ABSTRACT
Patients referred with concerns related to hoarding and squalor frequently pose significant management challenges. We conducted a retrospective analysis of 120 patients referred to an Aged Care Assessment Service. The hoarding only group comprised 27%, squalor only 15% and hoarding and squalor 53%. Mild cognitive impairment was the most common cognitive diagnosis, no cognitive diagnosis was made in 25% and the usual diagnostic process could not be followed in 13%. This analysis provides relevant Australian specific data to assist with planning service delivery for a group of patients with complex management issues.
Subject(s)
Cognitive Dysfunction/diagnosis , Hoarding Disorder/psychology , Hygiene , Age Factors , Aged , Aged, 80 and over , Alcoholism/psychology , Alzheimer Disease/psychology , Australia , Dementia, Vascular/psychology , Female , Humans , Male , Mental Status and Dementia Tests , Retrospective StudiesABSTRACT
BACKGROUND: Faecal incontinence significantly affects a patient's quality of life, and limited research has been conducted into effective interventions that are specific to residential aged care. Australian and New Zealand prevalence data indicate a general faecal incontinence rate of 12-13% in older adults and up to 50% in residential aged care. OBJECTIVE: The objective of this article is to describe the suggested initial investigation and management of faecal incontinence in older adults residing in residential aged care. Discussion of invasive management strategies is outside the scope of this article. DISCUSSION: Faecal incontinence is difficult to treat and there is limited evidence to support any treatment beyond three to six months. However, recognition remains the major barrier to treatment with non-invasive interventions that are available to reduce episode frequency and prevent complications. A combination of exercise programs and integrated continence care in residential aged care may provide significant benefit
if there are sufficient staffing resources available.
Subject(s)
Fecal Incontinence/diagnosis , Fecal Incontinence/therapy , Quality of Life/psychology , Disease Management , Fecal Incontinence/epidemiology , Humans , PrevalenceABSTRACT
ABSTRACTBackground:Despite of their limited availability and potential for significant variation between and within each modality, this is the first study to prospectively measure the clinical utility of MRI and/or SPECT brain scanning in addition to the routine diagnostic workup of patients presenting to memory clinic. METHODS: A single center study was conducted over a convenience of 12-month sampling period. For each patient referred for MRI and/or SPECT scanning, the primary geriatrician or psychogeriatrician was asked to assign an initial diagnosis. The initial diagnosis was then compared with the final consensus diagnosis after any scans or neuropsychology testing had been completed. RESULTS: During the 12-month study period, 66 patients (26%) were referred for scans out of a total of 253 patients included in the study. There were 16/44 (36%) positive MRI outcomes and 13/35 (37%) positive SPECT outcomes. The diagnosis changed consistent with the MRI scan findings in 11/44 (25%) and changed consistent with the SPECT scan findings in 9/35 (26%). Potentially reversible pathology was identified in a single patient, 1/50 (2%), via an MRI scan that suggested normal pressure hydrocephalus. The number needed to test for one positive outcome was 3.8 (95% CI 2.0-23.3), 6.0 (95% CI NA), and 1.7 (95% CI 1.3-2.5) for MRI only, SPECT only, and MRI and SPECT together, respectively. CONCLUSIONS: The clinical utility of MRI and/or SPECT scanning in this study may be broadly superior to the available international evidence, and further research is needed to identify predictors of positive scan outcomes.
