Clinical Gerontologist最新文献

Background: Many older adults in Colombia have lived through violent and stressful life events, particularly in areas of poverty. The aim of this qualitative study was to understand the impact of stressful life events on the mental health and wellbeing of older Colombians living in areas of relative poverty.

Methods: Older adults (aged 60+) living in the Turbo region in Colombia were interviewed face-to-face between August and December 2021. Transcripts were coded in Spanish and English by at least two researchers, using inductive thematic analysis.

Results: Twenty-six older adults participated in the study. Four overarching themes were generated: Living in violent and dangerous communities; Disturbing gender violence and gender roles; Lack of mental health awareness; Coping mechanisms. Older adults experienced a long narrative of stressful life events. Younger generations appeared to disrespect older members of Society. Without any mental health support, older adults coped by accepting the extreme situations or seeking solace in their faith.

Conclusions: The health system and Government need to build up trust and generate an awareness of mental health, as older Colombians will not approach psychological support otherwise. Intergenerational community-based interventions may provide a first avenue of mental health support.

Objectives: This study aimed to explore the relationships between aging attitudes and the outcomes of successful aging, including whether aging attitudinal types moderate psychological adjustment in the context of medical and mental health diagnoses.

Methods: In total, 409 community-dwelling women aged 40-79 years in Australia completed the Reactions to Aging Questionnaire (RAQ), Geriatric Depression Scale, Center of Epidemiological Studies Depression Scale, and Geriatric Anxiety Inventory. Information about medical and mental health diagnoses were collected.

Results: Overall, aging attitudes and all three RAQ subscales were negatively correlated with scores on measures of depression and anxiety, and number of medical diagnoses. Attitudinal types toward aging were found to moderate the relationship between the number of mental health diagnoses and scores on the psychological measures of depression but not anxiety. Unique RAQ domain-specific relationships were found with the number of mental health diagnoses.

Conclusions: The findings support the link between aging attitudes and psychological outcomes, the potential clinical value of RAQ attitudinal typologies classification as well as a multidimensional conceptualization of aging attitudes.

Clinical implications: The findings reinforce the need for efforts to reduce ageism on a societal level, as well as informing clinical decision-making with older clients.

Objectives: Personality traits and affective disorders are both related to functional limitations. It is unknown whether personality traits have an additional effect on functioning in older adults with affective disorders. We studied the association between personality traits and functioning within this group.

Methods: We performed a cross-sectional study of 180 older patients referred to outpatient specialized geriatric mental health care centers with a depressive, anxiety and/or somatic symptom disorder according to DSM-criteria. We studied the association between the Big Five personality traits and functional limitations assessed with the WHO-DAS II, adjusting for potential confounders, including the severity of various affective disorders.

Results: The 180 patients (57.1% female, mean age 69.2 years) had an average WHO-DAS II score of 31.3 (SD 15.1). Lower scores on Conscientiousness were associated with more overall functional limitations (p = .001), particularly limitations in self-care (p = .001) and household activities (p = .001). Lower Extraversion scores were associated with more limitations in getting along with others (p = .001).

Conclusions: Personality traits are related to functional limitations independent of the severity of affective disorders in older adults.

Clinical implications: Personality traits may be used as predictive factors for functioning in older adults with affective disorders.

Objectives: To investigate whether baseline depressive symptoms impacted the effectiveness of an exercise intervention among (pre)frail older adults.

Methods: This is a subanalysis of a stepped-wedge cluster randomized trial implementing an exercise intervention, with an application of the integration of the Health Belief Model, Theory of Planned Behavior, and Health Action Process Approach, among 149 community-dwelling (pre)frail older adults. The intervention effectiveness was examined by baseline depressive symptoms (depressive symptoms (n = 40) and non-depressive symptoms (n = 109).

Results: Intervention effects were observed among (pre)frail older adults regardless of baseline depressive symptoms on frailty, social function, as well as physical and mental quality of life (QoL). (Pre)frail people with depressive symptoms, compared to those without depressive symptoms, were likely to benefit more in muscle mass, muscle strength, lower extremity function, activities of daily living (ADLs), cognitive function, depressive symptoms, and physical QoL, but less in dynamic balance, instrumental ADLs (IADLs), and mental QoL.

Conclusions: These findings implicate that cognitive and psychological strategies should be integrated into exercise interventions among (pre)frail people with depressive symptoms to improve their functional independence and well-being.

Clinical implications: Interventions that accommodate depressive symptoms may result in improved outcomes for (pre)frail people with depressive symptoms.

Objectives: Our understanding of elder abuse (EA) phenomena has largely been shaped from the perspective of researchers and professionals whose conceptualizations often differ from the perceptions of older adults who experience mistreatment. This study sought to understand the most distressing aspects of EA victimization from the perspective of survivors.

Methods: Using a descriptive phenomenological approach, individual interviews were conducted with a diverse sample (n = 32) of EA survivors, recruited from EA support and Adult Protective Services programs in New York City and Los Angeles. Analysis followed a constant comparison process involving two independent coders to understand distressing aspects of EA victimization.

Results: The following themes emerged as the most distressing aspects of EA victimization: fear, disbelief, disrespect, concern for perpetrator and other family members, feelings of loss, and incongruity between survivor wishes and systemic responses. Distressing aspects of EA victimization spanned personal, relational, and systemic levels of ecological influence.

Conclusions: Findings from this study advance basic knowledge on EA phenomena and carry direct implications for programs designed to support and meet the needs of survivors.

Clinical implications: Findings identify particularly distressing psycho-emotional aspects of EA victimization for clinicians interacting with survivors that can serve as targets of intervention.

Objectives: This study assessed the feasibility and efficacy of "Online Resilience," a three-lesson online intervention based on third-wave cognitive behavioral therapy (CBT) principles, inspired by acceptance and commitment therapy (ACT), designed for emotionally healthy adults aged 75 and older.

Methods: A randomized controlled study with 62 participants (mean age = 81) divided into Experimental and Control groups. Outcomes included resilience, well-being, mood, and sleep quality, measured pre-, post-, and at one-month follow-up.

Results: The intervention showed feasibility among emotionally healthy older adults with higher baseline resilience and well-being, with attrition rates comparable to similar programs. Resilience improvements were significant post-intervention but diminished by follow-up. Sleep quality improved significantly at follow-up, though control group data was unavailable for comparison. Mood stability was maintained in the intervention group while declining in controls.

Conclusion: "Online Resilience" shows promise for promoting resilience, mood stability, and sleep quality in older adults, though limited long-term effects and high attrition warrant program refinements.

Clinical implications: Brief, self-guided online interventions like this can enhance access to mental health support for older adults, serving as cost-effective preventive tools. However, future programs should address attrition and target individuals with varying baseline psychological resources.

Objectives: Data on the direct and indirect associations between physical activity (PA) and sleep quality in old age via psychosomatic mechanisms (e.g. mobility, pain, loneliness, depression, and anxiety) remain scarce in low- and middle-income countries (LMICs). We explored the association of PA with poor sleep quality (PSQ) among individuals aged ≥ 50 in Ghana and explored the potential mediating factors in this association.

Methods: We analyzed community-based data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study. We assessed PA using the International Physical Activity Questionnaire (IPAQ). Two items on nighttime and daytime sleep problems in the last 30 days were used to measure PSQ. Multivariable ordinary least square (OLS) regressions and bootstrapping models were performed to evaluate the associations.

Results: Overall, 1,201 participants (M_age = 66.15 ± 11.58 years; 63.3% female) were included in the analysis. PA was independently associated with decreased PSQ in the overall sample (B = -0.181, 95%I = -0.271 to -0.092) and in women (B = -0.195, 95%I = -0.305 to -0.084). The association was stronger in the ≥ 65 (B = -0.138) than in the 50-64 age group (B = -0.213). Mobility (37.06%), pain (23.66%), loneliness (6.71%), and comorbid anxiety and depression (8.95%) mediated the PA-PSQ association.

Conclusions: PA was associated with decreased PSQ levels, which was particularly explained by psychosomatic factors.

Clinical implications: Clinicians encourage older adults to engage in regular PA and manage psychosomatic problems may improve their sleep health.

Objectives: We examined the moderating effects of household income, subjective socioeconomic status (SES), social contact, and social engagement on the work-depressive symptoms relationship.

Methods: We analyzed data from 5,216 adults aged 60 and older from six waves (2008-2018) of the Korean Longitudinal Study of Ageing (KLoSA).

Results: Two-level mixed-effects models showed that within-individual variation in work status was negatively associated with depressive symptoms. The relationship between work and depressive symptoms was stronger for older adults with low household income than for those with the average household income and was not significant for those with high household income. Moreover, the work-depressive symptoms relationship was stronger among older adults with low levels of subjective SES and social engagement and fewer social contacts compared with those with average or high levels of subjective SES and social engagement and more social contacts.

Conclusions: The greater impact of work on depressive symptoms in older adults with limited financial and social resources highlights the importance of addressing these deficits to improve mental health.

Clinical implications: Clinicians should consider that the effect of work on depression varies depending on income, subjective SES, and social participation. Addressing financial hardship and promoting social participation are important for preventing depression in older adults.