts and Relationship Impacts subscales). Internal reliabilities were excellent for the helpful impact scales, and the pattern of impacts was consistent with the treatment model. Helpful impact scales were most strongly correlated with client Session Evaluation Questionnaire Depth and Positivity scales and client global helpfulness ratings. A components of variance analysis suggested that client and therapist factors account for large amounts of variance in SIS ratings, some of which could be predicted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identity negative priming in older adults and individuals with dementia of the Alzheimer type.

This study addressed the question of whether dementia of the Alzheimer type (DAT) produces a breakdown in aspects of the inhibitory component underlying selective attention. Two measures of identity negative priming and 2 measures of distractor interference were obtained. In Experiment 1, participants were presented with overlapping picture stimuli, and in Experiment 2, participants were presented with overlapping written word stimuli. The results of both experiments produced reliable and similar size negative priming in young and old adults, but there was no evidence of negative priming in the individuals with DAT. In contrast, the naming latencies of all 3 groups showed a reliable and similar size distractor interference effect. These results suggest that although the inhibitory component underlying selective attention is impaired in individuals with DAT, the ability to differentiate a target from a distractor may be preserved under certain task conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)