Clinical Gerontologist最新文献

Objectives: This study examined the role of religious coping and preparedness in shaping caregivers' acceptance of death following the loss of a care recipient with Alzheimer's disease or related dementias. Two competing path models were tested to determine whether preparedness serves as a mediator or an outcome in the relationship between religious coping and acceptance.

Methods: Data were drawn from the bereavement battery of the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) study. The analytic sample included 41 bereaved caregivers who completed measures of positive and negative religious coping, preparedness for death, and acceptance of death. Path analyses were conducted in R using the lavaan package.

Results: Bivariate analyses indicated that both positive and negative religious coping were significantly associated with greater preparedness, and preparedness was strongly related to acceptance. The first path model, where preparedness predicted coping and acceptance, showed poor global fit. In contrast, the second model, where coping predicted preparedness, which in turn predicted acceptance, showed excellent fit.

Conclusions: Preparedness emerged as a mechanism linking religious coping with acceptance, highlight an important pathway for supporting caregivers in bereavement.

Clinical implications: Findings suggest that interventions focused on religious coping enhance preparedness which improves caregivers' acceptance in the bereavement process.

Objectives: To examine whether satisfaction with meaningful activities (MA) is associated with self-rated sleep quality and sleep duration among community-dwelling older adults.

Methods: Data were drawn from 833 individuals aged ≥65 years who participated in a health survey between 2018 and 2019 in Japan. Sleep quality (good, moderate, or poor) and duration ( < 6, 6-8, or ≥8 h) were assessed through a questionnaire. Participants selected the MA they considered most meaningful from a list of 95 activities in the Aid for Decision-Making in Occupation Choice, and their satisfaction with these MA were measured.

Results: Ordinal logistic regression analysis, with sleep quality or duration as the dependent variable and satisfaction with MA as the independent variable, showed that higher satisfaction with MA was significantly associated with lower odds of poor sleep quality (OR: 0.84, 95% CI: 0.72-0.97, p = .03), but not with sleep duration. However, the association was not significant in sensitivity analyses that reversed the model.

Conclusions: Satisfaction with MA may be associated with better sleep quality in older adults.

Clinical implications: Evaluating and enhancing satisfaction with MA may help identify older adults at risk of poor sleep quality, indicating that MA may be useful in supporting sleep.

Objectives: Young-onset dementia (YOD) presents unique care challenges, particularly due to behavioral and psychological symptoms of dementia (BPSD). BPSD impacts long-term care acceptance; nonetheless, which symptoms most influence facility acceptance decisions remains understudied. We aimed to investigate how long-term care insurance (LTCI) facilities' acceptance policies for individuals with YOD relate to their perceptions of BPSD difficulty.

Methods: A cross-sectional survey was conducted in 360 LTCI facilities in Sapporo City. Perceived difficulty of 12 BPSD domains and facility acceptance policies were assessed. Statistical analyses included chi-squared tests, decision tree analysis, and logistic regression.

Results: Eight BPSD - such as delusions, anxiety, and nighttime behavioral disturbances - were significantly associated with negative acceptance policies. Decision tree and regression analyses showed that facilities perceiving nighttime disturbances and irritability as difficult were significantly less likely to accept individuals with YOD. Conversely, universally challenging symptoms such as agitation/aggression did not distinguish acceptance decisions.

Conclusions: Specific combinations of perceived BPSD difficulties - particularly nighttime disturbances and irritability - were associated with the willingness of these facilities to accept individuals with YOD.

Clinical implications: Targeted training focusing on nighttime disturbances, irritability, and delusions, along with enhanced information-sharing and YOD-specific support networks, may reduce care barriers and promote acceptance in LTCI settings.

Objectives: The current study examined the relationship between social engagement and cognitive function among older Mexican heritage Latinos in the U.S. Although social engagement has been identified as a factor that is protective against cognitive decline and dementia, its association with cognitive health in Mexican heritage Latinos is understudied.

Methods: Data on cognitive health, social network characteristics, perceived social support, and social engagement were collected in a sample of older Mexican heritage Latinos in South Texas.

Results: Social network characteristics, perceived social support, and social engagement were significantly correlated with cognitive health. A hierarchical multiple regression analysis was used to test the relative strength of these factors in predicting cognitive health, while controlling for relevant covariates. Social engagement was found to be a significant predictor of cognitive function, beyond the effects of perceived social support and social network characteristics.

Conclusions: Findings highlight social engagement as a modifiable behavioral factor that may support cognitive health in aging Mexican heritage Latinos.

Clinical implications: The results suggest that screening for and enhancing social engagement may be a valuable clinical strategy for preserving cognitive function in older Latinos at risk of poor cognitive health outcomes.

Objectives: Sleep and circadian problems are prevalent among midlife and older adults. Unfortunately, treatments for these problems are limited by poor memory for treatment.

Methods: We conducted a pilot trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction paired with the Memory Support Intervention (TSC+MSI) for midlife and older adults with sleep and circadian problems (N = 26) (preregistration NCT04373538). After treatment, patients were offered optional booster messages. Aims were to (1) test change in clinical outcomes after TSC+MSI, (2) assess perceptions of TSC+MSI, and (3) evaluate patient engagement, preferences, and preliminary outcomes of booster messages.

Results: Following TSC+MSI, patients significantly improved on sleep disruption, sleep-related impairment, functional impairment, and select sleep diary outcomes. Therapist use of memory support strategies moderated improvements in sleep-related and overall impairment. TSC+MSI was perceived as acceptable by patients and feasible by therapists. Most patients opted in to the boosters. Sleep-related impairment significantly improved from pre-booster to post-booster.

Conclusions: Following TSC+MSI and boosters, improvements were observed in clinical outcomes, and signals supported feasibility and acceptability.

Clinical implications: Although comparisons with control conditions and larger samples are needed, TSC+MSI and booster messages may improve sleep and circadian and related outcomes among midlife and older adults.

Objectives: The relationship between affective disorders and frailty in older adults remains underexplored, despite their impact on quality of life and healthcare costs. This study aimed to investigate the relationship between affective symptoms, cognitive impairment, functional decline and frailty.

Methods: A cross-sectional study was conducted with 153 patients aged ≥60 years from two Psychogeriatric outpatient clinics. Standardized tools were used, including the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Verbal Fluency Test (VFT), Pfeffer Questionnaire and Katz Index (to assess functional decline), Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI), and a clinical-sociodemographic questionnaire. Spearman correlations and Poisson regression were performed.

Results: Frailty prevalence was 62.1, and significant associations were found between frailty and depressive symptoms on GDS-15 (OR = 6.74), cognitive impairment on VFT (OR = 2.80), CDT (OR = 4.33), MMSE (OR = 4.88) and functional disability on Pfeffer (OR = 14.95). Multivariate analysis identified polypharmacy (OR = 1.64), depressive symptoms (OR = 1.97), cognitive impairment in VFT (OR = 1.30), and functional disability in Pfeffer (OR = 1.96) as independent predictors of frailty.

Conclusions: These findings reinforce the association between affective disorders, cognitive impairment, functional decline and frailty in older adults.

Clinical implications: The use of integrated tools can help identify patients at greater risk of frailty, guiding multidisciplinary interventions in geriatric mental health.

Objectives: This study examines the relationship between executive function (EF) in daily life and depressive symptoms in older adults, focusing on how age-related EF deficits contribute to depressive symptoms.

Methods: Data were collected from 404 community-dwelling older adults in Gangwon-do, South Korea. Depressive symptoms were assessed using the Korean version of the Short Form of the Geriatric Depression Scale (KGDS-SF), and EF deficits were measured using the Korean version of the Short Form of the Barkley Deficits in Executive Functioning Scale (KBDEFS-SF), an ecologically validated tool. Regression analysis and a mediation model were employed to investigate how age-related EF deficits contribute to depressive symptoms.

Results: EF deficits, particularly in self-organization/problem-solving and self-regulation of emotion, were significantly associated with increased depressive symptoms. However, only deficits in self-organization/problem-solving mediated the relationship between age and depressive symptoms.

Conclusions: Age-related deficits in self-organization/problem-solving significantly contribute to depressive symptoms in older adults.

Clinical implications: Interventions aimed at improving self-organization and problem-solving skills are critical for managing depressive symptoms in older adults, as these abilities are influenced by age and may mediate the relationship between age and depression.

Objectives: Valid and reliable measurement of mindfulness is essential to identify mechanisms of change and potential racial or cultural differences in mindfulness-based interventions. We examined the psychometric properties of the Five Facet Mindfulness Questionnaire 15-item version (FFMQ-15) in a sample of Black and White caregivers of persons with dementia (PWDs).

Methods: Eighty-two caregivers of PWD participated in a treatment study at a VA Medical Center. Internal consistency was calculated using Cronbach's alphas overall and separately by racial group. Average inter-item correlations were used to optimize the scale. Construct validity was examined through bivariate correlations.

Results: Results indicated (a) FFMQ-15 scores demonstrated fair internal consistency overall but poor reliability among Black caregivers, (b) removing two negatively correlated items improved internal consistency for Black caregivers, and (c) mindfulness was negatively correlated with depression, anxiety, and caregiver burden.

Conclusions: Findings indicate some items on the FFMQ-15 may perform differently in Black compared to White caregivers of PWD. Results interpreted with caution; additional research is needed to determine cultural or contextual influence of possible measurement inequivalence.

Clinical implications: The FFMQ-15 may reflect different experiences of mindfulness among Black caregivers of PWD. Culturally responsive assessment is needed; Sociocultural factors and caregiving environment should be considered.

Objectives: Examine different sources of social support/network depending on depressive symptoms among older adults.

Methods: Data were obtained from two waves of the Age, Gene/Environment Susceptibility - Reykjavik Study (AGES-Reykjavik): Wave I (2002-2006, N = 5.764) and Wave II (2007-2011, N = 3.316). Seven questions (meet with friends/children feeling close to family/friends telephone children/friends living alone were used as: single question (social support)/social network score (SNS). The Geriatric Depression Scale (GDS) screened for depressive symptoms, recoded as: low score (GDS score < 6) and high score (GDS score ≥6). Longitudinal linear regression assessed associations between social questions and GDS score at follow-up among low and high depressive symptoms.

Results: Among low depressive symptoms (mean age 77) decrease in depressive symptoms was found for those meeting with children (β: -0.439, p = .007); friends (β: -0.288, p = .002); feeling close to family (β: -0.232, p ≤ .001) and friends (β: -0.217, p = .009). Among high depressive symptoms (mean age 78) decrease in depressive symptoms was when telephoning children (β: -4.679, p = .002); meeting with children (β: -2.725, p = .018).

Conclusions: In older community-dwelling adults regular social support decreases depressive symptoms with most meaningful support arriving from children and friends.

Clinical implications: Incorporating social network assessments into routine geriatric evaluations could help identify individuals at higher risk of developing or sustaining depressive symptoms.

Objectives: Sub-threshold cases of depression and anxiety disorders in older adults are often undetected and undertreated. The 7-item Duke Anxiety-Depression Scale (DUKE-AD) assesses mental distress; this study evaluated the psychometric validity and cross-cultural applicability of its Persian version (DUKE-AD-PERSIAN).

Methods: A cross-sectional study among 500 older adults assessed for content and face validity as measured by 20 experts, and estimated content validity ratio (CVR) and item-level content validity index (I-CVI). Exploratory and Confirmatory Factor Analyses (EFA, CFA) examined the factor structure.

Results: Participants had a mean age of 70.62 ± 7.42 years and mean anxiety-depression score of 25.05 ± 22.39. The implemented EFA and CFA's outputs (CMIN = 29.933, DF = 11, pvalue = 0.002, CMIN/DF = 2.721, RMSEA = 0.05 (95% CI: 0.034, 0.084), PNFI = 0.511, PCFI = 0.515, TLI = 0.969, IFI = 0/984, CFI = 0.984) supported unidimensionality of the scale. The estimated reliability and stability coefficients (Cronbach's α = 0.98, ICC = 0.97) were acceptable.

Conclusions: Findings supported the reliability and validity of the Persian DUKE-AD as a brief self-report measure for assessing anxiety and depression in older adults.

Clinical implications: The Persian DUKE-AD enables efficient screening of anxiety and depression symptoms among older adults, facilitating early intervention in primary care and community health settings.