Clinical Gerontologist最新文献

Objectives: This systematic review assessed use of third-wave psychotherapies in reducing psychological distress and improving psychological well-being and quality of life in people with Parkinson's disease and critically evaluated intervention adaptations.

Methods: A literature search, conducted across five databases identified randomized controlled trials (RCTs) evaluating third-wave psychotherapies for individuals with Parkinson's disease.

Results: Ten RCTs were identified of which nine evaluated mindfulness-based interventions, and one acceptance and commitment therapy. Methodological quality ranged from moderate to high, but sample sizes were small, and only one study was adequately powered. Five reported on Parkinson's specific adaptations. The trial with the largest sample size reported a significant effect of Mindfulness Yoga on depression and anxiety, psychological well-being and quality of life. Other findings were mixed across all outcomes.

Conclusions: There was evidence of an effect of Mindfulness Yoga on our pre-defined outcomes. Pilot and feasibility trials showed that mindfulness-based interventions were well received and provided feedback on adaptations. There was a lack of data to draw conclusions regarding non-mindfulness-based therapies.

Clinical implications: Larger trials of mindfulness-based interventions are required to establish the clinical meaningfulness of treatment effects. Further research is needed to adapt and explore on non-mindfulness-based interventions such as acceptance and commitment therapy.

Objectives: Simple reminiscence has been used as a non-pharmacological strategy to improve emotional well-being and adaptation in older adults, particularly those with mild cognitive impairment due to Alzheimer's disease. This study examined the effects of a simple reminiscence-based intervention on different reminiscence functions in this population.

Methods: 113 participants were randomly assigned to an experimental (n = 61) or control group (n = 52). The experimental group received 16 reminiscence sessions over eight weeks. Assessments occurred pre-, post-intervention, and at follow-up. The eight subscales of the Reminiscence Functions Scale served as the study's primary outcome variables. Intervention effects were analyzed using 2 × 3 mixed ANOVAs (group × time).

Results: The results showed significant improvements in adaptive reminiscence functions, including identity, problem-solving, and preparation for death, as well as in the prosocial functions of conversation and teaching/informing in the experimental group compared to the control group.

Conclusions: These findings suggest that simple reminiscence can be an effective strategy for preserving and enhancing adaptive reminiscence functions in older adults with mild cognitive impairment due to Alzheimer's disease. Clinical Implications: This intervention can be integrated into routine care for individuals with cognitive impairment, helping maintain emotional-cognitive functioning and improve quality of life.

Objectives: Arthritis is associated with poor quality of life (QOL) among older adults; and QOL is even worse among those with arthritis and multimorbidity (MM). Illness intrusiveness and perceived control have been identified in studies of single illnesses as modifiable mechanisms for QOL, but are understudied in older adults with arthritis and MM. We investigated the role of these potential mechanisms with QOL among older adults with arthritis and MM.

Methods: Secondary analysis of a sample of older adults aged ≥ 62 years with arthritis and MM (N = 228) using PROCESS macro for SPSS.

Results: Participants were on average 72 years with 4 chronic illnesses, and high levels of pain intensity and illness intrusiveness. Perceived control was a significant mediator (but not moderator) in the relationship between illness intrusiveness and QOL, even after adjustment for pain intensity [β = -0.16, 95% CI (-0.13, -0.06)].

Conclusions: Lower levels of illness intrusiveness were associated with improved QOL through greater perceived control. Longitudinal studies are needed to further assess these mechanisms in older adults with arthritis and MM to adapt existing interventions.

Clinical implications: Perceived control may be a target for future behavioral interventions to improve QOL in this population.

Objectives: The purpose of this study was to explore the mediating roles of care receiver clinical factors on the relationship between care partner preparedness and care partner desire to seek long-term care admission for persons living with dementia at hospital discharge.

Methods: This study analyzed data from the Family centered Function-focused Care (Fam-FFC), which included 424 care receiver and care partner dyads. A multiple mediation model examined the indirect effects of care partner preparedness on the desire to seek long-term care through care receiver clinical factors (behavioral and psychological symptoms of dementia [BPSD], comorbidities, delirium severity, physical function, and cognition).

Results: Delirium severity and physical function partially mediated the relationship between care partner preparedness and care partner desire to seek long-term care admission (B = -.011; 95% CI = -.019, -.003, and B = -.013; 95% CI = -.027, -.001, respectively).

Conclusions: Interventions should enhance care partner preparedness and address delirium severity and physical function in hospitalized persons with dementia to prevent unwanted nursing home placement at hospital discharge.

Clinical implications: Integrating care partner preparedness and care receiver clinical factors (delirium severity and physical function) into discharge planning may minimize care partner desire to seek long-term care.

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 cross-sectional study aims to investigate the relationship between cognitive reserve (a well-known protective factor in aging) and attachment style in a sample of healthy older individuals.

Methods: The study assessed the cognitive reserve and attachment styles of 160 older adults (all involved in a romantic relationship at time of data collection).

Results: Findings highlighted high avoidance-based styles in aging individuals. Data also highlighted how individuals with avoidant attachment are more likely to have a higher cognitive reserve.

Conclusions: Based on the results, cognitive reserve training might be useful to reduce anxiety in individuals with anxious attachment styles, who appeared to be the least engaged in activities that could benefit their cognitive reserve.

Clinical implications: Therapists should identify and address avoidant attachment styles in older clients, use strategies to increase cognitive reserve for those with avoidant attachment, and incorporate cognitive reserve-building activities into anxiety reduction programs for clients with anxious attachment styles.

Objectives: Remotely delivered attentional bias modification (ABM) studies involving persons with cognitive impairment are lacking. Thus, the feasibility of an adapted ABM paradigm with webcam-based eye tracking was explored.

Methods: Four of the eight participants recruited (males, M_age = 69 years, Alzheimer's disease = 3, mild cognitive impairment = 1) completed up to four daily ABM sessions. Tasks comprised pre- and post-intervention depression (PHQ-9), anxiety (GAD-7), and rumination (RRS) measures, a cognitive screen (TICS) (A), affect (PANAS) (B) and dot-probe AB measures (C), and dot-probe ABM (D) (Session 1-A, B, C, D, C, and B; Sessions 2 to 4-B, D, C, and B).

Results: The intervention was feasible (as defined by completion rates) and appeared beneficial in this small sample (as defined by post-intervention improvements in mood). Sessions were long, and task completion/adherence was impacted by task access/participants' ability to complete tasks independently. Mind wandering, stimuli familiarity, and eye/fatigue were reported.

Conclusions: The intervention requires further adaptation (e.g. fewer eye-tracking tasks per session). Limitations include participant self-selection/loss, a lack of control group, and that the determinants of mood change are unclear.

Clinical implications: ABM, a novel intervention, may be an effective mood-disorder treatment for individuals with cognitive impairment.

Objectives: Patients often struggle with psychological and social stressors that accompany life-limiting chronic illness. Because psychosocial concerns may be conveyed through emotional sentiments, this study aimed to identify emotional expressions to describe psychosocial contexts communicated during goals of care conversations.

Methods: This qualitative study evaluated 26 transcripts of goals of care conversations using a "goals of communication guide" from the ADvancing system Alleviation with Palliative Treatment (ADAPT) trial in VA Eastern Colorado and Puget Sound Health Systems. Using an inductive and deductive approach, a codebook was developed to examine participants' expressed emotions regarding overall goals of care, illness, end of life, and family involvement. Major themes around psychosocial concerns were summarized.

Results: Four themes on psychosocial contexts in goals of care conversations emerged, with instances of both positive and negative affect. Participants commonly discussed contexts relating to: acceptance of illness, the feeling of being a burden; illness transitions; and suffering from disease.

Conclusions: Unprompted within these conversations, patient emotional sentiments in goals of care conversations highlight psychosocial contexts important to patient values and preferences around treatment decisions.

Clinical implications: Emphasis on clinician recognition of these psychosocial contexts may help clinicians better support and elicit patient goals and preferences.

Objectives: This study investigates racial/ethnic disparities in dementia risk and protective factors using data from the Health and Retirement Study (HRS) and the Harmonized Cognitive Assessment Protocol (HCAP).

Methods: A retrospective analysis of 3,495 individuals aged 65+ from the 2016 HCAP linked to the HRS was conducted. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) scores. Risk factors included midlife cardiovascular conditions, hearing loss, current smoking, depression, and physical inactivity. Protective factors were education and wealth. The Oaxaca-Blinder decomposition method was used to quantify the contribution of these factors in explaining racial/ethnic disparities in cognitive functioning.

Results: Black participants had 2.883 times higher odds of developing dementia compared to Whites, while Hispanic participants had 1.230 times higher odds (not statistically significant). Mid- and late-life risk and protective factors explained 32% of the cognitive gap between Black and White participants, and 70% between Hispanic and White participants, leaving 68% and 30% unexplained, respectively.

Conclusions: Addressing disparities in education, wealth, cardiovascular risks, depression, and hearing loss can reduce cognitive dysfunction in older adults.

Clinical implications: Clinicians should target modifiable risk factors like depression and physical inactivity, particularly in minority populations. Addressing socioeconomic disparities is also crucial for improving cognitive health.