Care Needs of Dementia Key Caregivers

Garima Srivastava, Rakesh Kumar Tripathi*, S.C. Tiwari*,  Bhupinder Singh#

*Department of Geriatric Mental Health, King George's Medical University, UP, Lucknow, India

 Abstract:

Background: Dementia is the most devastating mental health problem of elderly and needs extra attention to care. Therefore, this study was conducted to identify the care needs of dementia key caregivers and their quality of life (QOL).

Methods: Sample consisted of purposively selected 24 dementia key caregivers fulfilling the inclusion and exclusion criteria from the inpatient of the Department of Geriatric Mental Health, KGMU, UP, Lucknow. Semi-structured proforma for sociodemographic details, Zarit Burden Interview and WHOQOL-BREF were administered.

Statistical Analysis: Mean, SD, t test, Chi Square with Yate’s correction were used to analyze the data.

Results:  All key caregivers of dementia patients felt mild to moderate level of burden.  Significant difference was found on burden areas of ‘expectation’ (p<.01) and ‘incompetence’ (p<.05) between males and females key caregivers. Mean scores on physical, psychological, social relationship and environmental QOL were found to be on lower side of dementia key caregivers.

Key Words: Dementia, Key care giver, Burden and QOL
Note: Paper was presented in national Annual Conference of Indian Association for Geriatric Mental Health held at Mysore, 2012.

available on following link: http://www.intarchmed.com/content/7/1/26/abstract

Novel occupational therapy interventions may improve quality of life in older adults with dementia

Prakash Kumar, Sarvada Chandra Tiwari, Ashish Goel, Vishnubathla Sreenivas, Nand Kumar, Rakesh Kumar Tripathi, Vineet Gupta and Aparajit Ballave Dey

Author Affiliations

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International Archives of Medicine 2014, 7:26  doi:10.1186/1755-7682-7-26

Published: 20 May 2014

Abstract (provisional)

Background

Dementia is a major health problem in advancing age with no definitive treatment. Occupational therapy interventions are recognized strategies in treatment of dementia. Quality of life (QOL) assessment has been reliably used as an objective index of an individual's well being pertaining to interventions in dementia. A randomized controlled trial was conducted to study the effects of a novel occupational therapy program in improving QOL of subjects having mild to moderate dementia.

Methodology: 273 subjects older than 60 years were screened. 196 were excluded having cognitive impairment with no dementia (CIND). Remaining 77 subjects after satisfying DSM IV criteria for diagnosis of dementia were included in the study and were randomly assigned to experimental and control groups. Experimental group received a novel occupational therapy regimen along with medical treatment, while control group received only medical treatment for 5 weeks. Outcome measures included standard occupational therapy assessment and WHOQOL-BREF. Subjects were assessed at baseline and post intervention.

Result: The mean age of participants was 69.39 years with male preponderance (80.5 % male, 19.5%female). The quality of life (QOL) scores of physical and psychological domain in experimental groups significantly increased from 37.30 +/- 5.42 and 45.13 +/- 3.52 to 45.43 +/- 7.32 and 51.50 +/- 6.46 respectively. The QOL scores in social and environmental domains did not change significantly. The QOL scores in control groups declined in all domains with statistical significance found in social and environmental domain. (29.67 +/- 4.58 and 38.49 +/- 1.77 to 28.45 +/- 5.26 and 38.18 +/- 2.15 respectively)

Conclusion

This novel occupational therapy program improved the short term physical performance and psychological well being domain of quality of life in older adults with dementia. An improved physical performance is achieved by physical exercise of novel program and it creates sense of independency, increased motivation, positive outlook and reduced behavioral and psychological symptoms. The long term effects of the intervention can be ascertained in a study with longer period of intervention and follow-up.

Trial registration: [CTRI/2014/01/004290]

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Abstract of Prevalence of psychiatric morbidity among urban elderlies.........

Link of the paper http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2014;volume=56;issue=2;spage=154;epage=160;aulast=Tiwari

ORIGINAL ARTICLE

Indian Journal of Psychiatry, Year : 2014  |  Volume : 56  |  Issue : 2  |  Page : 154-160

Prevalence of psychiatric morbidity among urban elderlies: Lucknow elderly study

SC Tiwari1, Rakesh Kumar Tripathi1, Aditya Kumar1, AM Kar2, Ragini Singh3, VK Kohli4, GG Agarwal5 1 Department of Geriatric Mental Health, King George Medical University, Lucknow, Uttar Pradesh, India 2 Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India 3 Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India 4 Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India 5 Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India Click here for correspondence address and email Date of Web Publication 11-Apr-2014

Abstract   Background: Paucity of systematic studies in elderly mental health in an aging population is an urgent need, which is required to address services and planning issues for health. Aim: The present study aims to investigate the distribution of physical, neuropsychiatric, and cognitive disorders of a community sample of elderlies with certain socioeconomic data. Materials and Methods: A door-to-door household survey was conducted to identify houses with elderlies (≥55 years) in two urban localities of Lucknow. Mini mental state examination (MMSE), Survey Psychiatric Assessment Schedule (SPAS)/Mood Disorder Questionnaire (MDQ) and physical and neurological examination were used for screening all consenting elderlies. MMSE positive participants were assessed on Cambridge Mental Disorders of the Elderly Examination-Revised for diagnosis of cognitive disorders; SPAS/MDQ positives were assessed on Schedule for Clinical Assessment in Neuropsychiatry based clinical interview for diagnosis of neuropsychiatric disorders other than cognitive disorders (using ICD-10 criteria). Routine and indicated laboratory/radiological investigations on all and on MMSE/SPAS (organic section) positive/physically ill participants respectively were done to confirm organic and/or physical illness. Only percentages were calculated to find the distribution of morbidity. Results: The sample had proportionate age structure as that of the surveyed population and had balanced gender representation in each age deciles. Prevalence of neuropsychiatric disorders (with/without comorbidities) was 11.8% in the elderlies (60 years and above) highest being in the 60-69 years age group. Being women and of lower socioeconomic status was more commonly associated with a neuropsychiatric diagnosis. 7.6% of the elderlies had cognitive impairment. Overall findings suggest a prevalence rate of 17.34% of total psychiatric morbidity among elderlies. A significant number had comorbid physical illness diagnoses. Conclusion: More than half the elderlies had some diagnosable physical or mental ailment. The study familiarizes us to the significant amount of physical and psychiatric comorbidity in the particular age group. About one-fifth was found to suffer from psychiatric morbidity, which any health services for the elderly should be oriented towards. Keywords: Cambridge mental disorders of the elderly examination-revised, cognitive impairment, comorbid physical illness, elderly, prevalence, psychiatric morbidity How to cite this article: Tiwari S C, Tripathi RK, Kumar A, Kar A M, Singh R, Kohli V K, Agarwal G G. Prevalence of psychiatric morbidity among urban elderlies: Lucknow elderly study. Indian J Psychiatry 2014;56:154-60 How to cite this URL: Tiwari S C, Tripathi RK, Kumar A, Kar A M, Singh R, Kohli V K, Agarwal G G. Prevalence of psychiatric morbidity among urban elderlies: Lucknow elderly study. Indian J Psychiatry [serial online] 2014 [cited 2014 Apr 17];56:154-60. Available from: http://www.indianjpsychiatry.org/text.asp?2014/56/2/154/130496

S. C. Gupta Young Scientist Award- 2013

Cognitive functioning of community dwelling urban older adults with reference to socio-demographic variables 

Rakesh Kumar Tripathi^1*and S. C. Tiwari²

¹Assistant Professor cum Clinical Psychologist, ² Professor & Head, Department of Geriatric Mental Health, King George’s Medical University) Lucknow

Email: rastripathi@gmail.com, *Presenting and Communicating Author

Published in Indian Journal of Clinical Psychology, 40(2), 92-102, 2013.

Abstract

Study was conducted to identify socio-demographic variables associated with cognitive functioning of community dwelling urban older adults.  The study is based on a PhD work of the first author carried out alongwith the data collection of ICMR, New Delhi funded research project on same subjects. All houses in randomly selected 2 municipal wards of urban Lucknow were visited. Houses where at least one family member aged 60 years and above was residing were identified and listed. Subjects were included in the study after obtaining written informed consent by the subjects/family members according to inclusion/exclusion criteria.  Hindi Cognitive Screening Test (HCST), Semi-structured socio-demographic proforma and SES scale were administered. A cut off score of 24 was applied to differentiate cognitively impaired subjects from normal.  Thus, an equal number of cognitively impaired (150) and Normal (150) subjects on HCST were finally recruited in a consecutive series. Brief Cognitive Rating Scale was administered on all 300 subjects to assess level of cognitive functioning. As and when required, the family members were cross checked about the information given by the elderly subjects.  The information which was difficult to elicit from the subjects with cognitive impairment were obtained from their family members. Data was analyzed using statistical software SPSS version 12.0. and GraphPad InStat demo version 3.05 Inc year 2000. 

            Results showed age, education, living arrangements and occupation were found to be significantly associated with cognitive functioning of the older adults aged 60 years and above living in an urban community.   

Key Words: BCRS, Cognitive function, HCST, Older adults, Socio-demographic variables

Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in northern India

SC Tiwari¹, Garima Srivastava², Rakesh Kumar Tripathi¹, NM Pandey¹, GG Agarwal³, Smita Pandey⁴, Samyak Tiwari^5
1 Department of Geriatric Mental Health, King George's Medical University, Lucknow, India
² Department of Geriatric Mental Health, King George's Medical University, Lucknow; Department of Psychology, Allahabad University, Allahabad (UP), India
³ Department of Statistics, Lucknow University, Lucknow, India
⁴ Department of Geriatric Mental Health, King George's Medical University, Lucknow; Institute of Behavioural Sciences, Gujarat Forensic Sciences University, Gandhinagar, Gujarat, India
⁵ Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India

Date of Submission	07-Jun-2011
Date of Web Publication	19-Nov-2013

Indian Journal of Medical Research Year : 2013  |  Volume : 138  |  Issue : 4  |  Page : 504-514 http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2013;volume=138;issue=4;spage=504;epage=514;aulast=Tiwari Correspondence Address: S C Tiwari Department of Geriatric Mental Health, King George's Medical University, Lucknow 226 003  India Abstract

Background & objectives: The population of elderly is growing globally and so are the physical illnesses and psychiatric morbidity. This study was planned to assess the prevalence and patterns of psychiatric morbidity amongst rural older adults in Lucknow, north India.
Methods: A survey was conducted in subjects aged 60 yr and above to identify the cases of psychiatric morbidity in rural population from randomly selected two revenue blocks of Lucknow district, Uttar Pradesh, India. All subjects were screened through Hindi Mental Status Examination (HMSE) and Survey Psychiatric Assessment Schedule (SPAS) to identify for the suspected cases of cognitive and the psychiatric disorders, respectively. The subjects screened positive on HMSE and SPAS were assessed in detail on Cambridge Mental Disorder of the Elderly Examination-Revised (CAMDEX-R) and Schedule for Clinical Assessment in Neuropsychiatry (SCAN), to diagnose cognitive disorders and psychiatric disorders (other than the cognitive), respectively on the basis of International Classification of Diseases-10 (ICD-10) diagnostic guidelines.
Results: The overall prevalence of psychiatric morbidity in rural older adults was found to be 23.7 per cent (95% CI=21.89-25.53). Mood (affective) disorders were the commonest (7.6%, 95% CI=6.51-8.80), followed by mild cognitive impairment (4.6%, 95% CI=3.72-5.53), mental and behavioural disorders due to substance use (4.0%, 95% CI=3.17-4.87) and dementia (2.8%) [Alzheimer's disease (2.4%, 95% CI=1.81-3.16) and vascular (0.4%, 95% CI=0.16-0.73)].
Interpretation & conclusions: Overall prevalence of psychiatric morbidity amongst rural elderly in this study was found to be less in comparison to those reported in earlier studies from India. However, prevalence pattern of different disorders was found to be similar. Therefore, it appears that a stringent methodology, refined case criteria for diagnosis and assessment by trained professionals restrict false diagnosis.

Keywords: Aged - CAMDEX-R - cognitive disorders - dementia - epidemiology - HMSE - mood disorders - northern India - prevalence

How to cite this article: Tiwari S C, Srivastava G, Tripathi RK, Pandey N M, Agarwal G G, Pandey S, Tiwari S. Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in northern India. Indian J Med Res 2013;138:504-14

How to cite this URL: Tiwari S C, Srivastava G, Tripathi RK, Pandey N M, Agarwal G G, Pandey S, Tiwari S. Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in northern India. Indian J Med Res [serial online] 2013 [cited 2013 Nov 21];138:504-14. Available from: http://www.ijmr.org.in/text.asp?2013/138/4/504/121491

Whether Delirium Acts as ECT?

Case Series	Open Access
Whether Delirium Acts as ECT? Department of Geriatric Mental Health, King George’s Medical University (KGMU), IndiaShailendra Mohan Tripathi, Department of Geriatric Mental Health, King George’s Medical University (KGMU), IndiaRakesh Kumar Tripathi*, Department of Geriatric Mental Health, King George’s Medical University (KGMU), IndiaIndrapal Singh, Department of Geriatric Mental Health, King George’s Medical University (KGMU), IndiaShrikant Srivastava and Department of Geriatric Mental Health, King George’s Medical University (KGMU), IndiaTiwari SC Corresponding Author : Rakesh Kumar Tripathi Department of Geriatric Mental Health King George’s Medical University (KGMU), India E-mail: rastripathi@yahoo.com Received March 18, 2013; Accepted July 15, 2013; Published July 24, 2013 Citation: Tripathi SM, Tripathi RK, Singh I, Srivastava S, Tiwari SC (2013) Whether Delirium Acts as ECT? Aging Sci 1:107. doi:10.4172/2329-8847.1000107 Copyright: © 2013 Tripathi SM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Related article at Pubmed Scholar Google Abstract   Full Text   PDF   References Abstract Delirium is defined by the acute onset of fluctuating cognitive impairment and a disturbance of consciousness with reduced ability to attend. It may occur at any age but is more common in older adults. By virtue of working in the psychogeriatric hospital (Department of Geriatric Mental Health, King George’s Medical University, Lucknow, India), authors experienced that many elderly patients with psychiatric illness develops delirium because of various reasons. Subsequently, we observed that psychiatric manifestations of the patients improved significantly following recovery from delirium. A series of such four cases (case 1- Depression with psychotic features, 2- Manic episode, 3- Bipolar affective disorder current episode mania and 4- Depressive episode) later developed delirium has been presented and discussed in this paper. ICD-10 criteria were used for the diagnosis of delirium and psychiatric illnesses. Average stay of these patients in the hospital was 10 days. We found that signs and symptoms of these psychiatric disorders disappeared almost completely following the recovery from delirium. Therefore, it can be assumed that delirium potentially acts similar to ECT. By reporting such case we open a new dimension of research for effective treatment of the psychiatric patients. Inducing delirium in a patient is unethical but understanding pathophysiology behind it will certainly open the door for better cure of the ailing psychiatric patients. This full paper is available on following link: http://www.esciencecentral.org/journals/whether-delirium-acts-as-ect-2329-8847.1000107.php?aid=17271 Best wishes on World Elder's Day- 1st October  Let us work for smile on their faces......

http://www.esciencecentral.org/journals/whether-delirium-acts-as-ect-2329-8847.1000107.pdf

Psychiatric morbidity and quality of life of inmates in old age homes

Authors : Shamsi Akbar¹, S.C. Tiwari², Nisha Mani Pandey³, Rakesh Kumar Tripathi⁴, Ambrish Kumar⁵

          1Ph.D. Scholor, 2Professor & Head, 3Senior Research Officer, 4Assistant Professor & Clinical Psychologist, 5Social Worker, Department of Geriatric Mental Health, King George’s Medical University  Lucknow, India.

The First Poster Award in GERON-2013

Introduction: The rapid growth in the proportion of older adults in the country has important consequences and implications. Some of the areas that would be affected include those related to health and health care, family composition, living arrangement, housing and migration. As a result of these socio-demographic evolutions and situations, older adults at times are forced to shift from their own homes to institutions/ old age homes. These and other factors make the older adults increasingly vulnerable to mental health problems. There is also some preliminary evidence that life in old age homes is perceived by inmates as more supportive, though the issue is not well studied.

Aim: To assess the psychiatric morbidity and quality of life of elderly people residing in old age homes.

Material and Methods: The present study was carried out in a specific population of in-mates of old age homes in District Bareily, Uttar Pradesh. Fourty elderly subjects from three old age homes, aged 60 yrs or above, were residing in those setting for one and half years or more, have given their informed consent to participate in the study, were recruited for the purpose. SPAS was used to screen the study population for psychotic and non-psychotic symptoms. The Psychiatric diagnosis was made according to International classification of diseases 10^th Revision Diagnostic criteria. WHOQOL –BREF were administered to assess quality of life. SPSS-16 was used for statistical analysis.

Results:  The most of the elderly were females, aged between 60-69 yrs, educated up to 8^th and were widow/widower. Prevalence of psychiatric illness among elderly in-mates was found to be significantly correlated   with their quality of life. The inmates who were suffering from psychiatric illness had good quality of life and those who were not suffering from psychiatric illness had very good quality of life.

Key words: Old age home, Psychiatric morbidity and quality of life.

Reference: Akbar S, Tiwari SC, Garg RK, Pandey NM, Tripathi RK, Kumar A.  Psychiatric morbidity and quality of life of inmates in old age homes.  Indian Journal of Geriatric Mental Health, vol.9 No.(1), supplement, 18,  May 2013.

The poster was presented by Miss S. Akabar in 9th National Annual Conference of Indian Association for Geriatric Mental Health at Lucknow on 19-20 August, 2013(GERON-2013)