Clinical Gerontologist最新文献

Objectives: Caregivers for people with dementia (PWDs) often experience sleep problems due to stressors associated with their role (e.g. concern about PWDs' nighttime wandering). We investigated whether a technology system, People Power Caregiver (PPCg), that helps monitor the caregiver's home would benefit caregivers' sleep.

Methods: Primary caregivers of PWDs (Study 1: N = 70, Age M = 64.54, SD = 11.82, range = 35-84; Study 2: N = 92, Age M = 62.73, SD = 11.10, range = 32-89) were assigned to a fully activated PPCg condition or control condition (Study 1: partially active PPCg; Study 2: waitlist control). Caregivers completed the Pittsburgh Sleep Quality Index at baseline, three-months, and six-months.

Results: Caregivers in the control conditions reported significantly worsening sleep efficiency whereas in comparison, those in the active conditions reported improving sleep efficiency.

Conclusions: Given how critical sleep is both for caregivers' health and the care they provide, these findings underscore potential benefits of in-home technologies for protecting caregivers' sleep.

Clinical implications: Technology-based interventions that help monitor the home may support caregivers' sleep. Protecting caregivers' sleep may also preserve their ability to provide high-quality care as their loved one's disease and associated functional decline progresses.

Objectives: Family accommodation (e.g. providing excessive reassurance, facilitating avoidance) is widespread and exacerbates anxiety in children and young adults, however has not been examined in older adults. There are reasons to expect that family accommodation may also exacerbate anxiety in later life. However, it is important to consider that age-related changes in physical or cognitive abilities may necessitate the need for functional assistance from others during assessment. This study aimed to examine the phenomenology and clinical correlates of family accommodation in older adults.

Methods: Participants were 32 community-dwelling older adults, aged 60-88 (M = 69.78, SD = 8.62; 31% with a probable anxiety disorder) and their supporters. Dyads reported on supporter accommodation, mental health and functional ability and completed a behavioral stress task designed to elicit behavioral accommodation (intrusiveness, reassurance, and avoidance).

Results: 80% of supporters of older adults with anxiety engaged in accommodation.Accommodation was associated with greater anxiety severity, but not functional ability.

Conclusions: Family accommodation is common from supporters of older adults with anxiety, and linked to increased anxiety. Assessment and modification of these environmental reinforcers may be important targets for treatment.

Clinical implications: Accommodation is an important environmental factor maintaining late-life anxiety, and should be reduced.

Objectives: Many older Colombians have been exposed to violence. This study sought to explore stakeholders' perceptions of older adults' mental well-being needs and mental well-being service provision within a Colombian displaced community.

Methods: Employing an exploratory qualitative design, semi-structured and in-depth interviews were conducted with stakeholders of health, public health and welfare services between October 2021-June 2022. Two public advisors were involved in devising the topic guide, which elicited information on older adults' mental well-being needs and service provision. Interviews were conducted in Spanish, transcribed verbatim and translated into English. Data were analyzed by an inductive thematic analysis.

Results: Thirteen stakeholders were interviewed. Three themes were generated: 'older adults' unmet well-being needs;' characterizing the provision of mental well-being services; and barriers and facilitators to increasing the provision of mental well-being services. Older adults experienced considerable mental well-being needs. While stakeholders' motivation to address unmet needs appeared high, service provision seemed limited and fragmented, hamstrung by insufficient resources.

Conclusions: Older adults in this community are underserved. Greater priority and resources, need to be allocated to mental well-being services.

Clinical implications: Greater and widely accessible resources, human and financial, are required to further expand the current provision of mental well-being services.

Objectives: Evidence for the association between purpose in life and cognitive health is primarily from North American and European samples. This study evaluates this association in a large sample from Malaysia, an upper-middle-income country in Southeast Asia.

Methods: Participants (N = 5,579) from the Malaysian Ageing and Retirement Study reported on their purpose in life and subjective memory and were administered tasks that measured episodic memory, verbal fluency, and overall cognitive function.

Results: Purpose was associated with better subjective memory (β=.13), episodic memory (β=.06), verbal fluency (β=.12), and overall cognitive function (β=.07) (ps < .001). The associations were similar across sex and retirement status; purpose was more strongly related to subjective memory and overall cognitive function among older participants. Behavioral/social factors accounted for up to one-third of the associations, but all associations remained statistically significant.

Conclusions: The positive association between purpose and cognition generalizes to a middle-income country in Southeast Asia. Similar to Western samples, behavioral and social factors accounted for part but not all the association. More research is needed in lower- and other middle-income countries to fully evaluate generalizability.

Clinical implications: Purpose may help support healthier cognitive aging across diverse populations and be a useful target to improve cognitive aging outcomes.

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: Dementia caregiving often results in caregiver burden, but self-mastery may buffer against burden's negative impact. This work explores the link between these variables, examining potential moderators, through systematic review and meta-analysis.

Methods: A PubMed, PsychInfo, Scopus, and Medline search in April 2024 resulted in 25 eligible studies. The Appraisal tool for Cross-Sectional Studies assessed bias risk. Meta-regression via continuous random effects model was conducted in R to examine the relationship between dementia caregiver burden and self-mastery as well as moderating variables.

Results: A medium strength meta-correlation, r=-.347 (95% CI: -.413, -.278, p < .0001) was detected. Percent of extended family caregivers (e.g. nieces, cousins, grandchildren; β=-1.01, 95% C.I. (-1.71, -.32), p < .01) and percent of cases with frontotemporal dementia (β=-.67, 95% C.I. (-1.20, -.13), p < .05) attenuated the relationship.

Conclusions: Results may support the role of self-mastery in mitigating effects of caregiver burden, though experiences unique to extended family or frontotemporal dementia may weaken that relationship. The current review was limited by lack of diversity in potential moderator variables, pointing to needs for future research.

Clinical implications: Findings highlight the robustness of the relationship between self-mastery and caregiver burden, possibly informing self-mastery-based interventions and helping clinicians identify and treat at-risk caregivers.

Objectives: The aim of this study is to assess the effect of virtual reality (VR) sessions on the mental health of older adults.

Methods: This interventional multicentric study included 68 participants in residential aged care facilities in Auvergne-Rhône-Alpes and Nouvelle-Aquitaine (France). The intervention consisted of eight VR sessions that incorporated a personalized 360° video followed by social interaction. Changes in anxiety, depression, quality of life, emotional state, identification with care community, and loneliness were assessed in pre- and post-intervention. Experience with VR, such as sense of presence and cybersickness, were assessed after the first session.

Results: There was a significantly reduced depression score (pre Mean (M) = 5.2 ± 3.5; post M = 4.5 ± 3.3; p = .02) and a significantly increased quality of life score (pre M = 29.1 ± 5.3; post M = 29.8 ± 4.2; p = .03), but no reduction in the anxiety score. Average cybersickness was minimal (8.4 ± 11.2). Finally, the average sense of presence felt was high (5.6 ± 1.2).

Conclusions: This study shows the potential of VR sessions to enhance the mental health of institutionalized older adults. To substantiate these preliminary findings, a rigorously designed Randomized Controlled Trial may be essential.

Clinical implications: This intervention can be applied to institutionalized older adults to promote their mental health.

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: Our understanding of elder abuse (EA) phenomena has largely been shaped from the perspective of researchers and professionals whose conceptualizations often differ from the perceptions of older adults who experience mistreatment. This study sought to understand the most distressing aspects of EA victimization from the perspective of survivors.

Methods: Using a descriptive phenomenological approach, individual interviews were conducted with a diverse sample (n = 32) of EA survivors, recruited from EA support and Adult Protective Services programs in New York City and Los Angeles. Analysis followed a constant comparison process involving two independent coders to understand distressing aspects of EA victimization.

Results: The following themes emerged as the most distressing aspects of EA victimization: fear, disbelief, disrespect, concern for perpetrator and other family members, feelings of loss, and incongruity between survivor wishes and systemic responses. Distressing aspects of EA victimization spanned personal, relational, and systemic levels of ecological influence.

Conclusions: Findings from this study advance basic knowledge on EA phenomena and carry direct implications for programs designed to support and meet the needs of survivors.

Clinical implications: Findings identify particularly distressing psycho-emotional aspects of EA victimization for clinicians interacting with survivors that can serve as targets of intervention.