Geriatric Mental State Schedule Research Articles

Dependency in old age: A comparison of mental and physical factors

AbstractThe lavel of dependency of 412 patients aged 70 years or over living in hospitals, nursing homes or sheltered accommodation (N=312) or receiving care from the domiciliary nurising services (N=100) and of 100 elderly people living in the community in Hobart, Tasmania, was assessed using a version of the CARE schedule. Therespective roles of mental and physical factors were examined using other CARE intems and after administering the Geriatric Mental Status schedule and the Wechsler Memory Scale. Rank‐order correlations and log‐linear analyses indicated that physical impairment affecting mobility and upper limb function and cognitive impairment due to dementia were about equally strongly related to the level of dependency;at least moderate degrees of both mental and physical impairment were present in 20% of patients. Vision was often hard to assess in demented patients but was associated with dependency in the non‐demented. Dependency was significantly related to age and self‐rated healthbut not to deafness and was related to mood disorder only in non‐demented patients nursed at home. Apart from this, these patients showed similar relations between dependency and physical and mental impairments to those living in institutions. Central nervous system disease was associated with greater dependency than other medical diagnoses. Preventative programmes, and effective management and treatment of the individual, will depend on careful diagnosis of the causes ofdependency.

Prevalence of Dementia in the ‘Oldest Old’ of a Dutch Community

To estimate the prevalence rate of dementia in subjects 85 years of age and over. A two-phase design with the Mini-Mental State Examination (MMSE) in the screening phase and the Geriatric Mental State Schedule (GMS) in the diagnostic phase. Community survey including subjects in residential care. All (n = 1,259) inhabitants of Leiden, The Netherlands, aged 85 years and over on December 1, 1986. First phase participation rate was 71% (17% dropout due to death); second phase participation rate was 82%. DSM-III diagnosis of dementia without further specification of the etiology of the dementia. An overall prevalence rate of 23% (95% C.I.: 19%-26%) was found. This included 12% mild dementia, 7% moderate and 4% severe dementia. The prevalence rate was higher among women (24%) than among men (18%). It increased with age from 19% (95% C.I.: 16%-22%) in the group of 85-89 years to 32% (95% C.I.: 26%-39%) in the group of 90-94 years to 41% (95% C.I.: 25%-58%) in the 95+ group. A fifth of the 85+ and a third of the 90+ population suffer from dementia with an indication that half of the 95+ population is affected. With the expected steep rise in the number of the oldest old, dementia will stay a major health problem in the near future.

The prevalence of dementia in elderly Chinese

A stratified random sample of 612 Chinese aged 65 years and more and living in the community in Singapore was interviewed in 1985, using the Geriatric Mental State Schedule. The overall prevalence of dementia was 1.8%. The rate increased to 4.8% for those 80-84 years and 12.0% for those 85 years and more. An epidemiological survey of dementia in Beijing in 1986, also using the Geriatric Mental State Schedule, reported a similar rate of 1.8% for those 65 years and more. However, the prevalence of senile dementia was higher and multi-infarct dementia lower in Singapore than in Beijing.

A standardized interview for the elderly (GMS): Reliability studies comparing the Dutch language version with the original

AbstractA Dutch translation of the Geriatric Mental State Schedule was prepared and used. Here we report the replication of previous reliability (inter‐rater and retest) studies and present the first figures for the reliability of factor scores. The results have proved valuable for solving some (apparent) discrepancies between previous studies. Overall reliability results were shown to be satisfactory. Using the GMS scores Dutch patient groups appeared to be similar to the US‐UK project patient samples. Preliminary results of a small follow‐up study are provided. The total set of results makes it plausible that Dutch findings can be generalized and the use of the GMS in Holland can be extended.

Depressive disorder in elderly Chinese people

This is a study of the prevalence of depressive disorder among elderly Chinese people living in the community in Singapore. A total of 612 subjects were assessed using the Geriatric Mental State Schedule. The prevalence of depressive disorder was found to be 4.6%. The rate was higher among Chinese people between 65-74 years than among those 75 years and above, and also higher for females than males. The majority of cases were mild and the common symptoms were feelings of sadness, insomnia, headache, pessimism and tension. There was no depressive psychosis or mania.

The geriatric mental state schedule administered with the aid of a microcomputer: A pilot study

AbstractA version of the Geriatric Mental State Schedule developed for the microcomputer is described and compared to the usual paper version of the questionnaire. The advantages and disadvantages of the two techniques are discussed. A feasibility study of the microcomputer‐administered questionnaire is described. A shortened version of the Geriatric Mental State Schedule (version A) is administered to a number of geriatric patients attending psychogeriatric day hospitals. The study compares the microcomputer‐administered with the pencil‐and‐paper questionnaire. Two raters administer the questionnaire using the two techniques to a group of patients and the reliability is evaluated by comparing the correlation coefficients for the scores obtained on the questionnaire, as well as by evaluating Cohen's kappa statistic. The correlation results show that there is significant positive correlation between the paper and the microcomputer‐administered questionnaire. However, the kappa values comparing diagnoses obtained with the AGECAT program are not high and reasons for this are discussed. Further developments of the system, including an authoring program (QUESTLAN) for such questionnaires and the use of portable microcomputers in the community, are discussed.

Late paraphrenia — a follow‐up study

AbstractWe report a 3.7 year follow‐up study carried out on 42 patients with an original diagnosis of late paraphrenia who had had a CT scan and simple tests of cognition in addition to an assessment by means of the Geriatric Mental State Schedule. Mortality was found to be no different than in a control group. Patients showed improvement in target symptoms but exhibited a good deal of residual morbidity, particularly of motor and cognitive function. Cognitive performance, which was previously mildly impaired, showed some futher deterioration, usually falling short of clear‐cut dementia. Ventricular size on the CT scan was not a predictor of outcome. The article highlights the organic substrate of late paraphrenia but suggests that the cerebral changes are relatively subtle and slowly progressive.

Computerized psychiatric diagnosis in the elderly: AGECAT

This paper describes a computerized diagnostic system, AGECAT (Automated Geriatric Examination for Computer Assisted Taxonomy), designed for use with the Geriatric Mental State Schedule (GMS). AGECAT can be divided into three main parts. In the first part symptoms are aggregated to form symptom components. In the second part these components are grouped and compared, using a logical decision tree approach, to reach levels of confidence on eight syndrome clusters. In the third part these levels are compared, cluster by cluster and if the level of confidence is sufficiently high a decision is reached on the diagnosis. In addition the program provides a variety of other information on alternative diagnoses and any unusual features detected. Developing a portable program for this type of work presents an interesting computing task involving various programming tools. One of the benefits of computer methods is the way in which they enforce a precise statement of the theory involved. This advantage is lost if, as is usual, the version which humans read is a hand translation of the computerized version. The implementation of AGECAT has been designed to access a single master text which is used to produce all the target versions automatically, and the paper considers some of the advantages of this approach.

A microcomputer version of the Geriatric Mental State Schedule

A version of the Geriatric Mental State Schedule, which is a standardized questionnaire to assess the mental state of the elderly, has been adapted to be administered by microcomputer. The system is described and advantages of the technique are discussed, comparing it with the former pencil-and-paper version of the schedule. The hardware used and software developed are described, and a pilot study, assessing it in use on a small group of patients, is outlined. Further developments of the system are considered.

Engagement and depressive symptoms in a community sample of elderly people.

Fifty-three elderly women attending a day centre were interviewed and observed to examine hypotheses about depressive symptoms and behaviour. Observers were blind to interview findings. The Geriatric Mental Status Schedule (GMS) and Multiple Affect Adjective Checklist (MAACL) provided information on current symptoms and mood. Time-sampling was used to assess clients' level and type of engagement. No significant relation was found between 'disengagement' (absence of engaged activity) and symptom level. Those clients reaching the Feighner criteria for depression did not differ from other clients either in level of 'disengagement' or in type of engaged activity. Within the whole sample 'disengagement' was related to age and to self-reports of good health. 'Onlooking' was correlated with 'recent loss of interest' and self-blame'. Results are discussed in relation to behavioural formulations of depression and studies of engagement.

The reliability of a Survey Psychiatric Assessment Schedule for the elderly.

The Survey Psychiatric Assessment Schedule (SPAS) was used in a survey of elderly people living at home and in institutions to examine its reliability in determining mental state. A psychiatrist assessed the same subjects using the Geriatric Mental State Schedule (GMSS) and classified psychiatric disorder into three broad groups: organic disorders, schizophrenia and paranoid disorders, and affective disorders and psychoneuroses. The agreement between the psychiatrist's classification of mental state and the classification derived from SPAS was found to be satisfactory for organic disorders and less satisfactory for functional disorders. The limitations of this method of identifying psychiatric illness are examined.

A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. I. Development and reliability.

A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.

A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. II. A factor analysis.

One hundred geriatric psychiatric patients were examined with the Geriatric Mental State Schedule in New York and London, and a correlation procedure involving both clinical and statistical operations was carried out on the psychopathological data thus collected. Twenty-one factors were produced, including three dealing with cognitive impairment. Although it was found that elderly depressives show a profile of psychopathology quite different from that shown by patients with organic disorder, it was also found that patients with an apparently functional disorder may sometimes be diagnosed as an organic disorder, that subjective complaints of intellectual impairment are not good indicators of organic disorders, and may be associated with a depressive factor, and that complaints that could be dismissed as attributes of aging may actually be indicative of a depressive disorder in the elderly. The methodological implications, as well as the limitations of the sample size, are discussed.

Assessment of the Older Psychiatric Inpatient

Instruments, whether used in psychometrics or in other fields, must have a practical application if they are to repay the care spent in their use and development. The Geriatric Mental State schedule was developed in response to the need to answer the question whether functional psychiatric disorders were being misdiagnosed as organic brain syndrome and, if so, to what extent this influenced treatment and outcome. In the hospitals studied it was found that American psychiatrists were more likely to diagnose organic brain syndrome than British psychiatrists. Although elderly patients with affective disorder were less likely to be given American patients was as good, if not better, than the outcome in the British patients.