CBT-I and CBT-I+ were both effective at reducing insomnia and depression severity for older adults. Mental health services that deliver treatment for comorbid insomnia with cognitive behavior therapy may improve recovery outcomes for older adults with depression. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR); URL: https://www.anzctr.org.au; Trial ID: ACTRN12615000067572; Date Registered: December 12, 2014.
Objective: To establish the prevalence and patterns of elder abuse, and outcomes of intervention, among patients of four Australian Aged Care Assessment Teams.
Design: Descriptive study, with victims identified retrospectively from medical records for the first three months, and prospectively for the remaining nine months, of 1994.
Setting: Four area‐based Aged Care Assessment Teams in three States.
Patients: Referred patients over 65 years of age who lived in private homes and who met a predetermined definition of elder abuse.
Main outcome measures: Prevalence of abuse, types of abuse and the effect of interventions.
Results: The overall prevalence of elder abuse in the study population was 1.2% (95% CI, 0.4%–2.0%). The rate identified retrospectively was double that identified prospectively. Psychological abuse was the most common form of abuse detected. Patterns of abuse were identified and related to psychopathology of the abuser (30%), dependency of the older person and carer stress (25%), domestic violence (19%), carer abuse (18%) and financial dependency (8%). Interventions and outcomes varied according to the pattern of abuse.
Conclusion: Our findings on the factors causing elder abuse are consistent with those identified in previous Australian studies. The prevalence of elder abuse detected in this study was lower than that in other Australian and overseas studies. A more uniform approach to detection is necessary, which may be aided by improved identification and management techniques, and appropriate training of health professionals in aged care services in case definition, interventions and management.
An older adult's beliefs about sleep and sense of hopelessness were important psychological factors that helped explain how insomnia related to depression.
Cognitive impairment, especially dementia, has been found to be a major risk factor for elder abuse. This
paper reports a study of 54 cases of abuse and 100 non-abused people with dementia seen by the HornsbyRehabililalion & Aged Care Service in 1990-91. The aim of the study was to investigate the relationship between dementia and elder abuse considering the person with dementia as either the victim or abuser. The findings confirmed that when dementia was combined with factors such as psychiatric illness or substance abuse on the part of the carer, or pre-exivting family conflict (including domestic violence), there was a significant risk of abuse occum'ng. However, dementia did not place the sufferer at greater risk of physical andpsychological abuse, even when there was disturbed behavwur such as aggression andparanoia. Carers appeared to be at particular risk of physical abuse and psychological abuse. When abuse did occur, extra services of some types were required to maintain the person with dementia in the community, although victims were not at greater risk of institutionalisation than non-abused dementia sufferers.
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