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Establishing The Safety And Effectiveness Of A Diagnostic Therapeutic Trial For Asthma In Community Elderly
Funder
National Health and Medical Research Council
Funding Amount
$397,155.00
Summary
Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 5 ....Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 55 years. There are clear patient and system factors that contribute to under diagnosis. The patient factors are currently being addressed in a general practice patient pilot study. System issues make the diagnosis of asthma in general practice a difficult task. The study is important, as older people are more likely to access the general practitioner than a specialist for respiratory problems. Spirometry in general practice is not common and is of variable quality. The most common approach to diagnosis by the general practitioner is a diagnostic trial of medication to provide evidence of asthma. This can be broken down into four elements of: entry criteria to a therapeutic trial; choice of drug in a therapeutic trial; length of time for a therapeutic trial, and; assessment criteria in a therapeutic trial. No evidence-based guidelines are available to assist the general practitioner in each of these stages making the therapeutic trial a safety and effectiveness issue of major importance, especially in the older person. The purpose of the study proposed is to conduct a randomised controlled trial in a representative population sample of older people to determine the evidence-based components of a diagnostic therapeutic trial for the guidance of general practitioners. The study will also assess which diagnostic questions and medical tests provide greatest assistance to the general practitioner in diagnosing asthma in the older person.Read moreRead less
Improving Diagnosis Of Early Frontotemporal Dementia Syndromes
Funder
National Health and Medical Research Council
Funding Amount
$451,716.00
Summary
Frontotemporal dementia is difficult to identify and diagnose accurately, although it is almost as common as Alzheimer’s disease before the age of 65. Improving its detection and diagnostic accuracy is the focus of my fellowship for the next 4 years. As a neuropsychologist with over 15 years clinical experience in dementia, I will combine clinical, neuroimaging and neuropathological approaches to identify early presentations of frontotemporal dementia and other dementia syndromes.
The Diagnosis Of Depression In Alzheimer's Disease
Funder
National Health and Medical Research Council
Funding Amount
$361,000.00
Summary
During the next 3 decades the number of persons older than 85 years will more than double, and the health care need of this burgeoning population are assuming greater importance. Among the most significant but often overlooked conditions in the elderly is depression, which is associated with marked disability, functional decline, risk of hospitalization, diminished quality of life, caregiver burden, increased service utilization, and mortality from comorbid medical conditions or suicide. The Wor ....During the next 3 decades the number of persons older than 85 years will more than double, and the health care need of this burgeoning population are assuming greater importance. Among the most significant but often overlooked conditions in the elderly is depression, which is associated with marked disability, functional decline, risk of hospitalization, diminished quality of life, caregiver burden, increased service utilization, and mortality from comorbid medical conditions or suicide. The World Health Organization predicts that by 2020 depression will be second only to heart disease as a cause of disability and premature death in established market economies. Depression is missed in approximately half of all elderly persons with mood disorder, and this frequency is certainly higher among individuals with dementia. The strategy to diagnose depression in dementia needs to be revised. Patients' reports are often unreliable due to memory problems and lack of full insight into their mood and behavioural changes. Caregivers may overestimate patients' symptoms of depression, especially when they themselves are depressed and overburdened, and clinicians' diagnoses are sometimes based on biased information and short observation periods. The situation in nursing homes is even worse, and there is a shortage of studies on how to diagnose depression in institutionalised patients with dementia. Using specific instruments to assess mood, behaviour and cognition we will develop valid and reliable criteria to diagnose depression in the different stages of dementia, and for patients living in different settings. This will facilitate the early recognition and adequate treatment of depression in individuals with dementia, it will greatly improve patient's quality of life, and will have a positive impact on caregivers' psychological well-being.Read moreRead less