Cognitive performance in older elderly men with late-life depression and cardiovascular comorbidities: symptomatological correlation.

BACKGROUND: Whether depression or cardiovascular disease would have a greater effect on worsening cognitive impairment in the burgeoning older elderly population is uncertain. Which disorder causes greater cognitive impairment was investigated. METHODS: A cross section of 207 cognitively impaired older elderly (≥75 years old) men was recruited from outpatient clinics in southern Taiwan between 2004 and 2008. Their medical charts were reviewed for their history of medical illnesses, and those undergoing a current major depressive episode were screened using the Mini-International Neuropsychiatric Interview. Four groups of men were enrolled: 33 healthy controls (HC), 101 cognitively impaired patients with cardiovascular comorbidities (CVCs), 34 patients with late-life depression (LLD), and 49 patients with LLD and cardiovascular comorbidities (LLD + CVC). Several neuropsychological tests (e.g., Mini-Mental State Examination (MMSE), WCST, and Trail Making Test (TMT) parts A and B) were used to assess the participants. RESULTS: Cognitive function scores were highest in the HC group and lowest in the LLD + CVC group. There were no significant differences between the two groups with LLD comorbidity, and LLD was mostly associated with cognitive performance. LLD + CVC group members had the lowest recall memory, but their overall MMSE score was not significantly different. Moreover, this group had a higher but nonsignificantly different perseverative error than did the LLD group. Similarly, the LLD + CVC group was nonsignificantly slower at the TMT-A and TMT-B tasks than was the LLD group. CONCLUSIONS: LLD worsens neuropsychological function more than cardiovascular comorbidities do.

Executive functions in elderly men.

The executive function deficit is greater in depressed patients with cardiovascular disease than in depressed patients without cardiovascular disease. Late-life depression is said to have a vascular etiology and would worsen the executive function. A cross-sectional design was used for this study. The study was done in outpatient clinics of Kaohsiung Veterans General Hospital and National Cheng Kung University Hospital, Taiwan. Three hundred thirty-five older elderly men (>75 years old) were chosen as study participants, some military veterans and some not. The mini-mental state examination was used to exclude those suspected of dementia, the Mini-International Neuropsychiatric Interview to screen those undergoing a current major depressive episode, and the revised Geriatric Depression Scale Short Form to measure the severity of depression. Specialist physicians obtained past histories of medical illnesses through chart reviews, history taking, and health examinations. Elderly men with major depression comorbid with cardiovascular disease had worse executive functions. Executive function impairment is greater in elderly men diagnosed with major depression comorbid with cardiovascular disease than in those without cardiovascular disease.

Reasons for living among older male Chinese residents of veterans' homes.

AIM: The purpose of this paper was to report a study of reasons for living among older male residents of veterans' homes in Taiwan. BACKGROUND: Suicide rates are high for older persons worldwide. Little is known about protective factors against suicide among elderly Chinese populations. METHOD: A qualitative descriptive design was used. Two veterans' homes, one government paid and one self-paid, were randomly selected from 18 institutions throughout Taiwan. Participants were 36 residents (≥65 years) who had expressed suicidal ideas in the past 6 months but had never shown suicidal behaviours. Data were collected in individual interviews from 2006 to 2007 and analysed by content analysis. RESULTS: Five major themes related to reasons for living were identified: fear of death, comparative improvement in health condition, maintaining self-dignity, family related concerns and concerns for staff. CONCLUSION: Fear of death, maintaining self-dignity and family related concerns are similar to reasons for living found in western studies, but not comparatively better health and concerns for staff. These differences may be due to our sample being veterans' home residents rather than community-dwelling elders and residents' perceived social support from staff. Since most healthcare providers are nurses and nurses' aides, they may consider promoting/maintaining older people's health, promoting their self-dignity, and strengthening relationships with family members and staff to strengthen protective factors against suicide in older Chinese/Asians. Given the aging population worldwide, nurses should become aware of protective factors related to suicide among older people to improve care for this population.

Nosocomial transmission of tuberculosis in two hospitals for mentally handicapped patients.

BACKGROUND/PURPOSE: An unexpected significant increase in the number of tuberculosis (TB) cases in one hospital for mentally handicapped patients in eastern Taiwan was observed in early 2002. An active screening program was performed to identify undetected TB cases and to investigate nosocomial transmission of TB in two hospitals for mentally handicapped patients in eastern Taiwan. METHODS: Active chest X-ray (CXR) screening followed by passive symptom screening were used to identify patients with pulmonary TB over 2 years in hospital A and B. IS 6110 restriction fragment length polymorphism and spacer oligonucleotide typing (spoligotyping) profiles of the isolates, clinical record of each case, TB control policies of the two hospitals, and risk factors of nosocomial transmission were analyzed. RESULTS: A total of 94.8% (2298/2423) inmates in hospital A and 96.3% (1902/1975) inmates in hospital B were screened by CXR at the beginning of 2002. During the 2-year study period, TB was diagnosed by sputum cultures for 30 patients in hospital A (notified disease rate = 619 per 100,000 population per year) and eight patients in hospital B (notified disease rate = 203 per 100,000 population per year). Seventeen patients (56.7%) in hospital A had six cluster pattern strains, and none did in hospital B, which highlighted the importance of immediate expert consultation and thorough isolation of TB suspects. CONCLUSION: This is the first study to prove that thorough isolation by referring patients to general hospital as soon as possible could decrease nosocomial transmission of TB in hospitals for mentally handicapped patients. Routine CXR screening at admission and maintaining a high alert for TB in daily practice are essential.

Prevalence and risk factors for depressive symptoms among veterans home elders in Eastern Taiwan.

BACKGROUND: Depression in the elderly has become a serious health care issue worldwide. However, no studies have determined the prevalence and risk factors for depressive symptoms among a representative sample of veterans home elders in Taiwan. OBJECTIVES: To determine the prevalence and risk factors for depressive symptoms among veterans home elders in eastern Taiwan. METHOD: Elderly veterans (n = 947) were recruited from four veterans homes in eastern Taiwan. RESULTS: The prevalence of depressive tendency was 35.5%. Logistic regression analysis demonstrated that depressive status in this sample was significantly predicted by poorer functional status, dissatisfaction with living situation, poorer perceived health status, and lower education level. CONCLUSIONS: The risk factors for depressive symptoms identified in this study need to be considered when assessing the health of elderly veterans. In addition, strategies to improve elderly veterans' perception of health status, physical function and living situation should be considered in interventions to reduce their depressive symptoms.