Clinical Gerontologist最新文献

Objectives: To evaluate the effectiveness of cognitive interventions in enhancing the cognitive function of community-dwelling older adults living alone.

Methods: Five databases were systematically searched for articles published until December 2024. The search identified three randomized controlled trials (RCTs) and four non-RCTs, including case - control studies and quasi-experimental studies, with sample sizes ranging from 20 to 78. After risk of bias was assessed, data were synthesized using a random-effects model.

Results: Interventions such as robotic assistance, reminiscence therapy, animal-assisted therapy, creative therapies, and multicomponent programs significantly improved cognitive function (mean difference [MD] = 2.85 in MMSE), reduced depression (standardized MD =  -0.85), and mitigated loneliness (MD =  -10.13 in UCLA-LS). High heterogeneity was observed, attributable to diverse protocols, participant characteristics, and study designs. Attrition and confounding biases were also identified.

Conclusions: Cognitive interventions can improve cognitive and psychosocial outcomes in community-dwelling older adults living alone. However, further research is required to confirm these findings.

Clinical implications: Socially interactive cognitive interventions are a promising strategy for improving the cognitive and mental health of community-dwelling older adults living alone. Clinicians should implement these accessible interventions to improve the population's quality of life and support their independent living.

Objectives: While data suggest that Filipino Americans face a higher incidence of dementia compared to other Asian subgroups, Filipino American family caregivers are understudied. Thus, the objectives of this scoping review are (a) to characterize the scope of the literature related to Filipino American family caregivers of older adults living with dementia and (b) to identify gaps and discuss implications for future studies.

Methods: We conducted a scoping review in CINAHL, Embase, PsycINFO, PubMed, and Scopus. Qualitative content analysis was conducted to identify themes.

Results: Twenty-two publications were included. Few examined Filipino Americans as the sole focus; most included them among Asian Americans more broadly. Key findings indicate language and cultural family expectations around caregiving affect recognition of dementia, decisions to seek care, and caregiver responsibilities. Four interventions were identified. Burden, stress, depression, and service utilization were commonly explored caregiver outcomes.

Conclusions: Future research can (a) recruit more diverse samples from within the Filipino American population, (b) examine social determinants of health, (c) incorporate historical knowledge of Asian Americans, and (d) measure caregiver-specific outcomes.

Clinical implications: Clinicians can recognize population-specific caregiving needs to help family members recognize dementia symptoms, reduce stigma around dementia, and promote access to caregiver support services.

Objectives: Loneliness and depression are prevalent, mutually reinforcing mental health concerns in older adults. Identifying psychological resources, such as aging attitudes, that may moderate loneliness--depression relationships is crucial. This study investigated this relationship in older adults and the moderating effects of aging attitudes.

Methods: This one-year, three-wave longitudinal study of 437 older adults was analyzed using a Bayesian random intercept cross-lagged panel model to examine the relationships between loneliness and depression, with aging attitude as a stable moderator.

Results: Random intercept cross-lagged analysis revealed that, at the between-person level, positive aging attitudes were associated with lower trait-level loneliness and depression. At the within-person level, depression exhibited a significant negative auto-regression effect, whereas loneliness did not. Cross-lagged analyses indicated that increases in depression significantly predicted decreases in subsequent loneliness. Conclusions: Aging attitudes played a complex moderating role. Instead of buffering the consequences of depression, positive attitudes toward aging strengthened the link between within-person fluctuations in depression and subsequent loneliness, a relationship that was absent among individuals with negative attitudes.

Clinical implications: Clinicians should assess aging attitudes to tailor interventions, treating loneliness and depression as coupled symptoms in those with positive views, while using targeted strategies for those with negative attitudes.

Objectives: This study examined the association between childhood adversity and cognitive aging trajectories among Chinese older adults, exploring the mediating role of depressive symptoms.

Methods: Using five waves of the China Health and Retirement Longitudinal Study (CHARLS 2011-2020), we applied the group-based trajectory model, multinomial logistic regression and mediation analysis.

Results: Cognitive aging trajectories in older Chinese adults were classified into three patterns: high baseline with slow decline (HBSD), medium baseline with moderate decline (MBMD), and low baseline with rapid decline (LBRD). Childhood adversity increased the likelihood of being in the LBRD (OR: 1.21, 95% CI: 1.15-1.27) and MBMD (OR: 1.11, 95% CI: 1.06-1.15) compared with HBSD, and in the LBRD relative to MBMD (OR: 1.09, 95% CI: 1.05-1.15). Depressive symptoms significantly mediated the associations between childhood adversity and cognitive aging trajectories.

Conclusions: Childhood adversity has a direct effect and an indirect effect on cognitive aging trajectories through the depressive symptoms. Addressing depressive symptoms may help mitigate the long-term negative impact of early-life adversity on cognitive aging in older adults.

Clinical implications: Targeting depressive symptoms may be a key intervention point for promoting healthy cognitive aging in older adults who experienced childhood adversity.

Objectives: Investigate the effectiveness of an Acceptance and Commitment Therapy (ACT) group intervention on anxiety symptoms in Brazilian family caregivers of people with dementia (PWD).

Methods: Single-center, unblinded, double-arm, pilot randomized controlled trial. Fifty-seven family caregivers of PWD with mild to severe anxiety symptoms were randomized to intervention group (n = 29) or waiting list group (n = 28). The intervention group received eight videoconference sessions of group ACT. Participants completed measures of anxiety and depressive symptoms, caregiver burden, psychological flexibility and quality of life (QOL) at Weeks 0, 9 and 20.

Results: Participants in the intervention group had lower scores of anxiety compared to control at weeks 9 and 20, when assessed using the GAD-7. No between-group effects were observed for depressive symptoms, caregiver burden (ZBI-12), QOL, or psychological flexibility. In the completer analysis only, a significant reduction in anxiety symptoms measured by HADS-A was observed at Week 20.

Conclusions: This pilot study provides initial evidence that group ACT may reduce anxiety symptoms in family caregivers of PWD. Larger, fully powered trials are needed to confirm these findings and to clarify effects on other caregiver outcomes.

Clinical implications: Videoconference Group ACT, shows potential as a scalable intervention to reduce family caregivers' anxiety.This study was registered in the Brazilian Clinical Trial Registry (Registro Brasileiro de Ensaios Clínicos - REBEC; Identifier: RBR-10m9tg2r).

Objectives: Art therapies are emerging non-pharmacological complementary treatments for Parkinson's disease (PD). This systematic review and meta-analysis aimed to evaluate their effects on non-motor symptoms, motor symptoms, quality of life (QoL), and activities of daily living (ADLs) in adults aged 50 years and older with PD.

Methods: PubMed, Scopus, Cochrane, and Web of Science databases were searched from 2014 to 2025. Of 40 initially identified studies, 33 met inclusion criteria and were included in the review; 24 were incorporated in the meta-analysis using a robust variance estimator to address repeated measurements.

Results: Art therapy was associated with significant improvements in both executive functions [RVE (Mean) = 0.971, 95% CI (0.951, 0.991), Z = 50.323, p < .001] and attention [RVE (Mean) = 0.854, 95% CI (0.834, 0.874), Z = 10.892, p < .001]compared with controls in the follow-up [RVE Mean) = 0.971 95%CI(0.951, 0.991), Z = 50.323, p < .001]. In single-group studies, depressive symptoms decreased post-intervention [RVE (Mean) = 6.289, 95% CI (1.101, 11.477), Z = 10.878, p = .049] but increased again at follow-up [RVE (Mean) = 12.094, 95% CI (0.318, 23.871), Z = 10.878, p = .049] Conversely, outcomes such as freezing of gait, QoL, and PD progression at follow-up favored the control groups rather than the treatment groups.

Conclusions: Evidence suggests that Art therapy may enhance executive functioning - especially at follow-up - and attention in older adults with PD. However, current evidence does not demonstrate consistent benefits in other non-motor or motor outcomes and ADLs. Brief, structured interventions (e.g. 20 sessions of 60 min, twice weekly) administered by dance instructors appear most promising. The improvements observed in control groups further underscore the potential value of active, structured interventions such as exercise or rehabilitation.

Clinical implications: Art therapy may serve as a valuable non-pharmacological intervention to support executive functioning and attention in older adults with PD, with improvements observed at follow-up. Single-group studies suggest potential short-term benefits for depressive symptoms, although these effects may not be sustained over time. Structured interventions in high-quality controlled trials, personalized to patient profiles and preferably delivered by specialized professionals, may optimize outcomes. Further research based on high-quality, adequately powered clinical trials is needed to identify the most effective approaches and to determine whether benefits extend beyond cognitive outcomes. Direct comparisons of different art-based modalities may help identify the most effective approaches for improving patient outcomes.

Objectives: This study examined the association between self-critical rumination and attitudes toward aging in older adults.

Methods: A cross-sectional descriptive design was employed between December 2024 and September 2025 with 391 older adults in Türkiye. Data were collected using the Self-Critical Rumination Scale (SCRS) and the European Attitudes to Aging Questionnaire (EAAQ). Analyses included descriptive statistics, Pearson correlation, and linear regression.

Results: A moderately strong negative correlation was found between SCRS and EAAQ total scores (r = -.518, p < .001). Higher SCRS scores were positively correlated with the EAAQ psychosocial loss subscale (r = .507, p < .001) and negatively correlated with physical change and psychological growth subscales (p < .001). Self-critical rumination accounted for 26.9% of the variance in attitudes toward aging (B = -.896, R2 = .269, p < .001). Participants with higher income, better perceived health, no sleep problems, and regular eating habits reported lower rumination and more positive attitudes.

Conclusions: Elevated self-critical rumination was associated with more negative attitudes toward aging, particularly regarding psychosocial loss. Health-related factors significantly influenced both rumination and attitudes toward aging.

Clinical implications: Targeted cognitive-behavioral interventions and health-promoting strategies, implemented by psychiatric nurses, may support positive aging attitudes and psychological well-being in older adults.

Objective: This study examined sleep-parameter differences across frailty levels in older adults.

Methods: Community-dwelling adults aged ≥65 years were classified as frail, pre-frail, or robust based on five frailty phenotypes. Sleep was assessed using a wrist-worn wearable device, which measured total time in bed (TIB), total sleep time (TST), light sleep, deep sleep, rapid eye movement sleep, wake after sleep onset, restless time, and sleep efficiency.

Results: A total of 70 participants were included in the analysis: 37 robust, 23 pre-frail, and 10 frail older adults. Significant between-group differences were observed in TIB, TST, light sleep, deep sleep, and restless time. Frail adults demonstrated significantly longer TIB and TST compared with both robust and pre-frail adults, spent a greater proportion of time in light sleep, and showed longer restless time relative to the robust group.

Conclusions: These findings suggest that wearable-based sleep monitoring may serve as a practical tool for identifying sleep-related characteristics of frailty in community settings.

Clinical implications: Wearable sleep data may help clinicians guide personalized, sleep-pattern - specific interventions, such as using sleep-control strategies for individuals with frailty. Incorporating objective sleep monitoring into routine geriatric care may enable more precise and individualized approaches to support healthy aging.

Objectives: This study examined whether the link between adverse childhood experiences (ACEs, including child maltreatment, financial hardship, and household dysfunction) and later-life loneliness was mediated by quality of social relationships.

Methods: Data came from the Health and Retirement Study (N = 11,700). Five path models were tested: four individual relationship types (spouse, children, relatives, and friends) and one combining all relationship types.

Results: In the spouse model, child maltreatment and financial hardship increased loneliness via lower support and higher strain; household dysfunction showed no significant indirect effect. In the children and other relatives models, child maltreatment and financial hardship again showed significant indirect effects via lower support and higher strain, whereas household dysfunction had a small indirect effect via higher strain only. In the friendship model, only child maltreatment had a significant indirect effect on loneliness. In the combined model, child maltreatment was consistently associated with lower support and higher strain across relationship types, except for strain with friends.

Conclusions: ACEs increased loneliness partly by reducing social support and increasing social strain, with patterns varying by ACE and relationship type.

Clinical implications: Loneliness interventions should address skills for rebuilding trust and supportive social ties.

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.