Anticonvulsants in the treatment of aggression in the demented elderly: an update

Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. METHODS: Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. RESULTS: To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. CONCLUSION: So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.

Anticonvulsants in the treatment of aggression in the demented elderly: an update

Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. METHODS: Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. RESULTS: To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. CONCLUSION: So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.

A Preliminary Review of Behavioural Biometrics for Health Monitoring in the Elderly

This article explores the potential of ICT-based biometrics for monitoring the health status of the elderly people. It departs from specific ageing and biometric traits to then focus on behavioural biometric traits like handwriting, speech and gait to finally explore their practical application in health monitoring of elderly.

Young people and youth policies in Spain in times of austerity: between juggling and the trapeze

The aim of this article is to present and discuss the situation regarding young people and youth policy in Spain via the parameters of the magic triangle linking policy, research and action: (1) the situation of young people in Spain today -some indicators are highlighted regarding the main challenges and opportunities for young people, with references to the so-called"Ni-Nis" (neither studying nor working)- and the movement of the"outraged" youth that occupied the streets of Spain"s major cities in May 2011; (2) the current approaches adopted by public youth policies in Spain and limitations and difficulties encountered by the government in attempting to meet the demands of young people; (3) social work with young people and professionals involved in youth policies. In the last section, we conclude with some open questions and proposals for the immediate future

The experience of identity transformation process for people living with tetraplegia and paraplegia = El proceso de reconstrucción de la identidad de las personas afectadas de una paraplejia o tetraplejia

A spinal cord injury (SCI) is perceived as a source of biographical disruption, not only at a physical level but also in terms of people’s life stories, their motivation and their self-esteem. The aim of this study is to explore the factors that people with spinal cord injuries perceive as contributing to rebuilding their sense of self. Two focus groups were established from the SCIcommunity, one of which was made up of 14 people with paraplegia and the other of 9 people with tetraplegia. In addition, four individual interviews were conducted with the participants. The results of content analysis show that the two most prominent factors in the process of identity renegotiation are the partial transformation of the subject’s identity followed by a coming to terms with that new identity. To rebuild self-worth, the importance of finding a balance between change and continuity was identified. Renegotiation of identity after a spinal cord injury is a complex phenomenon that greatly influences the SCI individual’s quality of life perceptions. Reaching a balance between the changes experienced due to the injury and finding a sense of continuity can be either facilitated or obstructed by the economic, political, legal, architectural, and social context

El cuidado de los ancianos en el entorno familiar : valoración de los recursos de apoyo mediante grupos de discusión

Introduction: in the present study several collectives with knowledge of the reality of family care of the elderly assessed several socia and healthcare resources and suggested several possibilities for improvement. Method: four discussion groups were used as a data collection technique. The groups were composed of caregivers, representatives-users of associations for the elderly, experts in geriatrics, and social services professionals. Results: the various discussion groups positively evaluated the Home Help Service, the Support Teams of the Home Service Programs, Interdisciplinary Community Health Workers Units, Daytime Care Centres, and the Family Rest Programme but suggested some changes to all of them. The discussion groups also indicated the need to improve the material, economic and emotional assistance given to caregivers and asked for training, institutional coordination, anddissemination of information about available resources and assistance. Conclusions: some changes are required to improve the current social and health resources available to families caring for the elderly within the family unit. Among the suggestions for improvement proposed by the participants, many are useful and could easily be applied, whereas others provide an interesting starting point for debate and reflection. Knowledge and understanding of the situation of caregiving families, based on their own experiences and those of the people who know them, is in itself sufficient to initiate and implement changes to provide resources appropriate to their needs

Built environment and elderly population health: a comprehensive literature review

Global population aging over recent years has been linked to poorer health outcomes and higher healthcare expenditure. Policies focusing on healthy aging are currently being developed but a complete understanding of health determinants is needed to guide these efforts. The built environment and other external factors have been added to the International Classification of Functioning as important determinants of health and disability. Although the relationship between the built environment and health has been widely examined in working age adults, research focusing on elderly people is relatively recent. In this review, we provide a comprehensive synthesis of the evidence on the built environment and health in the elderly.