Clinical Gerontologist最新文献

Objectives: Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia.

Methods: We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment.

Results: Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160).

Conclusions: Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness.

Clinical implications: ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.

Objectives: Past geriatric studies related to the mediating role of physical activity in depression are scarce. This is perhaps the first study to examine the mediating effects of physical activity on the associations between depression and age, and education among older adults.

Methods: Statistical analyses of cross-sectional data from a nationally representative survey on Malaysian older adult health were conducted. Structural equation modeling was used to assess the extent to which physical activity mediated the relationships between depression and age, and education. Associations between variables were explored using multivariable logistic regressions.

Results: Analyses were based on a sample of 3974 older adults (aged ≥60 years). Only 12.2% of older adults had depression. Age was positively associated with the odds of depression. Better educated older adults were less likely to experience depression than less educated older adults. Physical activity fully mediated the association between depression and age, whereas it partially explained the depression-education relationship.

Conclusions: Older age and low educational levels were risk factors for depression, and physical activity was identified as a mediator.

Clinical implications: Older and less-educated older adults should be encouraged to participate in physical activity, and those at risk of depression should be given special attention.

Objectives: Although the association between sleep disorders and frailty has been well established, little is known about the cognitive appraisal mechanisms underlying this association. Building on the transactional theory of stress and coping, this study explores the role of self-efficacy and coping style in the association between sleep quality and frailty among community-dwelling older adults.

Methods: In this cross-sectional study, 585 community-dwelling older adults were investigated using the Pittsburgh Sleep Quality Index, Tilburg Frailty Indicator, General Self-Efficacy Scale, and Simplified Coping Style Questionnaire. Descriptive statistics and hierarchical regression were performed. A moderated mediation model was established using the PROCESS macro.

Results: Poor sleep quality affects frailty directly (B = 0.193, p < .01) and indirectly via self-efficacy (B = 0.063, p < .01). The negative impact of poor sleep on frailty through self-efficacy was moderated by both positive and negative coping style (index =  -0.007). The moderating effect was stronger when participants' negative coping tendencies increased.

Conclusions: Poor sleep quality indirectly influences frailty by modifying self-efficacy. Effective coping strategies can help attenuate this association.

Clinical implications: Timely sleep assessment and tailored strategies such as psychoeducational programs and targeted coping skills training may be beneficial for preventing frailty in older adults.

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: Exposure to ageism may be internalized in older adults, and this can have severe consequences. However, little research has addressed reducing internalized ageism. Thus, Reimagine Aging, a 6-week process-based intervention to reduce internalized ageism, was designed and implemented, using education, acceptance and commitment therapy, and attributional retraining to target theoretically based mechanisms of change.

Methods: Seventy-two older adults (M = 70.4 years, SD = 6.4 years) participated in Reimagine Aging, consented to participate in this robust single-sample pilot study, and provided valid data. Participants completed questionnaires prior to, immediately following, and 2 months after the intervention.

Results: Participants' self-perceptions of aging (${\eta }_p^2$=0.37, p < .001) and perceptions of older adults (${\eta }_p^2$=0.27, p < .001) became significantly more positive, associated with large effect sizes. Furthermore, these positive gains were mediated by increases in psychological flexibility, mindfulness, and perceived control.

Discussion: This study provides initial support for this process-based intervention targeting a reduction of internalized ageism.

Clinical implications: This program has the potential to reduce the negative impact internalized ageism has on the health of older adults. Furthermore, it provides novel insights into intervention targets and tools that may be useful in achieving this reduction.

Background: For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce.

Methods: In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4).

Results: There was a significant decrease in depressive symptoms across both arms with Cohen's d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations.

Conclusions: Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs.

Clinical implications: Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations.

Trial registration: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).

Objectives: This pilot study assessed the feasibility of a group-based telephone-delivered meditation intervention to reduce social isolation in older adults. It included weekly training sessions and daily practices of loving-kindness meditation in small groups via telephone conferences for six weeks and an extended group meditation practice for another six weeks.

Methods: Community-living older adults (age 60+) with multiple chronic conditions and experiencing social isolation were recruited. Each participant was assessed at the pretest, posttest, and follow-up (6 and 12 weeks after pretest). Outcome measures included social interaction, loneliness, and depressive symptoms. Open-ended questions were asked in the posttest and follow-up.

Results: Sixteen individuals enrolled, and fourteen completed the program (87.5% retention). Completers showed high levels of adherence (95% attendance to training) and acceptability and a statistically significant increase in social interaction at follow-up. Qualitative data suggest that participants experienced changes in emotion regulation, motivation and confidence, and sense of belonging.

Conclusions: A group-based telephone-delivered meditation intervention targeting chronically ill older adults who experience social isolation is technically feasible, very acceptable, and potentially beneficial to them.

Clinical implications: Older adults enjoy learning meditation. Telephone conferencing is a low-cost tool for engaging socially isolated older adults in social interactions and group meditation.

Objectives: This study investigated whether the relationship between thwarted belongingness and depressive symptoms was moderated by self-warmth and self-coldness and whether the moderating effects were conditional on place of residence (urban versus rural).

Methods: A sample of 236 Australian adults aged 65 to 97 years (M = 73.63, SD = 6.53) completed the Geriatric Depression Scale, Interpersonal Needs Questionnaire, and Self-Compassion Scale.

Results: The interaction between thwarted belongingness and self-warmth was significant for urban but not rural older adults. For urban older adults, the relationship between thwarted belongingness and depressive symptoms weakened as levels of self-warmth increased. The association between thwarted belongingness and depressive symptoms was significantly stronger for older adults living in rural areas than in urban areas. The relationship between thwarted belongingness and depressive symptoms strengthened as self-coldness levels increased.

Conclusions: Self-warmth is a protective factor for older adults living in urban areas and experiencing thwarted belongingness. Self-coldness is an additional risk factor for older adults experiencing thwarted belongingness.

Clinical implications: Interventions focusing on increasing self-warmth among urban older adults and decreasing self-coldness among older adults might weaken the relationship between thwarted belongingness and depressive symptoms.