Clinical Gerontologist最新文献

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.

Objectives: This mixed-methods study examines the acceptability, feasibility, and preliminary effect of a novel, remotely delivered group intervention (Empower@Home: Connected) targeting depression, social isolation, and loneliness in older adults (≥ 60).

Methods: Acceptability was assessed via participant satisfaction, and feasibility was measured by attrition rates and session attendance. Participants completed pre- and posttest measures of depression, social isolation, and loneliness, with depression also assessed biweekly. Post-intervention, participants completed semi-structured qualitative interviews about their experiences.

Results: 31 participants completed the intervention. The intervention had high acceptability and feasibility. Depressive symptoms significantly decreased. Reductions in loneliness and social isolation were observed but not statistically significance. Linear mixed modeling revealed a significant reduction in depressive symptoms during the intervention. Qualitative interviews highlighted participants' beliefs in the intervention's impact. They appreciated the convenience of remote delivery and valued shared experiences and emotional support from group interactions.

Conclusions: This uncontrolled pilot intervention was acceptable, feasible, and reduced depressive symptomatology. Future research should refine social isolation and loneliness components and explore the intervention's long-term impact.

Clinical implications: This pilot remote group-based interventions to address depression, social isolation, and loneliness in older adults was acceptable and feasible, making it a potentially valuable option for improving mental health care.

Objectives: Selective Optimization with Compensation (SOC) is an empirically supported model of successful aging. Acceptance and Commitment Therapy (ACT) is an empirically supported intervention that has a theoretical model which is complementary to the SOC model. Combining the two models can provide a more comprehensive view of successful aging. The relationships between key SOC and ACT variables in relation to age-related wellbeing were explored among a sample of older American adults.

Methods: Older adult participants (n = 87) were recruited online from social media sites. This sample size provided sufficient power to test hypotheses. Participants completed measures of demographic characteristics, ACT constructs (acceptance, defusion, present-moment-awareness, self-as-context, values), SOC utilization, geriatric morale, purpose in life, and quality of life.

Results: Acceptance and defusion were significantly correlated with SOC variables and wellbeing. Acceptance and defusion mediated the relationship between SOC utilization and age-related wellbeing.

Conclusions: Acceptance and defusion were associated with better adjustment to the potential losses that co-occur with aging. Acceptance and defusion may also promote more openness to making changes in daily behaviors that can permit optimization and compensation of age-related losses.

Clinical implications: Interventions that promote acceptance and defusion may be promising for older adults as they navigate the aging process.

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.