Articles: dementia.
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Int J Geriatr Psychiatry · Feb 1997
From states of confusion to a national action plan for dementia care: the development of policies for dementia care in Australia.
The release of Australia's National Action Plan for Dementia Care in 1992 was the culmination of more than a decade of policy development over which the federal government assumed an increasing role, and the participatory approach fostered under its Social Justice Strategy promoted collectivist and political attempts to address the issues of dementia care. This article begins with an account of four phases of policy development, with the transition from one to the next marked by changes in thinking about dementia care being incorporated into policy and then expressed in programmes and in care practices. In the second part of the article, the goals and structure of the National Action Plan are outlined and its implementation and outcomes discussed. Continuation of the policy climate in which the National Action Plan was formulated is a crucial, but uncertain, factor for future development.
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Das Gesundheitswesen · Feb 1997
[Drug utilization by elderly patients in Bremen old age and nursing homes with special reference to psychotropic drugs].
In five homes for the aged in the city of Bremen that were also nursing homes, we studied the drug supply and drug intake of 301 inmates with particular reference to psychotropics, basing on the available records. The average regular drug intake covered 3.99 drugs. Furthermore, prescriptions for an average of 1.16 additionally required drugs were issued. ⋯ More than one half of the inmates (50.8%) were given prescriptions for psychotropics; 45.2% took at least one psychotropic permanently. Prescription of benzodiazepines of medium or long half-time was strikingly frequent; these are in fact drugs that are usually unsuitable for administration to elderly persons. As far as antidepressants/tranquilisers are concerned, we noticed that tricyclic antidepressants were prescribed almost exclusively.
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Am J Geriatr Psychiatry · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of trazodone and haloperidol for treatment of agitation in patients with dementia.
The authors compared the efficacy and side effects of trazodone and haloperidol for treating agitated behaviors associated with dementia. Twenty-eight elderly patients with dementia and agitated behaviors were randomly assigned to double-blind treatment with either trazodone (50-250 mg/day) or haloperidol (1-5 mg/day) for 9 weeks. ⋯ Improvement in individual areas suggested that repetitive, verbally aggressive, and oppositional behaviors responded preferentially to trazodone, whereas symptoms of excessive motor activity and unwarranted accusations responded preferentially to haloperidol. These results indicate that moderate doses of trazodone and haloperidol are equally effective for treatment of overall agitated behaviors in patients with dementia, but specific symptoms may respond preferentially to a particular agent.
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Dementing disorders are found most commonly in the elderly. However, the approaches derived from the diagnosis and management of these patients exemplify principles which can equally well be applied to the management of psychiatric disorders in younger patients. These principles include the process of syndromic diagnosis, the need for multi-dimensional assessment, the recognition of the interaction of biological and psycho-social factors in the etiology and treatment of psychiatric symptoms and the crucial role of the family in the management of patients with dementia. In this paper these principles are discussed.