Clinical Gerontologist最新文献

Objectives: This study aims to evaluate differential effects of an individualized music listening intervention for people living with dementia in institutional care.

Methods: Data from 118 people living with dementia, with a mean age of 84.05 years (SD = 7.00 years, 76.3% were female), was used to investigate effects of 6 weeks of listening to individualized music. Participants were randomly assigned to an intervention group, listening to individualized playlists for 20 min every other day, and a control group, receiving standard care. Effects of the intervention were analyzed by proxy ratings using Goal Attainment Scaling. Different aspects of quality of life were also assessed and analyzed using standardized questionnaires at four assessment points.

Results: Attainment of individual goals following 6 weeks of individualized music listening was more frequently reported from the nursing staff in the intervention group, compared to the control group (d = .57). There were no effects of listening to individualized music regularly considering questionnaire data on different aspects of quality of life.

Conclusions: Using a personalized measure may help to understand the potential of individualized music listening more adequately.

Clinical implications: The results indicate that listening to music can lead to positive but individually different effects.

Registration: German Clinical Trials Register (DRKS00013793); ISRCTN registry (ISRCTN59052178).

Objectives: To examine older adults' cannabidiol (CBD) use and its associations with cannabis use and physical/mental health and other substance use problems.

Methods: Using the 2022 National Survey on Drug Use and Health (N = 10,516 respondents age 50+), we fitted generalized linear models (GLM) with Poisson and log link using CBD as the dependent variable in the 50-64 and the 65+ age groups.

Results: In the 50-64 age group, 18.3% and 18.0% reported past-year CBD and cannabis, respectively, use. In the 65+ age group, the percentages were 14.3% and 8.0%. GLM results showed significant positive associations with both medical and non-medical cannabis use in both age groups. CBD use was positively associated with physical/mental health and illicit drug use problems in the 50-64 age group and with disordered psychotherapeutic drug use in the 65+ age group. Minoritized older adults had a lower likelihood of CBD use.

Conclusions: CBD use is common, more so than cannabis especially in the 65+ age group and positively correlated with both medical and nonmedical cannabis use.

Clinical implications: Research is needed to examine therapeutic benefits and negative effects of CBD use in late life. Public health education is needed for growing numbers of older-adult CBD users.

Objectives: Mindfulness-based interventions (MBIs) for persons with dementia (PwD) have yielded mixed results, possibly attributable to the fact that little is known about the validity and reliability of trait mindfulness self-report measures in PwD. This narrative review sought to identify studies involving self-reported trait mindfulness and other clinical measures that may hold information on the convergent validity and reliability of these measures in PwD.

Methods: Scientific databases were searched for studies involving PwD and mindfulness assessments.

Results: N = 426 studies from PubMed and N = 156 from PsychInfo databases were reviewed. Four cross-sectional studies were identified that allowed inferences about the validity of mindfulness measures. A qualitative review indicated that convergent validity with other measures varied with sample heterogeneity and cognitive impairment. Merely one MBI included self-reported trait mindfulness, however without reporting sample-specific validity or reliability.

Conclusions: Despite efforts to implement MBIs in PwD, information on basic methodological psychometric issues is minimal. Future studies ought to address the validity and reliability of self-reported mindfulness in detail across different stages of dementia.

Clinical implications: Results of MBIs need to be considered cautiously. Basic information about psychometric properties of mindfulness self-report measures is required and these measures need to be included systematically in MBIs.

Objectives: To explore the temporal sequence between cognitive function and activities of daily living (ADLs) in patients with Parkinson's disease (PD) and investigate whether apathy mediates these effects.

Methods: We recruited 486 patients from the Parkinson's Progression Marker Initiative. We constructed a cross-lagged panel model to explore the temporal sequence between cognitive function and ADLs and analyzed the longitudinal mediating effect of apathy on the relationship between cognitive function and ADLs.

Results: The slopes of ADLs and cognitive function were significant (p < .001), and lower levels of cognitive function indicated lower ADLs, suggesting that a decreased cognitive performance preceded ADLs decline. Cognitive function influenced apathy (negatively) (p < .001) and ADLs (p < .001). A significant indirect effect of cognitive function on ADLs through apathy was revealed by bias-corrected bootstrapping (β = 0.181, p < .001).

Conclusions: The rate of change in cognitive function was significantly correlated with that of ADLs, and a decreased cognitive performance preceded ADLs decline. Cognition was indirectly related to ADLs through apathy.

Clinical implications: The rate of change in cognitive function in patients with PD was correlated with that of ADLs, and a decreased cognitive performance preceded ADLs decline. Reducing apathy represents a promising approach to reducing the impact of cognitive decline on ADLs.

Objectives: Older adults underutilize mental healthcare, and ageism as a potential barrier has been under-researched. As ageism comes both from external sources and is internalized by older adults, we examined the prevalence of external and internalized ageist barriers to help-seeking and how depressive and anxiety symptoms differed based on how strongly older adults endorsed these ageist barriers.

Methods: A sample of 247 older adults completed measures online to assess barriers to mental healthcare (BMHSS-R), depressive symptoms (CES-D), and anxiety symptoms (GAD-7).

Results: Barriers representing internalized ageist stereotypes about older adult mental health were endorsed more frequently than external ageist barriers. Older adults endorsing ageist barriers to care reported significantly more depressive and anxiety symptoms than those not endorsing these barriers.

Conclusions: Ageism, particularly internalized beliefs that poor mental health is typical in older adulthood, was reflected in older adults' perceptions of barriers to seeking mental healthcare. Both internalized and external ageist barriers to care negatively influence well-being.

Clinical implication: To support older adult mental health, clinicians should dispel inaccurate, ageist stereotypes about older adult mental health internalized by their clients and work to increase and then communicate their openness and ability to provide competent mental healthcare to older adults.

Objectives: Memory concerns are common among older adults. The Multifactorial Memory Questionnaire (MMQ) is a well-validated participant-reported measure consisting of 57 items across three subscales assessing satisfaction with memory, self-perceived memory ability, and memory strategy use, respectively. Because short scales are often desired to accommodate clinical time constraints and reduce respondent burden, we created and evaluated 9-item versions of each subscale (MMQ-9).

Methods: In Study 1, we used an optimization strategy to identify subsets of items that maximized subscale reliability in a sample of 560 adults ages 50-90. In Study 2, we examined psychometric properties of the MMQ-9 in an independent sample of 638 adults ages 51-95.

Results: Internal consistency, test-retest reliability, and convergent and discriminant validity of each subscale met published criteria for good measurement properties. Confirmatory factor analysis validated the original factor structure. A hierarchical series of invariance models showed excellent fit, confirming robust measurement invariance across age, gender, and education.

Conclusions: The shortened MMQ-9 is a reliable, valid, and invariant measure of metamemory in middle-aged and older adults.

Clinical implications: The MMQ-9 is a reasonable instrument of choice when brief yet psychometrically strong measures of participant-reported memory are required for clinical assessment of patients with memory concerns.

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 study aimed to explore the association between sleep and social disconnectedness by examining the role of global cognitive function in diverse samples of older adults.

Methods: Study 1 compared differences in social disconnectedness between older adults with clinical sleep disorders and healthy sleepers. Studies 2 and 3 examined the relationship between objective sleep and social disconnectedness in community-dwelling older adults from two independent datasets. In the three studies, we analyzed the moderating effect of global cognitive function in the association between objective sleep and social disconnectedness.

Results: Study 1 showed that older adults with clinical sleep disorders had greater social disconnectedness, among whom those with better cognition showed less influence of sleep disorder on social disconnectedness. Studies 2 and 3 showed that nocturnal awakening was robustly associated with social disconnectedness in community-dwelling older adults. Global cognitive function moderated this association, counteracting the negative effect of nocturnal awakening on social function.

Conclusions: These findings suggest a relationship between objective sleep, particularly nocturnal awakening, and social disconnectedness, and the compensatory role of global cognitive function.

Clinical implications: Geriatric caregivers are encouraged to consider cognitive interventions to mitigate sleep-related, specifically excessive nocturnal awakening-related, social disconnectedness in older adults.

Objectives: Up to 40% of older adults in the US, including older African immigrants, report experiencing social isolation and loneliness. Despite this prevalence, there is limited understanding of how they cope with these challenges. This study aims to contribute to a broader understanding of the coping mechanisms employed by older African immigrants in the face of loneliness and social isolation.

Methods: Using a qualitative approach, this study recruited and conducted semi-structured interviews with 11 participants aged 63-79.

Results: Four themes emerged from the data through a thematic analysis approach which includes a) Positive self-talk and adaptation: "I have to cope with it," b) Technology/social media: "if I cannot interact physically outside, I go through social media/watch TV," c) Intergenerational engagement beyond caregiving: "They [grandchildren] are my immediate constituency," and d) Digging deep through faith: "Interactions have been mostly within the church."

Conclusions: Older African immigrants may find strategies to cope with social isolation and loneliness, but additional support may be needed to strengthen their coping skills and enhance their social network with people outside of their families.

Clinical implications: Intervention should focus on regular assessment and strengthening of their social network outside the family unit.