Clinical Gerontologist最新文献

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.

Objectives: Gerotranscendence has gained recognition as an important psychosocial theory, with leading studies promoting it through intervention programs. However, to date, few interventions have involved older adults living in Long-Term Care (LTC) facilities. This study aimed to explore the viability of implementing six-week program on gerotranscendence [GLOW] in an LTC facility.

Methods: A feasibility study was conducted with a group of six residents. Screening, consent, retention, adherence, and social validity indicators were considered. A Non-Pharmacological Therapy Experience Scale (NPT-ES) was used to assess the participation and engagement of each participant throughout the sessions. A focus group was also conducted.

Results: The consent, retention, and adherence rates for the program were satisfactory (100%), while the screening rate (22.22%) was lower due to the inclusion criteria. Participants agreed that the program was important and interesting. The scores of NPT-ES were high and increased over the course of the sessions.

Conclusions: The GLOW program can be considered a feasible, acceptable, and valuable tool for promoting gerotranscendence in older adults living in an LTC.

Clinical implications: Promoting an intervention rooted in gerotranscendence can be beneficial for older adults who live in LTC facilities on educational and emotional levels.

Objectives: An aggregated interventional N-of-1 or single-case design was used to assess the impact of a befriending intervention on a) health-related quality of life (HR-QoL), and b) the association between loneliness on HR-QoL among older adults.

Methods: Participants were n = 33 new users of the service, aged 60 + . Outcomes were measured at 13 timepoints across 26 weeks, and data were analyzed using generalized additive modeling (GAM) with a subset of data analyzed using supplementary visual analysis.

Results: Results indicate that the befriending service may reduce decline of HR-QoL (i.e. HR-QoL declined in the baseline phase over time: edf = 3.893, F = 3.0, p = .002, while in the treatment phase, HR-QoL remained more stable: edf = 5.98, F = 2.98, p = .008). The intervention also suppressed the impact of loneliness on HR-QoL.

Conclusions: Befriending interventions may prevent declines in HR-QoL, and may moderate the impact of loneliness on HR-QoL.

Clinical implications: Our preliminary findings suggest that befriending services may be useful if clinicians have concerns about the health impacts of loneliness for older people. It is difficult to evaluate community-based services, and we consider the challenges we faced, with a view to assisting others planning similar evaluations.

Objectives: The proportion of individuals with insomnia is increasing, and many older adults have insomnia. This study aimed to explore the relationships between family functioning and quality of life (QOL) among community-dwelling older adults with insomnia, as well as to explore the mediating role of sleep quality in this relationship.

Methods: The participants were 225 older adults with insomnia from community health service centers in Chongqing, China. The Family Care Index (APGAR) was used to assess family functioning, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the 36-item Short-Form Health Survey (SF-36) was used to assess QOL.

Results: The results showed that family functioning would be positively associated with QOL (p = .005) and that this relationship would be partially mediated by higher sleep quality (p < .001).

Conclusions: Family functioning has a direct effect on QOL and an indirect effect on QOL through the regulation of sleep quality. Maintaining good family functioning is important for improving sleep quality and QOL in older adults with insomnia.

Clinical implications: Developing family functioning-based assessments and targeted intervention strategies could be beneficial for older adults with insomnia.

Objectives: We explored the trajectories of sleep patterns and their relationship with conversion to MCI or dementia in a sample of older adults.

Methods: A total of 1984 participants ( >64 years old) in a population-based, longitudinal study (HELIAD), provided information regarding their sleep patterns. A full neurological exam and a comprehensive neuropsychological assessment were conducted to determine MCI and dementia diagnoses. Baseline and three-year follow-up associations of sleep patterns with cognitive status (healthy, MCI, dementia), age, education and sex were analyzed with the utilization of generalized estimating equation models.

Results: Baseline sleep patterns did not differentiate between initially healthy participants who converted either to MCI or dementia and those who remained healthy at follow-up. Baseline healthy participants who converted to MCI at follow-up reported more frequent sleep quality problems at follow-up than the consistently healthy participants (p = .032). Baseline healthy participants who converted to dementia at follow-up conveyed less frequent sleep disturbances(p = .009), greater sleep adequacy ratings (p = .006) and longer sleep duration (p = .001) at follow-up compared to their consistently healthy counterparts.

Conclusions: Sleep pattern trajectories were not associated with cognitive diagnosis. Sleep pattern alterations do not appear to predate conversion to MCI or dementia among cognitively healthy older adults.

Clinical implications: Discrepancies in self-reports might reflect a compromise in the ability to form objective judgments. These discrepancies may help differentiate between MCI and early dementia.

Objectives: In this study, we examine the association between multimorbidity and psychological distress and to what extent elder abuse mediates the association.

Methods: We analyzed cross-sectional nationally representative data from the "Building Knowledge Base on Population Ageing in India (BKPAI)." Multivariate logistic regression was used to understand the association between multimorbidity and psychological distress. We used Karlson-Holm- Breen (KHB) method to understand the role of elder abuse in mediating the association between multimorbidity and psychological distress.

Results: Older adults who ever experienced abuse (OR = 1.92 95%CI = 1.62, 2.26, p < .001) or in last one month (OR = 2.09 95%CI = 1.65, 2.64, p < .001) reported higher odds of psychological distress. Further, older adults with four or more chronic diseases are thrice more likely to report psychological distress (OR = 3.03 95%CI = 2.38, 3.82, p < .001). The results further suggest the mediating role of abuse on the association between multimorbidity and psychological distress.

Conclusions: The results suggest the role of elder abuse on the association between multimorbidity and psychological distress among older population in India.

Clinical implications: Creating an environment to reduce the abuse among older adults who have multimorbidity will be essential to reducing the psychological distress among older adults in India.

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: 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.