Clinical Gerontologist最新文献

Objectives: The prevalence of anxiety is widely observed among older adults on a global scale. In this study, we investigate the relationship between food insecurity and anxiety symptoms in older adults living in low- and middle-income countries (LMICs).

Methods: Utilizing data from the WHO's Study on Global AGEing and Adult Health (SAGE), a cross-sectional analysis was undertaken across six diverse nations - India, China, Ghana, Mexico, Russia, and South Africa. Multivariate logistic regression models were applied, and subgroup analyses and interaction analyses were performed.

Results: Results suggest a significant positive association between food insecurity and anxiety symptoms. The association was notably stronger in Ghana (aOR = 6.26) and South Africa (aOR = 5.64). The association was significant among men in Ghana, Mexico, and South Africa and among women in India, Ghana, Russia, and South Africa.

Conclusions: Measures to alleviate household food insecurity play a crucial role in enhancing the mental health of the growing older population in LMICs.

Clinical implications: Effective targeted interventions aimed at alleviating food poverty will play a crucial role in mitigating anxiety symptoms. Routine screening for food insecurity and mental health assessment is necessary, particularly when working with older population.

Objectives: The Individualized Positive Psychosocial Intervention (IPPI) is an evidence-based program that engages people living with dementia (PLWD) in brief (i.e. 10 minute) one-to-one preference-based activities two times a week. This study evaluated the feasibility of pragmatically implementing a pilot embedded pragmatic clinical trial of the IPPI program in nine nursing homes.

Methods: Feasibility was defined as the ability of NH communities to establish implementation champions and an implementation team, complete training, identify and enroll eligible residents, match IPPI protocols to residents' stated preferences, complete an average of two IPPIs per week per resident for 6 months, and complete IPPIs with fidelity.

Results: Seven NHs completed the project, enrolling a total of 130 eligible residents. Seventy staff were trained. Staff identified preferences, corresponding IPPIs, and a targeted symptom of distress for all enrolled residents. Staff completed an average of 44.71 IPPIs per person (over six months) for those that did not pass away or discharge, with an average of 3.91 days between IPPIs. All staff reached at least 80% intervention delivery fidelity.

Conclusions and clinical implications: The IPPI program is a feasible nonpharmacologic intervention for PLWD that can be implemented with fidelity over time in nursing homes by staff.

Objectives: The present study aimed to examine the immediate and long-term effects of mindfulness-based stress reduction (MBSR) on sleep problems and emotional health (depression and anxiety) of family caregivers of people with Alzheimer's disease (AD), along with the mediating role of improvements in emotional health resulting from the intervention.

Methods: A randomized controlled trial was conducted to allocate 80 family caregivers with sleep problems from a Shanghai community to either an 8-week MBSR (n = 40) or usual care (n = 40). Sleep quality, fatigue, depression, and anxiety were assessed at the baseline after the intervention and at 25-weeks follow-up.

Results: All symptoms were better in the MBSR group than in controls immediately after the intervention and at the follow-up. Mediation analysis suggested that anxiety rather than depression mediated the effect of MBSR on sleep quality.

Conclusions: These findings validated the long-term effects of MBSR on the sleep quality of family caregivers for individuals with AD and demonstrated that MBSR improved sleep quality by alleviating anxiety.

Clinical implications: MBSR could be integrated into targeted intervention programs for family caregivers for individuals with AD to enhance their sleep quality and emotional well-being.

Objectives: To evaluate the effectiveness of an Acceptance and Commitment Therapy (ACT)-based cognitive intervention on quality of life (QOL) and cognitive function among older adult residents with mild cognitive impairment (MCI) in residential care.

Methods: A randomized controlled trial was conducted with 215 older adults residents from six senior care facilities in southern Spain, allocated to an intervention group (n = 103) and a control group (n = 112). The intervention group participated in ACT-based cognitive training sessions twice weekly for 12 weeks. Assessments were conducted at baseline, post-intervention, and six months post-intervention. Structural equation modeling (SEM) examined relationships among intervention exposure, cognitive outcomes, emotional well-being, and QOL.

Results: The intervention group demonstrated significant improvements in cognitive function (MMSE +2.1 points, p < .001) and QOL (QOL-AD + 4.1 points, p < .001), while the control group showed slight declines. SEM analysis (χ² = 98.45, df = 72, p < .01; CFI = .94; RMSEA = .04) identified psychological flexibility (β = .35, p < .001) and social engagement (β = .21, p < .01) as significant predictors of QOL, explaining 42% of its variance (R² = .42).

Conclusions: ACT-based interventions effectively enhance QOL and cognitive function in older adult residents with MCI. Psychological flexibility and social engagement are key contributors to improved outcomes.

Clinical implications: Integrating structured ACT-based cognitive interventions in long-term care settings may support mental resilience, well-being, and cognitive health in older populations.

Objectives: Care recipients and caregivers share similar stressors and living environments and may thus present concordance in health-related outcomes, yet their sleep interdependence remains understudied. This study examined sleep interdependence among care dyads.

Methods: Longitudinal data from the National Health and Aging Trends Study and National Study of Caregiving were analyzed, including 2,204 dyads (2015 baseline; 2017 follow-up). Sleep disruptions were assessed as trouble falling back asleep. Cross-lagged panel models examined concurrent/longitudinal sleep interdependence; multiple group analyses ascertained whether the relationships differed by caregiving contexts (dementia/non-dementia) and living arrangements (co-residing/living apart).

Results: A stable actor effect emerged: Care recipients' and caregivers' sleep disruptions in 2015 predicted their own sleep disruptions in 2017. No cross-lagged partner effects were significant (p > .05). There was a significant synchronous partner effect in 2017 (β = 0.118, 95% CI = 0.048, 0.187). These relationships remained significant for dementia-care and co-residing dyads but not for non-dementia or living-apart care dyads.

Conclusions: This first longitudinal dyadic study identified sleep interdependence among care dyads, highlighting the importance of early intervention to reduce sleep disruptions. Targeted support for dementia caregivers and co-residing dyads is critical.

Clinical implications: Sleep hygiene interventions should leverage the interconnectedness of sleep within caregiving relationships.

Objectives: This study aimed to explore Nepali older adults' understanding of suicide and its solutions.

Methods: Focus groups were conducted to understand culturally appropriate ways to start conversations about suicide with Nepali older adults. Informed by the focus group findings, 24 interviews were then conducted with older adults in rural and urban areas.

Results: Thematic analysis resulted in three key themes: 1) meanings of suicide (damnation, fate, unnatural death, dishonor), 2) causes of suicide (lack of social support, limited resources, declining functioning, impaired cognition, mental pain, bad deeds), and 3) solutions (family/friends support, governmental/community role).

Conclusions: Cultural beliefs have shaped the perception of suicide among Nepali older adults. Their belief in fate can be a barrier to preventing suicide. However, their belief that suicide results in bad afterlife consequences can be exploited to potentially prevent it. Moreover, older adults thought that suicide prevention involves roles for family, community, and government.

Clinical implications: Interventions designed to increase mental health literacy and to capitalize on the practice of mindfulness associated with local religions may help to prevent suicide among Nepali older adults. Moreover, community resources should be available to assess the risks of suicide and offer support to vulnerable older adults.

Objectives: This study explored the impact of childhood hunger experiences on depressive symptoms in Chinese older adults, as well as the mediating roles of physical health and life satisfaction.

Methods: The data was sourced from three waves of surveys conducted by the China Social Tracking Survey in 2016, 2018, and 2020. Use OLS model and KHB method for regression analysis and mediation analysis.

Results: The results showed that childhood hunger experiences significantly increase depressive symptom scores and reduce mental health levels. In addition, physical health and life satisfaction partially mediated the relationship between childhood hunger experiences and depressive symptoms in older adults, and the effect was significant.

Conclusions: The findings of this research emphasize the negative impact of childhood hunger experiences on the mental health outcomes of older adults, with physical health and life satisfaction being important mediating pathways.

Clinical implications: Clinicians may wish to consider the impact of adverse childhood experiences on depressive symptoms in older adults; Healthcare providers or policymakers may want to consider how to reduce the negative impact of adverse childhood experiences, such as cultivating psychological resilience; Clinicians may wish to consider how to preserve the physical health of older adults and improve their life satisfaction.

Objectives: Participating in religious activities benefits older adults' mental health; however, the effects of grave visitation, a significant religious practice in Japan, on older adults' mental health remain unclear. Therefore, this study examined the relationship between grave visitation frequency and depressive symptoms.

Methods: A prospective cohort study of 273 community-dwelling older adults in Japan was conducted with baseline (2018) and follow-up (2022) assessments. Participants were categorized by visitation frequency: more or less than once a week. Changes in visitation frequency were classified as continued high, decreased, continued low, or increased. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Multivariable linear regressions were used to examine the association between visitation and depressive symptoms.

Results: Lower visitation at baseline was associated with worse GDS-15 scores in the follow-up. Those with decreased or continued low visitation had significantly worse depressive symptoms. After adjusting for baseline GDS-15 scores and covariates, the decreased group had significantly worse depressive symptoms than the continued high group.

Conclusions: The findings indicate that changes in grave visitation frequency are significantly associated with depressive symptoms.

Clinical implications: Supporting older adults' access to grave visitation through transportation or community programs may help maintain their well-being and emotional health.

Objectives: This study examined the relationship between polypharmacy and depressive symptoms among U.S. community-dwelling older adults and whether it varied by gender.

Methods: We conducted a retrospective population-based analysis of 3,354 adults aged 65 and older using data from the 2009 Health and Retirement Study Health and Well-Being Study. Polypharmacy was defined as the use of five or more prescription medications. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale (CESD-8). Negative binomial regression models assessed associations between polypharmacy and depressive symptoms and whether the relationship varied by gender.

Results: Over 40% of participants reported polypharmacy. In unadjusted models, polypharmacy was positively related to depressive symptoms (Incidence Rate Ratio [IRR] = 1.44, p < .01). In models adjusting for demographic and health characteristics, there was no statistically significant relationship between polypharmacy and depressive symptoms (Adjusted Incidence Rate Ratio [AIRR] = 0.99, p > .05). There were no significant gender differences in unadjusted or adjusted models in the relationship between polypharmacy and depressive symptoms.

Conclusions: Polypharmacy was not related to depressive symptoms among older women or men.

Clinical implications: Interventions to address physical health may be more salient to depression management than polypharmacy regardless of gender.

Objectives: This study evaluates Empower@Home, an older adult-centered, layperson-supported internet-based cognitive behavioral therapy (iCBT) program for depression using a concurrent mixed-methods design.

Methods: Adults aged 50+ with at least mild depressive symptoms enrolled in the program and were assessed pre- and post-treatment (N = 224). A subset participated in qualitative interviews post-treatment (N = 148). Paired t-tests and mixed-effects modeling assessed quantitative program effects, while qualitative data identified key themes of impact.

Results: Program completion was 90%. Depression symptoms significantly decreased (Cohen's d = 0.9 overall; d = 1.4 for those with moderate depression at baseline). Anxiety and social isolation also declined significantly. Moderation analyses showed that participants with lower education, antidepressant use, and more childhood adversities experienced faster symptom reduction. Qualitative findings aligned with quantitative results, highlighting acquisition and application of CBT skills and improved emotional well-being. Additional themes included increased insight and self-awareness, improved social relationships, empowerment, self-worth, and self-care.

Conclusions: Older adult-centered, layperson-supported iCBT shows promise in reducing depression and improving mental well-being in older adults.

Clinical implications: Findings offer insights for improving mental health treatment and outcomes for older adults.