Clinical Gerontologist最新文献

Introduction: Medications are common means of suicide. Rural areas have high suicide rates, greater proportions of older adults and veterans, and few providers. We assessed the implementation potential of community pharmacy interventions for lethal means management (LMM).

Methods: The feasibility, acceptability, and appropriateness of 8 LMM interventions were assessed by pharmacists in seven southeastern states via an online survey. Descriptive statistics were calculated.

Results: Pharmacists (N = 61) responded from 42 zip codes. The majority indicated that five (62.5%) interventions were very/extremely feasible, appropriate and acceptable. The greatest proportion rated medication therapy management (MTM) as very or extremely feasible, appropriate and acceptable (82%) followed by limiting prescription drug days' supplies (75.4%), blister packaging (68.9%), dispensing naloxone (62.3%), and suicide prevention training (59.0%). No pharmacies were currently distributing gun locks; however, some were already managing suicide risk with limited days' supply (31.7%), MTM (26.7%), naloxone distribution with every opioid dispensed (15.0%), monitoring patients for suicidal adverse events (16.7%), limits on sales or stock of non-prescription products (16.7%) or blister packaging (1.7%).

Discussion: Pharmacists endorsed LMM interventions, and most were already offering the endorsed interventions but not for LMM.

Clinical implications: The rural community pharmacists in this study believed several LMM services were highly feasible, acceptable and appropriate for use in preventing suicide.

Objectives: Veterans experience high rates of fatal and non-fatal firearm injuries. This risk may be compounded among Veterans who are rural-residing, aging, and/or experiencing cognitive decline or dementia. Firearm safety discussions are not broadly implemented across Department of Veterans Affairs (VA) healthcare settings due, in part, to concerns of causing Veterans to disengage from care. This study examines perceptions about firearm safety discussions to inform healthcare-based harm-reduction efforts.

Methods: We conducted interviews with 34 Veterans (median age 70) and 22 clinicians from four VA facilities that treat high rates of rural patients with firearm-related injuries.

Results: Most Veterans accepted the idea of universal firearm safety discussions at the VA. Some reported they might not be forthright in such discussions, but raising the topic would not stop them from engaging with VA care. Veterans and clinicians unanimously endorsed firearm safety discussions for older patients experiencing cognitive decline or dementia.

Conclusions: VA patients and clinicians are amenable to firearm safety discussions during healthcare visits and especially endorse the need for such discussions among high-risk populations.

Clinical implications: Universal firearm safety discussions could be incorporated into standard VA practice, particularly for Veterans experiencing cognitive decline or dementia, without risking Veteran disengagement from care.

Objectives: Health-related factors, such as health status, health anxiety, and health literacy, are established contributors to self-efficacy. However, the relationship between electronic health literacy and self-efficacy is less known. The present study examined the role of electronic health literacy in relation to self-efficacy among community-dwelling older adults.

Methods: Cross-sectional survey data were collected in the United States between September 2022 and March 2023. The survey dataset consisted of 191 responses from individuals in the United States who were ages 65 or older. It provided information about survey respondents' sociodemographic status, perceived health status, health anxiety, electronic health literacy, and self-efficacy. Hierarchical linear regression was conducted to analyze the data.

Results: Electronic health literacy was positively related to self-efficacy, and health anxiety was negatively related to self-efficacy, with sociodemographic status and perceived health status controlled.

Conclusions: The results indicate that electronic health literacy can be a source of self-efficacy among community-dwelling older adults.

Clinical implications: Improving older adults' electronic health literacy may help them maintain self-efficacy, and the improvement should be made, especially in the domains of evaluating health information found on the internet and making decisions based on the information.

Objectives: Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia.

Methods: We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment.

Results: Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160).

Conclusions: Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness.

Clinical implications: ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.

Objectives: Past geriatric studies related to the mediating role of physical activity in depression are scarce. This is perhaps the first study to examine the mediating effects of physical activity on the associations between depression and age, and education among older adults.

Methods: Statistical analyses of cross-sectional data from a nationally representative survey on Malaysian older adult health were conducted. Structural equation modeling was used to assess the extent to which physical activity mediated the relationships between depression and age, and education. Associations between variables were explored using multivariable logistic regressions.

Results: Analyses were based on a sample of 3974 older adults (aged ≥60 years). Only 12.2% of older adults had depression. Age was positively associated with the odds of depression. Better educated older adults were less likely to experience depression than less educated older adults. Physical activity fully mediated the association between depression and age, whereas it partially explained the depression-education relationship.

Conclusions: Older age and low educational levels were risk factors for depression, and physical activity was identified as a mediator.

Clinical implications: Older and less-educated older adults should be encouraged to participate in physical activity, and those at risk of depression should be given special attention.

Objectives: Although the association between sleep disorders and frailty has been well established, little is known about the cognitive appraisal mechanisms underlying this association. Building on the transactional theory of stress and coping, this study explores the role of self-efficacy and coping style in the association between sleep quality and frailty among community-dwelling older adults.

Methods: In this cross-sectional study, 585 community-dwelling older adults were investigated using the Pittsburgh Sleep Quality Index, Tilburg Frailty Indicator, General Self-Efficacy Scale, and Simplified Coping Style Questionnaire. Descriptive statistics and hierarchical regression were performed. A moderated mediation model was established using the PROCESS macro.

Results: Poor sleep quality affects frailty directly (B = 0.193, p < .01) and indirectly via self-efficacy (B = 0.063, p < .01). The negative impact of poor sleep on frailty through self-efficacy was moderated by both positive and negative coping style (index =  -0.007). The moderating effect was stronger when participants' negative coping tendencies increased.

Conclusions: Poor sleep quality indirectly influences frailty by modifying self-efficacy. Effective coping strategies can help attenuate this association.

Clinical implications: Timely sleep assessment and tailored strategies such as psychoeducational programs and targeted coping skills training may be beneficial for preventing frailty in older adults.

Objectives: The proportion of individuals with insomnia is increasing, and many older adults have insomnia. This study aimed to explore the relationships between family functioning and quality of life (QOL) among community-dwelling older adults with insomnia, as well as to explore the mediating role of sleep quality in this relationship.

Methods: The participants were 225 older adults with insomnia from community health service centers in Chongqing, China. The Family Care Index (APGAR) was used to assess family functioning, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the 36-item Short-Form Health Survey (SF-36) was used to assess QOL.

Results: The results showed that family functioning would be positively associated with QOL (p = .005) and that this relationship would be partially mediated by higher sleep quality (p < .001).

Conclusions: Family functioning has a direct effect on QOL and an indirect effect on QOL through the regulation of sleep quality. Maintaining good family functioning is important for improving sleep quality and QOL in older adults with insomnia.

Clinical implications: Developing family functioning-based assessments and targeted intervention strategies could be beneficial for older adults with insomnia.

Objectives: Exposure to ageism may be internalized in older adults, and this can have severe consequences. However, little research has addressed reducing internalized ageism. Thus, Reimagine Aging, a 6-week process-based intervention to reduce internalized ageism, was designed and implemented, using education, acceptance and commitment therapy, and attributional retraining to target theoretically based mechanisms of change.

Methods: Seventy-two older adults (M = 70.4 years, SD = 6.4 years) participated in Reimagine Aging, consented to participate in this robust single-sample pilot study, and provided valid data. Participants completed questionnaires prior to, immediately following, and 2 months after the intervention.

Results: Participants' self-perceptions of aging (${\eta }_p^2$=0.37, p < .001) and perceptions of older adults (${\eta }_p^2$=0.27, p < .001) became significantly more positive, associated with large effect sizes. Furthermore, these positive gains were mediated by increases in psychological flexibility, mindfulness, and perceived control.

Discussion: This study provides initial support for this process-based intervention targeting a reduction of internalized ageism.

Clinical implications: This program has the potential to reduce the negative impact internalized ageism has on the health of older adults. Furthermore, it provides novel insights into intervention targets and tools that may be useful in achieving this reduction.

Background: For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce.

Methods: In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4).

Results: There was a significant decrease in depressive symptoms across both arms with Cohen's d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations.

Conclusions: Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs.

Clinical implications: Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations.

Trial registration: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).

Objectives: This pilot study assessed the feasibility of a group-based telephone-delivered meditation intervention to reduce social isolation in older adults. It included weekly training sessions and daily practices of loving-kindness meditation in small groups via telephone conferences for six weeks and an extended group meditation practice for another six weeks.

Methods: Community-living older adults (age 60+) with multiple chronic conditions and experiencing social isolation were recruited. Each participant was assessed at the pretest, posttest, and follow-up (6 and 12 weeks after pretest). Outcome measures included social interaction, loneliness, and depressive symptoms. Open-ended questions were asked in the posttest and follow-up.

Results: Sixteen individuals enrolled, and fourteen completed the program (87.5% retention). Completers showed high levels of adherence (95% attendance to training) and acceptability and a statistically significant increase in social interaction at follow-up. Qualitative data suggest that participants experienced changes in emotion regulation, motivation and confidence, and sense of belonging.

Conclusions: A group-based telephone-delivered meditation intervention targeting chronically ill older adults who experience social isolation is technically feasible, very acceptable, and potentially beneficial to them.

Clinical implications: Older adults enjoy learning meditation. Telephone conferencing is a low-cost tool for engaging socially isolated older adults in social interactions and group meditation.