Identifying older people with dementia: the effectiveness of a multiservice census.

A census of all relevant services in an area can be used to identify people with mental impairment suggestive of dementia. Two censuses in Tayside, Scotland, were used to test the effectiveness of this method. False positives accounted for 12% of returns. After excluding false positives, by comparison with expected dementia prevalence based on EURODEM, 66% of all sufferers and 50% of those living in the community were identified by the censuses. By pro-rating for non-response, the proportion of sufferers known to services was estimated as 72%. The characteristics of those not known to services are unclear and further research is needed on this. The cost of a census in an area of 250,000 population is under pounds 3000. A multiservice census offers a simple, inexpensive, practicable method of constructing a sample frame for population needs assessment.

A population needs assessment profile for dementia.

The Tayside Profile for Dementia Planning is an instrument designed to obtain data for population needs assessment and planning. It provides a brief tool to collect a minimum dataset by non-specialists. Third-party informants-informal carers or involved professionals-are used as data sources. The key concept is the use of a descriptive profile rather than a summative score or categorization. The profile consists of a set of needs indicators, information on current service response and demographic and background data. Key levels of dependency are measured by time interval dependency. Validity, reliability, acceptability and usability are satisfactory, with the crucial exception that informal carers and professionals appear to perceive needs differently. Further research is needed to assess which type of informant provides the more useful data.

Matching services to needs in the health care of elderly people.

This paper is based on the results of a postal enquiry to health care professionals working in the care of elderly people in a Scottish Health Board. Responses fall into three main categories. The first refers to issues of process, where lack of information or delays in response create problems. Second, there are problems of scarcity, with both lack of provision and pressures on existing provision. Third, the responses relate to the impact of constrained choices, which are the consequences of that scarcity: either people are sent to existing services because of a lack of alternatives, or people cannot be referred on appropriately because of the lack of alternatives. The process of referral is, then, affected directly by the options that are available. In the process, compromises have to be made, and this produces mismatches between needs and services.

Perceived mismatches between needs and services in the health care of elderly people.

A postal enquiry to professionals involved in service delivery points to a number of problems in the process of referring elderly people appropriately. These problems related to lack of choice and constrained options, rather than mis-referral through inadequate assessment.

A local census of dementia sufferers.

The results of a census of all dementia sufferers known to institutional and community services in Angus are reported. A total of 859 sufferers were identified compared with an expected 1013 based on EURODEM prevalence rates. After allowing for cross-boundary flow to institutions, it was estimated that the true identification rate was 80% (809/1013). Of the estimated total 1063 sufferers (including cross-boundary flow): 26% were in hospital, 27% in residential or nursing homes, 27% in the community and known to services (often the GP), and 19% in the community and not known to services (or, at least, not returned by them in the census). With the co-operation of all concerned, a census approach can yield useful information at a much lower cost than a full survey.

Type A behavior, competitive achievement-striving, and cheating among college students.

The present study examined the cheating behavior in competitive and noncompetitive situations of 40 college students classified as Type A (16 women, 24 men) and 40 as Type B (19 women, 21 men). Type A-scoring students were more likely to cheat than Type B-scoring students irrespective of competition. The results suggest that in some situations, especially where expectations for success cannot be met, Type A-scoring students may cheat to achieve success.