Clinical Gerontologist最新文献

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.

Objectives: This study aimed to identify psychological factors and characteristics associated with fear of falling (FOF) and fear of falling avoidance behavior (FFAB) among older adults.

Methods: This cross-sectional study used data from the National Health and Aging Trends Study (Wave 9, n = 4,977).

Results: We found that increased fall history, more frequent depression and anxiety, and poorer perceived overall health were significantly higher among older adults with FFAB compared to FOF (ps < .001). Perceived overall health, depression, and anxiety explained a significant amount of variance in FOF and FFAB. Lastly, demographic characteristics differ between older adults reporting no FOF/FFAB, FOF, and FFAB.

Conclusions: FOF and FFAB are prevalent among older adults. Older adults experiencing FFAB had poorer health perceptions, more falls, and more frequent depression and anxiety than those experiencing FOF. The association of psychological factors and demographic characteristics with FOF and FFAB may indicate potential treatment targets. Clinical Implications: Addressing psychological variables, such as health perception, anxiety, and depression among older adults, may mitigate the impact of FOF and the development of FFAB; however, further research is needed.

Objectives: Arthritis is associated with poor quality of life (QOL) among older adults; and QOL is even worse among those with arthritis and multimorbidity (MM). Illness intrusiveness and perceived control have been identified in studies of single illnesses as modifiable mechanisms for QOL, but are understudied in older adults with arthritis and MM. We investigated the role of these potential mechanisms with QOL among older adults with arthritis and MM.

Methods: Secondary analysis of a sample of older adults aged ≥ 62 years with arthritis and MM (N = 228) using PROCESS macro for SPSS.

Results: Participants were on average 72 years with 4 chronic illnesses, and high levels of pain intensity and illness intrusiveness. Perceived control was a significant mediator (but not moderator) in the relationship between illness intrusiveness and QOL, even after adjustment for pain intensity [β = -0.16, 95% CI (-0.13, -0.06)].

Conclusions: Lower levels of illness intrusiveness were associated with improved QOL through greater perceived control. Longitudinal studies are needed to further assess these mechanisms in older adults with arthritis and MM to adapt existing interventions.

Clinical implications: Perceived control may be a target for future behavioral interventions to improve QOL in this population.

Objectives: This qualitative study explored the potential of piano training as a holistic intervention to enhance both cognitive and emotional well-being. The study aims to detail the experiences of older adults living with mild cognitive impairment (MCI) in a piano training program and recommend strategies to boost engagement.

Methods: Fourteen individuals (seven older adults with MCI and their family members) participated in individual semi-structured interviews before and after a 12-week group-based piano training program. These interviews were recorded, transcribed, open-coded, and analyzed by conventional content analysis.

Results: Participants with MCI reported improvements in mood, cognitive function, and social interaction. The learning process elicited mixed emotions, with both enjoyment and frustration occurring during the learning phases. Skill mastery and positive social interactions were crucial for sustained engagement throughout the program, although group settings sometimes led to negative self-comparisons.

Conclusions: Findings highlighted the need to address both cognitive and emotional needs in interventions for MCI. Neglecting these aspects can exacerbate feelings of low self-esteem and other negative emotions.

Clinical implications: Recommendations for cognitive training programs include positive reinforcement, personalized support, mental preparation for challenges, and rapport building to enhance participant motivation and adherence.

Objectives: The goals of this narrative review are to review the literature on psychotherapeutic interventions for older adults with histories of child maltreatment (CM) and to examine the unique considerations for assessing, diagnosing, and treating older adults with CM histories.

Methods: Online database searches were conducted to identify the extant research into the efficacy of psychotherapeutic interventions for older adults with CM-related trauma.

Results: Eight studies met inclusion criteria. The primary target diagnoses were post-traumatic stress disorder and depression. Psychotherapeutic interventions included Narrative Exposure Therapy, exposure-based treatments, Life Review Therapy, integrated treatments, and a spiritually-focused group therapy.

Conclusions: While limited in number and generalizability due to study design and sample size and characteristics, the studies provide preliminary evidence of potentially effective psychotherapeutic treatments for older adults with CM histories. Further research is needed to determine the most effective psychotherapeutic interventions for this population.

Clinical implications: Many older adults suffer for decades with the repercussions of CM. Due to knowledge gaps regarding best practices for treating older adults with CM histories, many clinicians are poorly equipped to treat this population. Therefore, awareness of CM-related pathology and familiarity with effective psychotherapeutic interventions are essential for clinicians to meet the needs of this population.

Objectives: Few studies of exposure therapy with adults 85 years and older exist. This case report presents results of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) modified for an 85-year-old Native American Cajun man with late-onset deafness, who used a cochlear implant, and reported high Western/non-Native American acculturation. The following modifications were made primarily in response to the client's individual, disability-related barriers to completing the standard PE protocol: (a) inclusion of the client's spouse in aspects of treatment planning and homework assignments; (b) variable session length and frequency; (c) homework was limited to the daily practice of breathing retraining and in vivo exposure to triggering images; and (d) therapist reliance on nonverbal indicators of distress during imaginal exposures.

Methods: The PTSD Checklist for DSM-5 (PCL-5) and 15-item Geriatric Depression Scale (GSD-15) were primary progress and outcome measures.

Results: The modified treatment was associated with clinically significant decreases in baseline PTSD (19 points) and depressive (8 points) symptoms.

Conclusions: PE protocol modifications did not compromise treatment outcomes for this client.

Clinical implications: PE protocols should be modified based on the individual needs of diverse older adults underrepresented in efficacy research.

Objectives: Older adults are the least likely age group to seek mental health services. However, few studies have explored a comprehensive range of sociodemographic, psychological, and social barriers and facilitators to seeking treatment in later life.

Methods: A cross-sectional, national sample of Canadian older adults (55+, N = 2,745) completed an online survey including reliable and valid measures of predisposing, enabling, and need characteristics, based on Andersen's behavioral model of health, as well as self-reported use of mental health services. Univariate and hierarchical logistic regressions predicted past 5-year mental health service use.

Results: Mental health service use was most strongly and consistently associated with greater perceived need (OR = 11.48) and mental health literacy (OR = 2.16). Less self-stigma of seeking help (OR = .65) and greater neuroticism (OR = 1.57) also predicted help-seeking in our final model, although their effects were not as strong or consistent across gender, marital status, and age subgroups.

Conclusions: The need category was crucial to seeking help, but predisposing psychological factors were also significant barriers to treatment.

Clinical implications: Interventions that target older adults high in neuroticism by improving perceptions of need for treatment, mental health literacy, and self-stigma of seeking help may be particularly effective ways of improving access to mental health services.

Objectives: Research indicates adverse childhood experiences (ACEs) were associated with subjective cognitive decline (SCD), with higher ACEs reported by sexual minoritized individuals (i.e. lesbian, gay, and bisexual; LGB). This study aimed to explore the relationships between ACEs and SCD based on sexual orientation in middle-aged and older adults.

Methods: The study included 76,592 participants from the 2019-2020 Behavioral Risk Factor Surveillance Survey (BRFSS). Multivariate logistic regressions analyzed ACEs status, score, and type associations with SCD.

Results: 2.18% of the participants identified as sexual minoritized individuals. More sexual minoritized individuals reported SCD compared to heterosexual individuals (10.70% for heterosexuals; 17.27% for sexual minoritized individuals). Positive association between SCD and ACEs status (OR = 2.18, 95%CI: 1.09-4.40) was identified among sexual minoritized individuals.

Conclusions: The association between ACEs and SCD was strong in both heterosexual and sexual minoritized populations. Given the higher experience of ACEs among sexual minoritized adults, the subsequent frequency of SCD among these adults also may be higher.

Clinical implications: Sexual minoritized older adults may have a history of numerous ACEs, which could contribute to a greater burden of SCD. Clinicians and other stakeholders may wish to consider relationships between ACEs and SCD based on sexual orientation.

Objectives: We assessed if positive life orientation (PLO) has increased among older individuals and explored gender disparities in PLO changes.

Methods: Two cohorts of 70-year-olds from Turku, Finland were included: the 1920 birth cohort (examined in 1991; n = 1,032) and the 1940 birth cohort (examined in 2011; n = 956). Participants completed an identical questionnaire assessing life satisfaction, feeling needed, future plans, zest for life, depression, and loneliness. A composite PLO score (range 0-1) was computed.

Results: The 2011 cohort had a higher mean PLO score than the 1991 cohort (.87 vs. .83, p < .001). The 2011 cohort reported higher sense of being needed, more future plans, and reduced loneliness (all p < .001). No significant differences were found in life satisfaction, zest for life, or depression. Gender disparities in PLO persisted across both cohorts, with men scoring slightly higher but following similar trends as women.

Discussion: PLO appears to have increased among older individuals.

Clinical implications: Recognizing the rising trend of PLO in recent decades may influence the development of societal and healthcare policies to further improve overall well-being among older individuals.

Objectives: Determinants of frailty are generally explored within context of somatic healthcare and/or lifestyle characteristics. To examine the impact of personality traits on change in frailty and the potential role of depression.

Methods: A 2-year follow-up study including 285 patients with a depressive disorder and 116 never-depressed controls. Multiple linear regression analyses were conducted to regress the Big Five personality traits (independent variables) on different frailty measures (dependent variables), including the Frailty Index, Frailty phenotype, gait speed, and handgrip strength. Analyses were adjusted for confounders (with and without depressive disorder) and baseline frailty severity. Interactions between personality traits and depressive disorder were examined.

Results: All personality traits were associated with change in at least one frailty marker over time. Over time, a higher level of neuroticism was associated with an accelerated increase of frailty, whereas a higher level of extraversion, agreeableness, conscientiousness and openness were associated with an attenuated increase of frailty. None of the associations were moderated by depression. Additional adjustment for depression decreased the strength of the association of neuroticism, extraversion and conscientiousness with frailty.

Conclusions: Personality traits have impact on frailty trajectories in later life.

Clinical implications: Underlying pathways and potential modification by psychotherapy merit further study.