Clinical Gerontologist最新文献

Objectives: This study examines not only the effects of functional limitations and chronic pain on depressive symptoms in older South Korean women, but also the moderating effect of living arrangements on these relationships.

Methods: This study employed a Correlated Random Effects model using panel data from Wave 5 to Wave 8 of the Korean Longitudinal Study of Ageing. The final sample included 2,443 individuals and 8,360 observations.

Results: The more severe the degree of functional limitations and chronic pain, the higher the level of depressive symptoms in older Korean women. Furthermore, the results of the Correlated Random Effects model showed that the associations between functional limitations and depressive symptoms were more positive among women living alone.

Conclusions: Given the variation in depressive symptoms by living arrangement among older women with functional limitations, the findings underscore the potential importance of living arrangements in the quality of life of older adults in South Korea.

Clinical implications: With an increase in the older population, the number of older women living alone is also growing. To enhance the quality of life in old age, interventions related to geriatric primary care or home care would be needed for older women living alone.

Objectives: Dementia caregiving often results in caregiver burden, but self-mastery may buffer against burden's negative impact. This work explores the link between these variables, examining potential moderators, through systematic review and meta-analysis.

Methods: A PubMed, PsychInfo, Scopus, and Medline search in April 2024 resulted in 25 eligible studies. The Appraisal tool for Cross-Sectional Studies assessed bias risk. Meta-regression via continuous random effects model was conducted in R to examine the relationship between dementia caregiver burden and self-mastery as well as moderating variables.

Results: A medium strength meta-correlation, r=-.347 (95% CI: -.413, -.278, p < .0001) was detected. Percent of extended family caregivers (e.g. nieces, cousins, grandchildren; β=-1.01, 95% C.I. (-1.71, -.32), p < .01) and percent of cases with frontotemporal dementia (β=-.67, 95% C.I. (-1.20, -.13), p < .05) attenuated the relationship.

Conclusions: Results may support the role of self-mastery in mitigating effects of caregiver burden, though experiences unique to extended family or frontotemporal dementia may weaken that relationship. The current review was limited by lack of diversity in potential moderator variables, pointing to needs for future research.

Clinical implications: Findings highlight the robustness of the relationship between self-mastery and caregiver burden, possibly informing self-mastery-based interventions and helping clinicians identify and treat at-risk caregivers.

Objectives: Gerotranscendence has gained recognition as an important psychosocial theory, with leading studies promoting it through intervention programs. However, to date, few interventions have involved older adults living in Long-Term Care (LTC) facilities. This study aimed to explore the viability of implementing six-week program on gerotranscendence [GLOW] in an LTC facility.

Methods: A feasibility study was conducted with a group of six residents. Screening, consent, retention, adherence, and social validity indicators were considered. A Non-Pharmacological Therapy Experience Scale (NPT-ES) was used to assess the participation and engagement of each participant throughout the sessions. A focus group was also conducted.

Results: The consent, retention, and adherence rates for the program were satisfactory (100%), while the screening rate (22.22%) was lower due to the inclusion criteria. Participants agreed that the program was important and interesting. The scores of NPT-ES were high and increased over the course of the sessions.

Conclusions: The GLOW program can be considered a feasible, acceptable, and valuable tool for promoting gerotranscendence in older adults living in an LTC.

Clinical implications: Promoting an intervention rooted in gerotranscendence can be beneficial for older adults who live in LTC facilities on educational and emotional levels.

Objectives: The aim of this study is to assess the effect of virtual reality (VR) sessions on the mental health of older adults.

Methods: This interventional multicentric study included 68 participants in residential aged care facilities in Auvergne-Rhône-Alpes and Nouvelle-Aquitaine (France). The intervention consisted of eight VR sessions that incorporated a personalized 360° video followed by social interaction. Changes in anxiety, depression, quality of life, emotional state, identification with care community, and loneliness were assessed in pre- and post-intervention. Experience with VR, such as sense of presence and cybersickness, were assessed after the first session.

Results: There was a significantly reduced depression score (pre Mean (M) = 5.2 ± 3.5; post M = 4.5 ± 3.3; p = .02) and a significantly increased quality of life score (pre M = 29.1 ± 5.3; post M = 29.8 ± 4.2; p = .03), but no reduction in the anxiety score. Average cybersickness was minimal (8.4 ± 11.2). Finally, the average sense of presence felt was high (5.6 ± 1.2).

Conclusions: This study shows the potential of VR sessions to enhance the mental health of institutionalized older adults. To substantiate these preliminary findings, a rigorously designed Randomized Controlled Trial may be essential.

Clinical implications: This intervention can be applied to institutionalized older adults to promote their mental health.

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.