Clinical Gerontologist最新文献

Objectives: The purpose of this study was to explore the mediating roles of care receiver clinical factors on the relationship between care partner preparedness and care partner desire to seek long-term care admission for persons living with dementia at hospital discharge.

Methods: This study analyzed data from the Family centered Function-focused Care (Fam-FFC), which included 424 care receiver and care partner dyads. A multiple mediation model examined the indirect effects of care partner preparedness on the desire to seek long-term care through care receiver clinical factors (behavioral and psychological symptoms of dementia [BPSD], comorbidities, delirium severity, physical function, and cognition).

Results: Delirium severity and physical function partially mediated the relationship between care partner preparedness and care partner desire to seek long-term care admission (B = -.011; 95% CI = -.019, -.003, and B = -.013; 95% CI = -.027, -.001, respectively).

Conclusions: Interventions should enhance care partner preparedness and address delirium severity and physical function in hospitalized persons with dementia to prevent unwanted nursing home placement at hospital discharge.

Clinical implications: Integrating care partner preparedness and care receiver clinical factors (delirium severity and physical function) into discharge planning may minimize care partner desire to seek long-term care.

Objectives: This study aimed to assess the knowledge, attitude, and practice of the healthcare professionals and paid caregivers toward non-pharmacological interventions (NPIs) for managing behavioural and psychological symptoms of dementia (BPSD) in Australian residential aged care homes (RACHs).

Methods: A cross-sectional, online survey was completed by RACH staff and physicians over the period 6 March-31 August 2023. Descriptive statistics were used to present the results.

Results: Ninety-six respondents participated (41.7% aged 35-54 years, 80.2% female, 38.5% nurses). While 50-65% of the respondents were extremely familiar with 15 of NPIs, only 22% believed there was a sufficient funding for their implementation, and 6% felt there were sufficient human resources. Although 66% of the respondents viewed NPIs as more useful than medications, only 46% expected consistent positive outcomes from NPIs. The most used NPIs were redirection, behaviour management, and validation therapy.

Conclusions: The study highlights that barrier such as inadequate funding, limited human resources, skepticism about NPIs' effectiveness, unfamiliarity with certain NPIs, and unfavourable attitude toward NPIs are likely to slow NPI adoption for BPSD management.

Clinical implication: To improve practice, it is essential to address these barriers through targeted education, and training, increased funding, and enhancement of the workforce.

Objectives: This study sought to design, implement, and evaluate a 6-week skills-based telehealth group for dementia caregivers within a VA setting.

Methods: The protocol was designed based on a CBT skill-building approach and was evaluated using the four levels of evaluation developed by Kirkpatrick (1998). Eight spousal caregivers of individuals with MCI or dementia participated in the pilot group within a VA geriatric clinic. Methods included comparison of pre- and post-intervention outcome measures (caregiver burden, depression, anxiety, flourishing) and inductive narrative analysis of qualitative feedback from participants.

Results: Qualitatively, the intervention was well received and participants identified several areas of subjective learning and skill implementation including increased behavioral and communication skills, knowledge, and connection with resources. However, paired-sample t-tests of group outcomes revealed no significant differences on measures of caregiver burden, depression, anxiety, and flourishing pre- and post-intervention.

Conclusions: Based on Kirkpatrick's levels of evaluation, this study revealed positive reception of a group-based intervention for dementia caregivers within a VA setting, but further investigation of intervention effectiveness is needed given the lack of significant change found on outcome measures. A virtual skills-based group may be a feasible option for dementia caregiver intervention within VA settings that warrants further investigation.

Objectives: This cross-sectional study aims to investigate the relationship between cognitive reserve (a well-known protective factor in aging) and attachment style in a sample of healthy older individuals.

Methods: The study assessed the cognitive reserve and attachment styles of 160 older adults (all involved in a romantic relationship at time of data collection).

Results: Findings highlighted high avoidance-based styles in aging individuals. Data also highlighted how individuals with avoidant attachment are more likely to have a higher cognitive reserve.

Conclusions: Based on the results, cognitive reserve training might be useful to reduce anxiety in individuals with anxious attachment styles, who appeared to be the least engaged in activities that could benefit their cognitive reserve.

Clinical implications: Therapists should identify and address avoidant attachment styles in older clients, use strategies to increase cognitive reserve for those with avoidant attachment, and incorporate cognitive reserve-building activities into anxiety reduction programs for clients with anxious attachment styles.

Objectives: Remotely delivered attentional bias modification (ABM) studies involving persons with cognitive impairment are lacking. Thus, the feasibility of an adapted ABM paradigm with webcam-based eye tracking was explored.

Methods: Four of the eight participants recruited (males, M_age = 69 years, Alzheimer's disease = 3, mild cognitive impairment = 1) completed up to four daily ABM sessions. Tasks comprised pre- and post-intervention depression (PHQ-9), anxiety (GAD-7), and rumination (RRS) measures, a cognitive screen (TICS) (A), affect (PANAS) (B) and dot-probe AB measures (C), and dot-probe ABM (D) (Session 1-A, B, C, D, C, and B; Sessions 2 to 4-B, D, C, and B).

Results: The intervention was feasible (as defined by completion rates) and appeared beneficial in this small sample (as defined by post-intervention improvements in mood). Sessions were long, and task completion/adherence was impacted by task access/participants' ability to complete tasks independently. Mind wandering, stimuli familiarity, and eye/fatigue were reported.

Conclusions: The intervention requires further adaptation (e.g. fewer eye-tracking tasks per session). Limitations include participant self-selection/loss, a lack of control group, and that the determinants of mood change are unclear.

Clinical implications: ABM, a novel intervention, may be an effective mood-disorder treatment for individuals with cognitive impairment.

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: An aggregated interventional N-of-1 or single-case design was used to assess the impact of a befriending intervention on a) health-related quality of life (HR-QoL), and b) the association between loneliness on HR-QoL among older adults.

Methods: Participants were n = 33 new users of the service, aged 60 + . Outcomes were measured at 13 timepoints across 26 weeks, and data were analyzed using generalized additive modeling (GAM) with a subset of data analyzed using supplementary visual analysis.

Results: Results indicate that the befriending service may reduce decline of HR-QoL (i.e. HR-QoL declined in the baseline phase over time: edf = 3.893, F = 3.0, p = .002, while in the treatment phase, HR-QoL remained more stable: edf = 5.98, F = 2.98, p = .008). The intervention also suppressed the impact of loneliness on HR-QoL.

Conclusions: Befriending interventions may prevent declines in HR-QoL, and may moderate the impact of loneliness on HR-QoL.

Clinical implications: Our preliminary findings suggest that befriending services may be useful if clinicians have concerns about the health impacts of loneliness for older people. It is difficult to evaluate community-based services, and we consider the challenges we faced, with a view to assisting others planning similar evaluations.

Objectives: This study investigates racial/ethnic disparities in dementia risk and protective factors using data from the Health and Retirement Study (HRS) and the Harmonized Cognitive Assessment Protocol (HCAP).

Methods: A retrospective analysis of 3,495 individuals aged 65+ from the 2016 HCAP linked to the HRS was conducted. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) scores. Risk factors included midlife cardiovascular conditions, hearing loss, current smoking, depression, and physical inactivity. Protective factors were education and wealth. The Oaxaca-Blinder decomposition method was used to quantify the contribution of these factors in explaining racial/ethnic disparities in cognitive functioning.

Results: Black participants had 2.883 times higher odds of developing dementia compared to Whites, while Hispanic participants had 1.230 times higher odds (not statistically significant). Mid- and late-life risk and protective factors explained 32% of the cognitive gap between Black and White participants, and 70% between Hispanic and White participants, leaving 68% and 30% unexplained, respectively.

Conclusions: Addressing disparities in education, wealth, cardiovascular risks, depression, and hearing loss can reduce cognitive dysfunction in older adults.

Clinical implications: Clinicians should target modifiable risk factors like depression and physical inactivity, particularly in minority populations. Addressing socioeconomic disparities is also crucial for improving cognitive health.

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: We explored the trajectories of sleep patterns and their relationship with conversion to MCI or dementia in a sample of older adults.

Methods: A total of 1984 participants ( >64 years old) in a population-based, longitudinal study (HELIAD), provided information regarding their sleep patterns. A full neurological exam and a comprehensive neuropsychological assessment were conducted to determine MCI and dementia diagnoses. Baseline and three-year follow-up associations of sleep patterns with cognitive status (healthy, MCI, dementia), age, education and sex were analyzed with the utilization of generalized estimating equation models.

Results: Baseline sleep patterns did not differentiate between initially healthy participants who converted either to MCI or dementia and those who remained healthy at follow-up. Baseline healthy participants who converted to MCI at follow-up reported more frequent sleep quality problems at follow-up than the consistently healthy participants (p = .032). Baseline healthy participants who converted to dementia at follow-up conveyed less frequent sleep disturbances(p = .009), greater sleep adequacy ratings (p = .006) and longer sleep duration (p = .001) at follow-up compared to their consistently healthy counterparts.

Conclusions: Sleep pattern trajectories were not associated with cognitive diagnosis. Sleep pattern alterations do not appear to predate conversion to MCI or dementia among cognitively healthy older adults.

Clinical implications: Discrepancies in self-reports might reflect a compromise in the ability to form objective judgments. These discrepancies may help differentiate between MCI and early dementia.