Clinical differentiation of Lewy body disease (LBD) from Alzheimer disease (AD) is still problematic. Many persons with LBD lack the cardinal features of visual hallucinations, fluctuations in cognition, and mild Parkinsonism proposed by McKeith et al. (2005). Some studies suggest that history or presence of depression may help distinguish LBD from AD, but this is confounded because many clinically diagnosed LBD patients have significant co-morbid AD pathology and vice versa (Ranginwala et al., 2008). We aimed to clarify whether history or symptoms of depression differentiate LBD from AD, in autopsy-confirmed patients, excluding patients with mixed AD and LBD pathology.

Late-life depression is an immense public health problem for which research on treatment interventions is very much needed. Between 1950 and 1990, average longevity worldwide increased from 46.6 years to 64.7 years (United Nations, 1993). With this surge in the elderly population has come an increased prevalence of late-life depression and its sometimes severe consequences. Older people with depressive symptoms have a threefold increase in mortality (Ashby et al., 1991). As many as 15% to 25% of nursing home residents in the United States have major depression (NIH Consensus Development Panel, 1992), and between 50% and 80% of elderly people who commit suicide have major depression (Clark, 1991; Conwell et al., 1991; Finkel & Rosman, 1995).

Background: Despite the increasing prevalence of Alzheimer's disease (AD), very few studies have examined advanced preparation for the possibility of becoming sick with AD, and these few studies indicate a general lack of preparation. This study aimed to expand knowledge regarding preparedness for AD among younger and older Israeli laypersons, and to explore the determinants of such preparedness, in terms of knowledge and beliefs concerning AD.

Methods: This study was based on a national representative sample of 632 Israeli laypersons. Participants were interviewed by telephone to assess their preparedness for AD, beliefs related to AD in terms of vulnerability, worry, fear, and perceptions about the importance of planning for the future, and their perceived knowledge of AD.

Results: Low levels of preparation for AD were reported, especially among younger participants. Multivariate analyses indicated that for both older and younger participants, taking actual steps to prepare oneself for AD was significantly associated with a general sense of preparedness, and that a general sense of preparedness was associated with perceptions regarding the importance of planning for the future. For older participants, a general sense of preparedness was also associated with greater knowledge of AD.

Conclusions: Findings indicate that Israeli laypersons are not preparing for AD, and that attitudes and beliefs play an important role in this preparation. Thus, measures should be taken to emphasize the importance of planning for the future contingency of AD in younger and older persons and to expand the knowledge of older persons regarding the disease.

The authors regret errors in the reporting of the confidence intervals in the Results section. In relation to the first simple mediation model, the sentence “In this analysis, the β (95% CI) values of the direct effect and indirect effect of marital status on sense of belonging were 1.32 (−2.70, −0.05) and 0.72 (−1.43, −0.01), respectively.” Should read: “In this analysis, the β (95% CI) values of the direct effect and indirect effect of marital status on sense of belonging were 1.32 (−2.70, 0.05) and 0.72 (−1.43, 0.01), respectively.” In relation to the hypothesized mediation model, the sentence “The β (95% CI) values of the direct effect and indirect effect of marital status on suicidal ideation were 0.19 (−0.06, −0.43) and 0.22 (0.11, −0.35), respectively” should read: “The β (95% CI) values of the direct effect and indirect effect of marital status on suicidal ideation were 0.19 (−0.06, 0.43) and 0.22 (0.11, 0.35), respectively.” In relation to the moderated mediation model, the text “The relation between marital status and sense of belonging was significant for men as its bootstrapped 95% CI did not include zero (0.20, −0.67). In contrast, this relation was not significant for women as its bootstrapped 95% CI included zero (−0.03, −0.25)” should read: “The relation between marital status and sense of belonging was significant for men as its bootstrapped 95% CI did not include zero (0.20, 0.67). In contrast, this relation was not significant for women as its bootstrapped 95% CI included zero (−0.03, 0.25).”

The prevalence of major depression ranges from 1% to 16% among elderly living in private households or in institutions, and in similar settings “patients” with clinically relevant depressive symptoms vary between 7.2% and 49% (Djernes, 2006). Community studies looking at point prevalence of depression in older people suggest rates between 10% and 20% depending on cultural situations (Rodda et al., 2011).

One of the pleasures of aging is observing the young: the intelligence, activity, curiosity, and imagination. When the young follow in one's footsteps, that is even better. It makes what we do seem important! This applies to our junior colleagues as well as to one's children.

Neuropsychological assessment involves the observation and measurement of an individual's behavior in relation to a given stimulus that has been selected for its likelihood to provoke an abnormal response in the presence of neurological damage. This approach incorporates a medical and psychological approach to diagnosis in that both pathology-specific signs and deviations from normal distributions are examined. In the case of Alzheimer's disease (AD), this methodology has assumed considerable importance. This is because behavioral indicators remain the principal basis for provisional diagnosis when there are no biological markers. Observations of elderly persons with and without senile dementia have led to the development of stimuli, or tests, that are able to assess the functioning of specific cognitive processes affected in AD as opposed to more common age-associated changes. Many of these tests have been found to be culturally portable. Diagnostic difficulties arise principally from the fact that many neuropsychological tests cannot be used in isolation, from uncertainty as to the limits of “normal” functioning and from the psychometric problems related to pathological thresholds and item-weighting. The usefulness of neuropsychological testing in the future could undoubtedly be enhanced by the use of measures derived from indices of decline in functioning rather than normative data and the development of functional testing in collaboration with cerebral imaging.

Older adult psychiatric inpatients may have impaired balance and have an increased risk of falling for many reasons (Pellfolk et al., 2009; Ko et al., 2009). This population may be on psychotropic medication, which is in itself an independent risk factor for falls (Stubbs et al., 2009). This is a group that may also be at elevated risk of osteoporosis and osteopenia; should they fall, they are more susceptible to osteoporotic fractures which are associated with high morbidity and mortality (Stubbs et al., 2009). To counteract this risk, older adult psychiatric services should seek to adopt the strategies identified as being “gold standard” in general older adult rehabilitation settings, such as a multifactorial falls intervention program (Gillespie et al., 2009). This would typically include a review of medication; environmental falls risk assessments, the provision of walking aids and strength and balance training (Gillespie et al., 2009).

In recognition of the challenges faced by older persons deprived of their liberty, a call was made for input into the 2022 report to the United Nations Human Rights Council (HRC) on older persons. This Position Statement outlines the views of two global organizations, the International Psychogeriatric Association (IPA) and the World Psychiatric Association Section of Old Age Psychiatry (WPA-SOAP), working together to provide rights and dignity-based mental health services to older persons and it was sent to the Independent Expert on the enjoyment of all human rights by older persons at HRC.