Clinical Gerontologist最新文献

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.

Objectives: This study was conducted to determine the relationships between activities of daily living (ADL), depression, and quality of life. Specifically, the study aimed to evaluate the potential mediating role of depression in the relationship between activities of daily living and quality of life in a sample of Iranian older adults.

Methods: This cross-sectional study recruited 118 older adult adults with multiple chronic conditions in Iran from December 2022 to September 2023. Data were collected using a demographic and health information questionnaire, the Katz Index, the Lawton scale, Old-World Health Organization Quality of Life, and the Geriatric Depression Scale. Path analysis was used to test the hypothesis.

Results: Participants' average age was 70.15 ± 6.91 years. BADL (B = 0.2, p = .02), and depression (B = -0.25, p = .004) were significantly related to the quality of life. The standardized indirect effect of BADL on quality of life was 0.08 (p = .006).

Conclusions: According to the results of this study, functional status can directly and also, indirectly affect the quality of life of older adults with multiple chronic conditions through depression.

Clinical implications: Health care providers are advised to carefully assess older adults' mental health and functional status and consider their relationships to quality of life.

Objectives: The study aimed to investigate the influence mechanism underlying the relationship between Internet use and depressive symptoms in Chinese older adults.

Methods: Data were derived from the 2018 wave of China Longitudinal Aging Social Survey. Mediation and moderation analyses were conducted using Ordinary list squares (OLS) regression analysis. To address potential endogenous issues, we employed the Propensity Score Matching (PSM) method to explore the association between Internet use and depressive symptoms.

Results: Our findings indicate that Internet use can significantly reduce depressive symptoms and enhance mental health of older adults. Loneliness mediated the relationship between Internet use and depressive symptoms among older adults, while socioeconomic status (SES) moderated this relationship. Furthermore, the four purposes of Internet use, namely online chatting, information searching, recreational activities, consumption and investment, were negatively associated with loneliness and depressive symptoms among older adults.

Conclusions: The findings emphasize the positive effects of Internet use on the mental health outcomes of older adults.

Clinical implications: The proper use of the Internet possesses considerable promise for clinical rehabilitation, targeting the enhancement of the mental health outcomes of older adults during their later life.

Objectives: The study evaluated the feasibility of implementing Dementia Collaborative Coaching (DCC) into the routine workflow of speech-language pathologists (SLPs) working in nursing homes (NHs). DCC is an intervention delivered by SLPs to train nursing assistants (CNAs) in communication strategies to support people living with dementia (PLWD).

Methods: We assessed the feasibility of identifying eligible PLWD; estimated intervention fidelity; evaluated suitability of outcome measures; and determined the preliminary impact on behavioral and psychological symptoms of distress (BPSD) among PLWD. SLPs completed a semi-structured interview to collect further acceptability data.

Results: Four SLPs in four NHs completed DCC with 10 CNAs and 15 eligible PLWD that they appropriately identified from their caseloads. SLPs conducted 90 DCC sessions with 64% fidelity and billed Medicare for all sessions. The outcome measure of Minimum Data Set item E0200B: Rejection of Care did not vary enough to be useful, but positive changes were noted on the Cohen-Mansfield Agitation Inventory, t(14) = 10.51, p < .001, Cohen's d = 2.76. Interviews further indicated feasibility.

Conclusions: It is feasible to implement DCC into the workflow of SLPs in NHs.

Clinical implications: Given the feasibility and preliminary positive impacts, SLPs could consider implementing DCC in routine care.

Objectives: This study examines sexual orientation/gender identity (SOGI) data collection in older adults from the UCHealth systems electronic health record.

Methods: Data of older adults aged 55 and older were analyzed between January 2019 and December 2022. Prevalence of SOGI documentation based on four new SOGI-related questions were analyzed along with social history documentation.

Results: Data were missing in reports (93% for sexual orientation and 96% for gender identity). Of 459,544 older adults potentially identifiable as a sexual or gender minority (SGM), 8.24% could be identified through other social history, and 91.76% could not. Data often returned a response of "undisclosed" (1.04%) or "unspecified" (98.79%), leaving .005% to represent the identifiable population of SGM minority adults.

Conclusions: SOGI data often was not documented through questions recommended since January 2019. It is unlikely that .005% accurately represents the SGM older patient population as national estimates are between 7%-11%. Lower reported percentages of SGM older adults may lead to less recognition of patient needs, and thus less equitable and personalized care.

Clinical implications: These findings exemplify the need for evaluation strategies to be designed to improve SOGI collection with the primary goal of promoting equity and inclusion for SGM older adults.

Objectives: To implement a transcultural adaptation of the Caregiver Guilt Questionnaire (CGQ) for the Brazilian population.

Methods: Five stages were involved in the adaptation: two independent translations by Brazilian nationals fluent in Spanish; summary of translations produced; back-translation; evaluation by expert panel of judges (n = 5); and lastly, assessment by family caregivers (n = 30).

Results: semantic changes were made to render the items more relevant to Brazilian culture and replicate the five factors of guilt proposed by the original questionnaire.

Conclusions: A Brazilian version of the questionnaire was produced and transculturally adapted for use in Brazil, allowing future validation and application.

Clinical implications: The CGQ allows healthcare professionals to quantify feelings of guilt. Clinicians and clinical researcher can use the scale to obtain more precise interventions.

Objectives: Currently, there is a growing interest on the benefits of volunteering. Nevertheless, there is scarce evidence for non-volunteering altruistic behaviors. This study aims to investigate the role of both altruism and volunteering on the cognitive performance of older individuals followed for four years.

Methods: This was cohort study carried out in 180 Brazilian older adults assessed in three different timepoints (baseline [2015-2016], 2 years of follow-up [2017-2018] and 4 years of follow-up [2019-2020]). Composite cognitive score was calculated based on the Mini-Mental State Examination, Verbal Fluency, Clock-Drawing test, and CERAD Word-List. Altruism was assessed through the Self-reported Altruism Scale and self-reported volunteering status. Mixed ANCOVAS were performed.

Results: For altruism, there were significant differences in all time points (Baseline, 2 years and 4 years) favoring higher cognitive scores for higher levels of altruism. However, no differences were observed for volunteering in all time points.

Conclusions: Having higher levels of altruism was significantly associated with better cognitive scores.

Clinical implications: Altruism, even without volunteering, seem to have positive effects on the cognitive functioning of older adults. Health professionals who take care of older adults might take account of the presence or absence of altruistic behaviors of their patients in their formulations and recommendations.

Objective: To evaluate the feasibility and acceptability of a virtually delivered psychoeducational skill-building intervention for ADRD caregivers.

Methods: A single-arm, pre-posttest pilot study design was employed to evaluate the intervention. Four 90-min group-based weekly sessions were combined with four individual coaching sessions via Zoom. Intervention components covered topics designed to reduce caregiver stress and distress, and a VR experience to help caregivers understand dementia. Data was gathered via REDCap pre- and post-intervention and through post-intervention interviews via Zoom.

Results: Results (N = 20) from individual interviews, surveys, and treatment implementation strategies suggest strong feasibility and acceptability. Key change exploration indicated medium effect sizes and statistical significance in preparedness for caregiving (t(19) = 2.69, p = .015, d = 63), communication (t(19) = 2.45, p = .024, d = 0.55), and a medium effect size for the mindful attention awareness scale (t(19) = 0.48, p = (0.637, d = 0.54). Further, participants reported their perceptions of improvement in outcomes such as the ability to care, increased understanding of memory loss, and confidence.

Conclusions: Through Alzheimer's Eyes is a feasible and acceptable intervention that blends technology with skill-building strategies to help caregivers manage their stress and distress regardless of their location.

Clinical implications: There is potential for interventions including VR to assist family caregivers in managing caregiving challenges and improve well-being.

Objectives: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings.

Methods: We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022.

Results: We screened 6,582 articles; 29 randomized trials met inclusion criteria. Three studies on patient-facing HCW interactions (e.g. medication management, diagnosing distress) showed mixed results on agitation; one study found no effect on quality of life. Six HCW-focused studies suggested short-term reduction in distress behaviors. Quality-of-life improvement or decreased antipsychotic use was not evidenced. Among 17 interventions combining HCW-focused and patient-facing activities, 0 showed significant distress reduction, 8 showed significant antipsychotic reduction (OR = 0.79, 95%CI [0.69, 0.91]) and 9 showed quality of life improvements (SMD = 0.71, 95%CI [0.39, 1.04]). One study evaluating HCW, patient-, and environmental-focused intervention activities showed short-term improvement in agitation.

Conclusions and clinical implications: Novel health care models combining HCW training and patient management improve patient quality of life, reduce antipsychotic use, and may reduce distress behaviors. Evaluation of intervention's effects on staff burnout and utilization is needed.

Objectives: Explore the indications for long-stay gabapentin use and elucidate the factors spurring the rapid increase in gabapentin prescribing in nursing homes (NHs).

Methods: National cross-sectional survey of NH prescribers distributed anonymously using SurveyMonkey. Sampling for convenience was obtained through crowdsourcing, leveraging collaborations with NH clinician organizations. Developed by a multidisciplinary team, pilot data/existing literature informed survey content.

Results: A total of 131 surveys completed. Participants: 71% white, 52% female, 71% physicians. Off-label gabapentin prescribing was ubiquitous. Nearly every clinician used gabapentin for neuropathic pain, most for any form of pain. Many clinicians also prescribe gabapentin to moderate psychiatric symptoms and behaviors. Clinicians' prescribing was influenced by opioid, antipsychotic, and anxiolytic reduction policies because gabapentin was perceived as an unmonitored and safer alternative.

Conclusions: Off-label gabapentin increases are closely linked to opioid reduction efforts as more NH clinicians utilize gabapentin as an unmonitored opioid alternative. Our results highlight, however, the less recognized significance of long-stay prescribing for psychiatric symptoms and the similar contribution of psychotropic reduction initiatives, a phenomenon warranting further scrutiny.

Clinical implications: Clinicians perceive gabapentin as safer than the drugs it is replacing. Whether this is true remains unclear; the individual- and population-level risks of increased gabapentin use are largely unknown.