Clinical Gerontologist最新文献

Objectives: Patients often struggle with psychological and social stressors that accompany life-limiting chronic illness. Because psychosocial concerns may be conveyed through emotional sentiments, this study aimed to identify emotional expressions to describe psychosocial contexts communicated during goals of care conversations.

Methods: This qualitative study evaluated 26 transcripts of goals of care conversations using a "goals of communication guide" from the ADvancing system Alleviation with Palliative Treatment (ADAPT) trial in VA Eastern Colorado and Puget Sound Health Systems. Using an inductive and deductive approach, a codebook was developed to examine participants' expressed emotions regarding overall goals of care, illness, end of life, and family involvement. Major themes around psychosocial concerns were summarized.

Results: Four themes on psychosocial contexts in goals of care conversations emerged, with instances of both positive and negative affect. Participants commonly discussed contexts relating to: acceptance of illness, the feeling of being a burden; illness transitions; and suffering from disease.

Conclusions: Unprompted within these conversations, patient emotional sentiments in goals of care conversations highlight psychosocial contexts important to patient values and preferences around treatment decisions.

Clinical implications: Emphasis on clinician recognition of these psychosocial contexts may help clinicians better support and elicit patient goals and preferences.

Objectives: Many older Colombians have been exposed to violence. This study sought to explore stakeholders' perceptions of older adults' mental well-being needs and mental well-being service provision within a Colombian displaced community.

Methods: Employing an exploratory qualitative design, semi-structured and in-depth interviews were conducted with stakeholders of health, public health and welfare services between October 2021-June 2022. Two public advisors were involved in devising the topic guide, which elicited information on older adults' mental well-being needs and service provision. Interviews were conducted in Spanish, transcribed verbatim and translated into English. Data were analyzed by an inductive thematic analysis.

Results: Thirteen stakeholders were interviewed. Three themes were generated: 'older adults' unmet well-being needs;' characterizing the provision of mental well-being services; and barriers and facilitators to increasing the provision of mental well-being services. Older adults experienced considerable mental well-being needs. While stakeholders' motivation to address unmet needs appeared high, service provision seemed limited and fragmented, hamstrung by insufficient resources.

Conclusions: Older adults in this community are underserved. Greater priority and resources, need to be allocated to mental well-being services.

Clinical implications: Greater and widely accessible resources, human and financial, are required to further expand the current provision of mental well-being services.

Objectives: The purpose of this pilot study was to evaluate the implementation feasibility and to establish preliminary efficacy of LDCare - a remotely delivered, manualized, multi-component intervention developed to support long-distance family caregivers (LDCs) of older adults with dementia.

Methods: The study design was a one-arm pre-post-intervention trial involving 40 LDCs - those living at least two hours away from their care recipient - who experienced significant caregiver burden. Feasibility was evaluated in terms of three indicators: recruitment capability, intervention acceptability and suitability. Preliminary efficacy of LDCare for reducing burden, strains, and depression from pre- to immediate post intervention was determined. Feasibility indicators were tracked over time, and participants completed pre-intervention and immediate post-intervention assessments.

Results: LDCs were recruited within the planned timeframe. The acceptability of LDCare was excellent, as demonstrated by high study retention (90%) and overall intervention adherence (95%) rates. The suitability of LDCare for addressing LDCs' needs was rated high. Wilcoxon Signed-Rank tests revealed statistically significant decreases in caregiver burden, strains, and depression from pre- to immediate post-intervention.

Conclusions: LDCare demonstrated high feasibility and preliminary efficacy among burdened LDCs.

Clinical implications: LDCare has potential for scalability and eventual integration within service offerings of caregiver support organizations.

Objectives: This cross-sectional study examined the relationships among caregiver burden, anxiety, and key psychological flexibility processes - cognitive fusion, experiential avoidance, and values-driven actions - in family caregivers of individuals with dementia.

Methods: Data were collected from 191 caregivers in the United States. Structural equation modeling was used to assess direct and indirect relationships among caregiver burden, anxiety, and key psychological flexibility processes.

Results: The model showed excellent fit. Caregiver burden had a significant direct effect on anxiety (59.1% of the total effect), while indirect effects accounted for 40.9%. Cognitive fusion was the only significant mediator between caregiver burden and anxiety, accounting for 20.8% of the total effect. Additionally, experiential avoidance - both alone and when preceded by cognitive fusion - significantly mediated the relationship between caregiver burden and reduced engagement in values-driven actions.

Conclusions: These findings highlight cognitive fusion as a key mechanism linking caregiver burden to anxiety. Furthermore, both cognitive fusion followed by experiential avoidance and experiential avoidance alone appear to influence the relationship between caregiver burden and values-driven actions.

Clinical implications: Clinicians may consider implementing skills training targeting cognitive fusion and experiential avoidance to mitigate the negative impact of caregiver burden on anxiety and values-driven actions.

Objectives: To determine whether culturally adapted dementia prevention animations increased dementia prevention knowledge in ethnically diverse communities.

Methods: A before-and after survey conducted online and in-person between 1 February and 5 June 2022. Participants viewed the animation in Arabic, Hindi, Tamil, Cantonese, Mandarin, Greek, Italian, Spanish, Vietnamese or English. Dementia knowledge was measured using two subscales from the dementia risk reduction knowledge instrument (KoDeRR), measuring knowledge of dementia risk factor mitigation strategies and appraisal of dementia risk factors (misconceptions).

Results: Among the 318 respondents there was a significant increase in dementia knowledge in most languages after viewing the animation (ps < 05; except for English). Mean performance on knowledge of dementia risk factor mitigation strategies significantly increased after viewing the animation (p < .001), with a clinically meaningful effect (mean change = 3.63). Appraisal of dementia risk factor misconceptions significantly increased in the Spanish group (mean change = 1.29, p < .001), but significantly decreased in the English group (mean change = -1.09, p < .001).

Conclusions: Viewing the animation in a language other than English was associated with an increase in KoDeRR scores for both the recognition of mitigation strategies and identification of misconceptions subscales.

Clinical implications: Codesigned, culturally adapted in-language dementia prevention animations improve dementia prevention awareness in ethnically diverse communities.

Objectives: Based on previous empirical research on financial stressors and resources and using a prevention science framework, this pilot study examined the effect and acceptability of a three-session older adult financial exploitation prevention intervention.

Methods: Forty-five older adults participated in the study. Each participant completed three 30- to 45-minute sessions. The sessions included financial exploitation vulnerability, financial literacy, techniques used by scammers, choosing a trusted advocate, and creating a financial inventory. At the end of each session, participants were asked how relevant and trustworthy the information presented was. Primary outcome measures were financial vulnerability and financial literacy. Secondary outcomes were other mental health and stress factors, as well as how many participants reported choosing a trusted advocate and creating a financial inventory.

Results: Financial literacy and financial vulnerability scores after the prevention intervention differed significantly from baseline scores. Participants' ratings after each session, with respect to usefulness and trustworthiness, were extremely positive.

Conclusions: The financial exploitation prevention intervention program demonstrated acceptability and a positive effect on reducing vulnerability to financial exploitation.

Clinical implications: Proper assessment of an older client's financial history and of plans to safeguard their financial future is integral to the overall well-being and health of older clients.

Objectives: This study aimed to identify psychological factors and characteristics associated with fear of falling (FOF) and fear of falling avoidance behavior (FFAB) among older adults.

Methods: This cross-sectional study used data from the National Health and Aging Trends Study (Wave 9, n = 4,977).

Results: We found that increased fall history, more frequent depression and anxiety, and poorer perceived overall health were significantly higher among older adults with FFAB compared to FOF (ps < .001). Perceived overall health, depression, and anxiety explained a significant amount of variance in FOF and FFAB. Lastly, demographic characteristics differ between older adults reporting no FOF/FFAB, FOF, and FFAB.

Conclusions: FOF and FFAB are prevalent among older adults. Older adults experiencing FFAB had poorer health perceptions, more falls, and more frequent depression and anxiety than those experiencing FOF. The association of psychological factors and demographic characteristics with FOF and FFAB may indicate potential treatment targets. Clinical Implications: Addressing psychological variables, such as health perception, anxiety, and depression among older adults, may mitigate the impact of FOF and the development of FFAB; however, further research is needed.

Objectives: Arthritis is associated with poor quality of life (QOL) among older adults; and QOL is even worse among those with arthritis and multimorbidity (MM). Illness intrusiveness and perceived control have been identified in studies of single illnesses as modifiable mechanisms for QOL, but are understudied in older adults with arthritis and MM. We investigated the role of these potential mechanisms with QOL among older adults with arthritis and MM.

Methods: Secondary analysis of a sample of older adults aged ≥ 62 years with arthritis and MM (N = 228) using PROCESS macro for SPSS.

Results: Participants were on average 72 years with 4 chronic illnesses, and high levels of pain intensity and illness intrusiveness. Perceived control was a significant mediator (but not moderator) in the relationship between illness intrusiveness and QOL, even after adjustment for pain intensity [β = -0.16, 95% CI (-0.13, -0.06)].

Conclusions: Lower levels of illness intrusiveness were associated with improved QOL through greater perceived control. Longitudinal studies are needed to further assess these mechanisms in older adults with arthritis and MM to adapt existing interventions.

Clinical implications: Perceived control may be a target for future behavioral interventions to improve QOL in this population.

Objectives: This qualitative study explored the potential of piano training as a holistic intervention to enhance both cognitive and emotional well-being. The study aims to detail the experiences of older adults living with mild cognitive impairment (MCI) in a piano training program and recommend strategies to boost engagement.

Methods: Fourteen individuals (seven older adults with MCI and their family members) participated in individual semi-structured interviews before and after a 12-week group-based piano training program. These interviews were recorded, transcribed, open-coded, and analyzed by conventional content analysis.

Results: Participants with MCI reported improvements in mood, cognitive function, and social interaction. The learning process elicited mixed emotions, with both enjoyment and frustration occurring during the learning phases. Skill mastery and positive social interactions were crucial for sustained engagement throughout the program, although group settings sometimes led to negative self-comparisons.

Conclusions: Findings highlighted the need to address both cognitive and emotional needs in interventions for MCI. Neglecting these aspects can exacerbate feelings of low self-esteem and other negative emotions.

Clinical implications: Recommendations for cognitive training programs include positive reinforcement, personalized support, mental preparation for challenges, and rapport building to enhance participant motivation and adherence.

Objectives: The goals of this narrative review are to review the literature on psychotherapeutic interventions for older adults with histories of child maltreatment (CM) and to examine the unique considerations for assessing, diagnosing, and treating older adults with CM histories.

Methods: Online database searches were conducted to identify the extant research into the efficacy of psychotherapeutic interventions for older adults with CM-related trauma.

Results: Eight studies met inclusion criteria. The primary target diagnoses were post-traumatic stress disorder and depression. Psychotherapeutic interventions included Narrative Exposure Therapy, exposure-based treatments, Life Review Therapy, integrated treatments, and a spiritually-focused group therapy.

Conclusions: While limited in number and generalizability due to study design and sample size and characteristics, the studies provide preliminary evidence of potentially effective psychotherapeutic treatments for older adults with CM histories. Further research is needed to determine the most effective psychotherapeutic interventions for this population.

Clinical implications: Many older adults suffer for decades with the repercussions of CM. Due to knowledge gaps regarding best practices for treating older adults with CM histories, many clinicians are poorly equipped to treat this population. Therefore, awareness of CM-related pathology and familiarity with effective psychotherapeutic interventions are essential for clinicians to meet the needs of this population.