People In Different Stages Research Articles

Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial)

ObjectiveThis study aims to identify whether pain and dementia-related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity. DesignCross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). Setting and ParticipantsA total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged ≥65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion. MethodsActivity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification. ResultsA total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack of inhibition OR, 0.894; P = .034). Conclusion and ImplicationsPain and dementia-related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.

Necessary Information of Afghan Immigrant Women with Breast Cancer in Iran in the Field of Health and Sanitary and the Way to Access it

Introduction: This study was aimed to identify the sanitary and health-oriented and information needs of Afghan immigrant women with breast cancer who are being treated and coping with their disease in health centers and hospitals in Iran.
 Method: The present study is a survey and applied in terms of purpose. The study population consisted of 72 Afghan immigrant female patients with breast cancer. A researcher-made questionnaire was used to collect information divided into 6 sections and had 65 questions. Kruskal-Wallis,Mann-Whitney U tests, and SPSS statistical software version 20 were used to analyze the data.
 Findings: The results showed no significant difference between the health information needs of immigrants based on age, marital status, literacy rate, occupation, treatment stage, manner and place of residence, and other demographic characteristics. “Achieving a healthy life” has been identified as the most critical information need (with a mean of 4.14), and “lack of familiarity with traditional sources related to sanitary and health” has been identified as the most crucial barrier (with a mean of 3.99) in accessing sanitary and health information.
 Conclusion: Paying attention to the information needs of cancer patients, especially immigrants and refugees with cultural differences and many social gaps with the host community (Iran), seems inevitable. As a result of being aware of the health information needs of these people in different stages of treatment and providing appropriate information by health professionals, informants, doctors, nurses, and medical staff, the situation will provide for better and more effective treatment of these patients in addition to reducing mental anxiety and psychological security in patients.

P63: Best Practice Guidance on Human Interaction with Technology in Dementia Update June 2023 – Recommendations from the INDUCT and DISTINCT Networks

Objective:INDUCT (Interdisciplinary Network for Dementia Using Current Technology), and DISTINCT (Dementia Inter-sectorial strategy for training and innovation network for current technology) are two Marie Sklodowska-Curie funded International Training Networks that aimed to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia.Methods:In INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support everyday life; technology to promote meaningful activities; and healthcare technology. In DISTINCT (2019-2023) 15 Early Stage Researchers worked on technology to promote Social health in three domains: fulfilling ones potential and obligations in society, managing one’s own life, and participation in social and other meaningful activities.Both networks adopted three transversal objectives: 1) To determine practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; 3) To trace facilitators and barriers for implementation of technology in dementia care.Results:The main recommendations resulting from all research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which was recently updated (Dec 2022 and June 2023) and will be presented at the congress. The recommendations are meant for different target groups, i.e. people in different stages of dementia, their (in)formal carers, policy makers, designers and researchers, who can easily find the recommendations relevant to them in the Best Practice Guidance by means of a digital selection tool.Conclusions:The INDUCT/DISTINCT Best Practice Guidance informs on how to improve the development, usage, impact and implementation of technology for people with dementia in various technology areas. This Best Practice Guidance is the result of intensive collaborative partnership of INDUCT and DISTINCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the projects.

First insights exploring Activities of Daily Living performance captured through activity sensors in a Smart Home Environment as an indicator of cognitive decline: A cross‐sectional Analysis

AbstractBackgroundSmart homes offer a unique potential not only for supporting various users’ needs but also for monitoring their activities. Herein the findings of the RADAR‐AD Smart Home study are presented. Using data from activity sensors installed in a smart home environment simulating real‐life conditions, we aim to detect deficits while performing Activities of Daily Living (ADLs) in three known groups of people in different stages of cognitive decline related to Alzheimer’s Disease (AD).MethodIn a fully equipped Smart Home (https://smarthome.iti.gr/), Fibaro smart plugs (to monitor power consumption), motion‐, door‐, flood‐sensors and panic buttons were installed. During their 24 hour visit, participants [13 Healthy Control (HC), 14 Preclinical AD (PreAD), 13 Prodromal AD (ProAD)] (Table 1) followed a protocol listing a number of ADLs (e.g., meal/beverage preparation) (Table 1). Data collection, feature extraction (i.e., activity duration, number of repetitions) and visualization of ADLs were performed through the CARL data collection and analysis platform for assisted living (https://carl.iti.gr/). (Figure 1). Two‐Way ANOVA and Mann‐Whitney were used to test the statistical significance between the groups.ResultComparing Activity Duration for different ADLs and groups (Figure 2), HC executed the ADLs in less time compared to PreAD and ProAD, while PreAD showed no difference in the majority of the tasks compared to ProAD. Three activities were completed by 50% of the HC, 36% of the PreAD and only 17% of the ProAD. Two‐way ANOVA revealed a statistically significant interaction between the effects of cognitive decline and Activity Duration F(3,106) = 3.504, p = 0.034. Mann‐Whitney analysis for the complex task “Meal Preparation” showed decreased duration for HC compared to PreAD (U = 33.00, p = 0.042) and ProAD (U = 17.00, p = 0.052).ConclusionThe RADAR‐AD Smart Home study provides a proof‐of‐concept for the use of home‐based sensors for investigating ADLs in patients with cognitive decline. This work has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking (grant No 806999). www.imi.europa.eu. This communication reflects the views of the RADAR‐AD consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein.

Construction, expression and group work. Establishing interdisciplinary links

The Universidad Nacional de La Plata and the Hospital Zonal de Rehabilitación El Dique signed a specific agreement as a framework for the realization of two interdisciplinary devices in charge of the Cátedra Libre Musicoterapia. The human rights approach -as a starting point to understand the user as a "subject of rights" and not as a "beneficiary", an integral notion of health and the collective elaboration based on potentialities, constituted the central axes of the task. The effects of "hospitalism" and chronicity were taken into account, that is, the suffering of the subject during his prolonged stay in the institution as a generator of de-subjectivizing effects that impact on the health condition and on the construction of social bonds. The experiences, of voluntary participation, were carried out in two different wards. In Pavilion No. 2, people in different stages of rehabilitation participated in the space where they worked on the relationship between rhythm and movement with a view to discharge. In the Canutti Pavilion, the open framing device allowed the accessible construction of pvc sikus and the assembly of a musical ensemble. The workshops provided a space for voluntary co-construction, enabled a way of doing with others, where individual interest and the consolidation of social ties were re-signified. The activity became a meaningful occupation incorporated into the usual routine. At the end of the workshops, the participants expressed the desire for the permanence of each device. This made it possible to visualize the identification and commitment with the space. The resignification of social ties within the framework of a group modality provided a new daily routine. We highlight the importance of the work taking a position of "subject of rights" and favoring an integral and interdisciplinary approach.

Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care.

Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care.

Youth participation in policy-making processes in the United Kingdom: a scoping review of the literature

ABSTRACT Young people’s voices remain underrepresented in health policy processes. This scoping review focuses on the United Kingdom (UK) and investigates how and to what degree young people have participated in policy-making processes. We adapt an established framework categorizing how young people are involved in policy-related processes, ranging from advisory roles to communicating findings. We report a spectrum of practical examples, highlighting opportunities for successful policymaking with youth, in relation to key factors, such as type of involvement, role of facilitators, and the integration of young people in different stages of the process.

Medical rehabilitation strategies in complex assistance of people with COVID-19. Literature review

Covid-19 infection is a challenge for the medical system. The development of programs and strategies for the rehabilitation of people in different stages of the disease is relevant and current. The study is a bibliographic synthesis that aimed to analyze the methods and strategies of medical rehabilitation of patients with the new “coronavirus infection”. Data were collected from the academic databases PubMed, PubMed Central, Google, collecting relevant articles from 2019-2021, using the keywords: [“Covid-19” or “Covid 19” or “2019- CoV” or “SARS- CoV” or“ new coronavirus” or “SARS-CoV-2”] and [“rehabilitation ”or“ physical medicine”]. Th e aim of the study was to estimate the consequences of COVID-19 and to identify methods of recovery treatment. Because Covid-19 severely affects the respiratory system, pulmonary rehabilitation interventions with respiratory techniques and postural drainage combined with other physiotherapeutic methods may be used for a patient with COVID-19. The wide range of clinical manifestations in COVID-19 reveals the importance of adapting the rehabilitation program to functional deficits and patient needs. Multifactorial programs combined with active and supportive methods (physical therapy, exercise, occupational therapy, reflex therapy) are effective and can be used in the complex care of patients with COVID-19 at all stages of treatment.

Salience of self-identification of transsexual people in different stages of medical transition

IntroductionTranssexuals are considered to be stable in their identity (White Hughto et al., 2016). Meanwhile, the stages of medical transition affect the mental state of transsexuals differently.ObjectivesThe aim was to reveal relationships between salience of self-identification in transsexual people being on different stages of medical transition.Methods151 transsexual people: 55 pre-operated Female-to-Male (FtM I), 25 FtM on a hormonal therapy (FtM II), 25 FtM after some surgical operations (FtM III); 12 pre-operated Male-to-Female-Transsexual (MtF I), 16 MtF on a hormonal therapy (MtF II), 18 MtF after some surgical operations (MtF III). The participants filled the modificated Kuhn’s test “Who am I?” (Tkhostov et al., 2014). The modification includes a Likert scale for evaluating one’s self-identifications in terms of salience: “How often do You think or remember this answer?” (Stryker, 2007).ResultsThere were differences between identity salience and stages of medical transition (F = 7,177; P < 0,001; η2 = 0,108). Transsexuals before medical transition demonstrated higher levels of identity salience (average score is 7,62 in FtM I and 7,75 in MtF I). Transsexuals on a hormonal therapy demonstrated sharply decreased level of identity salience (6,97 in FtM II and 6,19 in MtF II). Transsexuals after surgical operations reported increased level of salience (7,81 in FtM III and 7,23 in MtF III). There were no statistically significant differences between the groups by gender assigned at birth.ConclusionsData suggest that medical transition could change the salience of self-identification. Hormone therapy is associated with a sharp revision of the salience of self-identifications for transsexuals.

Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

BackgroundElectronic cigarettes (“e-cigarettes”) have altered tobacco smoking trends, and their impacts are controversial. Given their lower risk relative to combustible tobacco, e-cigarettes have potential for harm reduction. This study presents a simulation-based analysis of an e-cigarette harm reduction policy set in the USA.MethodsA system dynamics simulation model was constructed, with separate aging chains representing people in different stages of use (both of combustible cigarettes and e-cigarettes). These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of individuals who smoke, chosen to reduce the tobacco-attributable death rate (i.e., mostly combustible cigarette-attributable, but conservatively allowing e-cigarette-attributable deaths) to that due to all accidents in the general population. The policy is two-fold, removing existing e-liquid flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on tobacco smoking occur through three mechanisms: (1) diversion from ever initiating smoking; (2) reducing progression to established smoking; and (3) increasing smoking cessation. An important unintended effect of possible death from e-cigarettes was conservatively included.ResultsThe base-case model replicated the historical exponential decline in smoking and the exponential increase in e-cigarette use since 2010. Simulations suggest tobacco smoking could be reduced to the goal level approximately 40 years after implementation. Implementation obstacles (time delays, political resistance, and budgetary constraints) could delay and weaken the effect of the policy by up to 62% in the worst case, relative to the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations as negative feedback loops stabilize the system after the one-time “shock” introduced by policy changes.ConclusionsThe simulation suggests that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current evidence that e-cigarettes offset or divert from smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles can usefully inform policy design. Ongoing research is needed, given continuing changes in e-cigarette use prevalence, new policies being enacted for e-cigarettes, and emerging evidence for substitution effects between combustible cigarettes and e-cigarettes.

The effect of the integrated delivery system in rural areas of China.

With the continuous development of modern society, the management of chronic diseases has become the focus of the medical community in China. In particular, diabetes is a chronic disease that cannot be ignored. China has built an integrated delivery system to deal with imminent health problems. The purpose of this study is to investigate the effects of integrated rural supply system in China. We selected 1,061 patients with diabetes from the Zhili Town Health Center's hospital information system. We tracked and studied their outpatient and inpatient expenses, treatment behaviors, incidence of complications, and satisfaction over 5 years. We compared the data collected from 2014 to 2019 to determine the trends of these four factors and the effects of the integrated delivery system for patients with diabetes. We found that the average costs for diabetes patients in outpatient and inpatient departments were increasing slightly every year. The number of patients in tertiary hospitals has decreased significantly, while the number of patients in community hospitals (primary hospitals) has increased, and the number of patients in secondary hospitals has remained relatively unchanged. Meanwhile, the expenses per visit were also lower over this period in hospitals at all levels. Diabetes complications have been increasing marginally, and there is a relatively high degree of satisfaction among patients and doctors in primary hospitals, which is rising. Considering the various needs of people in different stages of life, the integrated delivery system provides and manages continuous services such as health promotion, disease prevention, diagnosis, treatment, rehabilitation, and management through cooperation between institutions at different levels of the health system.

Production and digital discussion of video presentations by students - a project report.

In the summer semester 2020, the module "People in different stages of life" in the Bachelor program "Interprofessional Health Care, B.Sc." had to be adapted to online teaching. The module exam, originally planned as an oral presentation, was presented by the students in interprofessional tandems as a video presentation using case studies. Based on cognitive and social constructivism, all students reflected on these video presentations using the "Think-Pair-Share” method. Similar to regular inverted classroom methods, knowledge transfer through the video presentations was asynchronous and cognitively constructive; accompanying discussion questions of the respective speakers were answered in writing by the fellow students (Think). The students met independently online in small groups on a regular basis to discuss the respective presentations and questions based on personal and professional experiences (Pair; socially constructed). In open online debriefings with the lecturers, the speakers and all interested students, relevant aspects were taken up and discussed again (Share). First experiences showed that the students enjoyed the production of the video presentations and that many of them voluntarily participated in the discussion rounds, in which aspects of health care beyond the presentations were discussed. Considering the experiences made, continuing online teaching in this format may be worthwhile for both lecturers and students.

On the way to self-employment: the dynamics of career mobility

This qualitative study offers empirically-based explanations of the dynamics of career mobility trajectories to self-employment, a popular phenomenon in real life but less so in the literature. Embedded in the career ecosystem of an emerging-economy country, we investigate the mobility dynamics of people in different stages of their self-employment career. We conducted in-depth interviews with 35 individuals who opted for entrepreneurship or self-employed careers, and deploy the interpretive phenomenology to explore the dynamics of career mobility of self-employment. The results demonstrate different patterns of mobility between self- and paid employment during individuals’ career sequences. The different push and pull forces that influence mobility are identified and explained. The study advances the theories of career and entrepreneurship literature by not only illustrating the mobility dynamics of self-employment as a stage of one’s career but by also exploring the dynamic mechanisms of the mobility, drawing on the career ecosystem framework.

Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care.

Background People with dementia who are being cared for in long‐term care settings are often not engaged in meaningful activities. Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour.

Managing frontline employee performance through coaching: does selling experience matter?

PurposeThe impact of managerial coaching on frontline employee performance has received initial support in literature in recent years. However, no studies have explored if this impact should vary according to the career stage that the employee is in. If an interaction effect exists, then managers should expect different results when coaching people in different stages of their careers. Otherwise, all employees (independently of their career stage) can benefit from the positive impact of coaching and, thus, the manager can expect a continuous positive outcome on employee performance throughout their careers. Accordingly, the purpose of this paper is to evaluate the moderation effect of an employee’s career stage on the relationship between managerial coaching and performance.Design/methodology/approachA sample of 318 financial advisors from two Canadian banks was used to collect data on the amount, and quality, of managerial coaching received by the employees, as well as their performance. multigroup confirmatory factor analysis ran in AMOS was used to test the moderation effect of experience.FindingsResults confirmed the positive effect of managerial coaching on frontline employee behavioral and sales performance, but no moderation effect was found. The measuring and causal models showed invariance for employees in their early (one to seven years of selling experience), middle (8-15 years), and late (more than 15 years) career stages, suggesting that managerial coaching will make a consistent contribution to performance throughout all the stages of the employee’s career.Research limitations/implicationsThe study makes two main contributions to the scientific literature. First, it offers an original study examining the effect of managerial coaching on frontline employee performance in the banking sector. Second, it examines the role of selling experience as a moderator in coaching processes, thus contributing to the limited literature on career stages.Practical implicationsThe study suggests that managers should equally devote their coaching efforts to all employees, independently of their selling experience. Contrary to the belief that rookies will benefit more from coaching, and that “you cannot teach an old dog new tricks,” results suggest that managerial coaching makes a continuous contribution to performance throughout all the stages of an employee’s career.Originality/valueTo the authors’ knowledge, this is the first study to examine the moderation effect of selling experience on coaching consequences, and one of the few to present evidence of the positive effect of managerial coaching on frontline employee performance in the banking sector.

Effects of Exercise on Functional Performance and Fall Rate in Subjects with Mild or Advanced Alzheimer's Disease: Secondary Analyses of a Randomized Controlled Study

Background: Exercise improves functional performance in subjects with dementia. However, whether the benefits of exercise are evident in all stages of dementia remains uncertain. This study examines how people in different stages of Alzheimer's disease (AD) benefit from exercise intervention in their physical functioning and risk of falling. Methods: The present study is a subanalysis of a randomized controlled trial examining the effects of exercise intervention (twice a week for 12 months) in AD patients (n = 194). We studied the effects separately in participants with mild dementia and in participants with advanced dementia. Results: In subjects with mild dementia, the deterioration in physical functioning was slower in the intervention group than in the controls. Changes in Functional Independence Measure at 12 months were -2.7 (95% CI -0.5 to -4.9) in the intervention group and -10.1 (95% CI -7.0 to -13.3) in the control group (p < 0.001). The exercise intervention proved effective in preventing falls among patients with advanced AD, with an incidence rate ratio of 0.47 (95% CI 0.37-0.60; p < 0.001). Conclusions: Regular exercise may slow the rate of functional deterioration in mild AD and reduce falls in patients suffering from advanced AD.

Body composition markers in older persons with COPD

Body composition has been shown to be correlated with physical performance, but data in older persons with diverse chronic diseases are lacking. We aimed at investigating the associations of body composition to gait speed and nutritional status of older people in different stages of chronic obstructive pulmonary disease (COPD). Cross-sectional analysis of data from Pulmonary Rehabilitation Geriatric Unit at INRCA in Casatenovo, Italy including 132 consecutively admitted COPD patients (mean age: 75 years) with data on body composition, walking speed and respiratory parameters. Body mass parameters were assessed using bioelectrical impedance analysis. Pulmonary function tests included spirometry and arterial blood gases. Differences among body composition markers were compared according to gender. Separate multivariate linear regression models with gait speed as the dependent variable were used to test for independent associations with body composition markers after adjusting for multiple confounders. Walking speed deteriorated with increasing severity of COPD. Men were heavier and had more lean mass than women. Participants in the fastest gait tertile were younger, had lower body mass index and fat mass (FM); higher lean-to-fat ratio and albumin levels and better respiratory function (FEV1, FVC) compared with those in the slower tertiles. Total body FM was an independent determinant of walking speed, while fat-free mass and lean-to-fat ratio were not. Excess body fat may be harmful for physical functioning among elders with COPD.

Are the stages of change relevant for the development and implementation of a web-based tailored alcohol intervention? A cross-sectional study

BackgroundComputer-tailored programs are a promising tool to stimulate health behavior change, such as reducing alcohol intake. Yet more research is needed to assess whether groups differing in their motivational level to change may need different types of feedback. Furthermore, it is unknown whether motivational level may also determine reactions to computer-tailored interventions. Our aim is to identify the potential relevance of the application of the stages of change concept in the development and implementation of alcohol interventions.MethodsA web-based instrument was used to disseminate a questionnaire and to provide tailored feedback messages among adults in the Netherlands (N = 170; 96 females). Motivational level was assessed by the stage of change construct. The survey furthermore assessed alcohol consumption, attitude, social influence, self-efficacy, and program evaluation (i.e., survey items, tailored advice, layout and functionality of the program). The Least Significant Difference method was used to compare people in different stages of change with regard to psychosocial determinants of drinking behavior and program evaluation.ResultsOf the respondents, 34.1% (n = 58) reported no intention to change to healthier drinking habits in the foreseeable future (precontemplation), 22.9% (n = 39) intended to improve their drinking behavior in the near future (contemplation/preparation) and 42.9% (n = 73) reported to currently adhere to the Dutch alcohol consumption guidelines (action/maintenance). When comparing the three groups, people in the action or maintenance stage reported the lowest number of pros of drinking alcohol, having most healthy drinking role models and the highest levels of self-efficacy regarding healthy drinking in difficult situations, whereas precontemplators reported to receive the least social support regarding healthy drinking. In general, the intervention was positively evaluated, but it seemed to be most appreciated by contemplators and preparers.ConclusionsStage-matched interventions may be useful to encourage people to reduce their alcohol intake. Different factors seem to be important for people in different motivational stages. Longitudinal studies are needed to determine whether these factors also predict stage transition. The intervention could be optimized by tailoring the feedback messages more precisely to the needs of people in different motivational stages, for example by applying the different processes of change.

One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 2000

Dementia and depression are common in advanced age, and often co-exist. There are indications of a decreased prevalence of depressive symptoms among old people in recent years, supposedly because of the manifold increase in antidepressant treatment. Whether the prevalence of depressive symptoms has decreased among people in different stages of dementia disorders has not yet been investigated. A comparison was undertaken of two cross-sectional studies, conducted in 1982 and 2000, comprising 6864 participants living in geriatric care units in the county of Västerbotten, Sweden. Depressive symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and the cognitive score was measured with Gottfries' cognitive scale. Drug data were obtained from prescription records. There was a significant decrease in depressive symptom score between 1982 and 2000 in all cognitive function groups except for the group with moderate cognitive impairment. Antidepressant drug use increased in all cognitive function groups. The prevalence of depressive symptoms decreased between 1982 and 2000, in all levels of cognitive impairment except moderate cognitive impairment. This might possibly be explained by the depressive symptoms having different etiologies in different stages of a dementia disorder, which in turn might not be equally susceptible to antidepressant treatment.

Care-related quality of life in old age

Promoting quality of life is a central theme in recent ageing policies, but what quality of life means in concrete terms for people in different stages of old age is rather unclear. This study presents a multi-dimensional model of care-related quality of life (crQoL) and, based on analyses of three Finnish cross-sectional datasets from the years 2004-2007, examines the distinctions between dimensions of QoL by age and gender, with a special focus on older home care clients. Correlation analyses (Pearson) and stepwise linear regression were applied to analyse variation in QoL by age group and the association between QoL and perceived quality of home care. The results suggest that individual QoL and the priorities of (physical, psychical, social, and environmental) dimensions in the assessment of QoL by older persons vary considerably and exhibit distinct profiles in different stages of ageing. In addition, four dimensions for good care corresponding to the crQoL model were identified and their empirical relevance demonstrated. From the perspective of older people in need of help, home care is not just about giving them the instrumental help they need to perform their daily activities, but rather about giving responsive care that reflects their personal preferences or their view on a "good life", and treats them with dignity and respect. The criteria for the evaluation of quality of home care should reflect these insights, and policy measures should take these differences into account.