Clinical Gerontologist最新文献

Objectives: To review the need-driven dementia-compromised behavior (NDB) model and its application in dementia care.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review guidelines. We searched electronic databases including Embase, PubMed, Web of Science, Cochrane Library, Scopus, and the Chinese databases CNKI, Wanfang, VIP, and SinoMed from November 1996 to December 2024.

Results: Overall, 22 studies were included. Eleven studies explored the factors influencing behavioral and psychological symptoms of dementia (BPSD), 10 focused on nursing interventions to meet patients' needs in dementia care, and only 1 developed an assessment tool to evaluate trigger factors of BPSD.

Conclusions: Identifying and assessing the background and proximal factors of patients with dementia can assist nurses and family caregivers in the early identification of patients at risk of BPSD. The NDB model-based assessment tool is used to assess possible BPSD triggers. Nursing interventions based on the NDB model positively affect BPSD and mood in people with dementia. These interventions can be tailored based on the background or target proximal factors of patients in specific settings.

Clinical implications: Using the NDB model, caregivers can identify triggers of BPSD in patients with dementia and implement personalized intervention measures.

Objectives: Social isolation is a serious public health issue with adverse physical and mental health problems. This cross-sectional study investigated the association between the number of friends and depression, anxiety, and insomnia in a sample of older adults in South Dakota.

Methods: A sample of 363 adults aged older than 59 (M = 69.78, SD = 6.72) completed self-report measures on their number of close friends and symptoms of depression, anxiety, and insomnia. Most of the participants were non-Hispanic White (96.3%), mostly married (81.1%), Republican (44.4%), and had two or fewer years of college education (44.0%).

Results: A series of logistic regression analyses showed that a smaller number of close friends was associated with high levels of depressive symptoms, anxiety, and insomnia.

Conclusions: The results showed that late-life close friendship is a significant protector against mental health problems.

Clinical implications: Screening for loneliness and social isolation is important for timely interventions. Clinicians are encouraged to use a brief valid measure to identify the presence of social isolation among older adults, especially those in rural communities.

Objectives: This study examined the associations between family functioning and depressive symptoms among older adults in Chinese nursing homes, focusing on the mediating roles of perceived stress and psychological resilience.

Methods: A cross-sectional survey was conducted among 229 older adults from five nursing homes in Southwest China. Standardized instruments were used, including the Family APGAR Index, Geriatric Depression Scale (GDS), Chinese Perceived Stress Scale (CPSS), and the 10-item Connor - Davidson Resilience Scale (CD-RISC-10).

Results: Family functioning was negatively associated with depressive symptoms (β = -0.82, p < .01). Perceived stress and psychological resilience were found to be significant mediators. The total indirect effect accounted for 49.56% of the overall association.Specifically, perceived stress (12.47%) and psychological resilience (26.91%) each served as independent mediators. A serial mediation pathway through perceived stress and then psychological resilience explained an additional 10.2% of the total effect.

Conclusions: Family functioning was associated with depressive symptoms among institutionalized older adults both directly and indirectly. The serial mediation model highlights potential pathways linking external and internal psychosocial resources to mental health in nursing homes.

Clinical implications: Interventions focusing on family support, stress reduction, and resilience enhancement may be relevant to the psychological well-being of older adults in nursing homes.

Objectives: This systematic review aims to provide a comprehensive overview of the available instruments to detect suicidal ideation and behavior in community-dwelling older adults. We further aim to evaluate the instruments' psychometric properties, diagnostic accuracy, and practical utility.

Methods: A systematic review of PubMed, PsycINFO, Sociological Abstracts, and Web of Science databases was carried out. Risk of bias was evaluated with the COSMIN risk of bias checklist or the QUADAS 2 tool.

Results: 22 studies detailing 22 instruments were found. Instruments either assessed suicidality directly or indirectly, through the assessment of depression or known risk factors. Psychometric evaluation showed that the validity was better in the original instruments rather than shortened instruments. Evidence for reliability was not always sufficient. All instruments had good diagnostic accuracy. Most instruments were suitable for primary care settings, but their use is context dependent.

Conclusions: A variety of instruments are used. Additional research is required for validation and practical use.

Clinical implications: Valid instruments assessing suicidality, depression, or risk factors can be used to detect suicide risk in community-dwelling older adults.

Objectives: To evaluate the psychometric properties of the Patient-Rated Parkinson's Anxiety Scale (PAS-PR) in people with Parkinson's Disease (PwPD).

Methods: In this cross-sectional study, we assessed Persian-speaking PwPD using the PAS-PR. Psychometric evaluation included: exploratory factor analysis (EFA); internal consistency (Cronbach's α), test - retest reliability (Intraclass Correlation Coefficient); PAS-PR/observer-rated PAS (PAS-OR) agreement (Bland-Altman); and convergent validity against Geriatric Anxiety Inventory (GAI), the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), the Beck Anxiety Inventory (BAI), and the 21-item Depression, Anxiety, and Stress Scale (DASS-21).

Results: Among 191 PwPD (58% male, mean age 69.2 ± 4.6 years; Hoehn & Yahr stages 1-4: 36.7%, 42.4%, 18.3%, and 2.6%, respectively), EFA revealed the expected three-factor structure. The PAS-PR demonstrated excellent reliability (α = 0.88; ICC = 0.96) and strong agreement with PAS-OR (96.19%). Convergent validity was established through significant correlations with GAI, HADS-A, BAI and DASS-21 (r = 0.61-0.75).

Conclusions: The PAS-PR, with its acceptable psychometric properties, proves to be a valuable tool for assessing anxiety in the Persian-speaking PwPD.

Clinical implications: The PAS-PR offers a practical, tailored tool for identifying diverse anxiety symptoms in Parkinson's patients, streamlining screening in clinical settings.

Objectives: The prevalence of anxiety is widely observed among older adults on a global scale. In this study, we investigate the relationship between food insecurity and anxiety symptoms in older adults living in low- and middle-income countries (LMICs).

Methods: Utilizing data from the WHO's Study on Global AGEing and Adult Health (SAGE), a cross-sectional analysis was undertaken across six diverse nations - India, China, Ghana, Mexico, Russia, and South Africa. Multivariate logistic regression models were applied, and subgroup analyses and interaction analyses were performed.

Results: Results suggest a significant positive association between food insecurity and anxiety symptoms. The association was notably stronger in Ghana (aOR = 6.26) and South Africa (aOR = 5.64). The association was significant among men in Ghana, Mexico, and South Africa and among women in India, Ghana, Russia, and South Africa.

Conclusions: Measures to alleviate household food insecurity play a crucial role in enhancing the mental health of the growing older population in LMICs.

Clinical implications: Effective targeted interventions aimed at alleviating food poverty will play a crucial role in mitigating anxiety symptoms. Routine screening for food insecurity and mental health assessment is necessary, particularly when working with older population.

Objectives: The Individualized Positive Psychosocial Intervention (IPPI) is an evidence-based program that engages people living with dementia (PLWD) in brief (i.e. 10 minute) one-to-one preference-based activities two times a week. This study evaluated the feasibility of pragmatically implementing a pilot embedded pragmatic clinical trial of the IPPI program in nine nursing homes.

Methods: Feasibility was defined as the ability of NH communities to establish implementation champions and an implementation team, complete training, identify and enroll eligible residents, match IPPI protocols to residents' stated preferences, complete an average of two IPPIs per week per resident for 6 months, and complete IPPIs with fidelity.

Results: Seven NHs completed the project, enrolling a total of 130 eligible residents. Seventy staff were trained. Staff identified preferences, corresponding IPPIs, and a targeted symptom of distress for all enrolled residents. Staff completed an average of 44.71 IPPIs per person (over six months) for those that did not pass away or discharge, with an average of 3.91 days between IPPIs. All staff reached at least 80% intervention delivery fidelity.

Conclusions and clinical implications: The IPPI program is a feasible nonpharmacologic intervention for PLWD that can be implemented with fidelity over time in nursing homes by staff.

Objectives: The present study aimed to examine the immediate and long-term effects of mindfulness-based stress reduction (MBSR) on sleep problems and emotional health (depression and anxiety) of family caregivers of people with Alzheimer's disease (AD), along with the mediating role of improvements in emotional health resulting from the intervention.

Methods: A randomized controlled trial was conducted to allocate 80 family caregivers with sleep problems from a Shanghai community to either an 8-week MBSR (n = 40) or usual care (n = 40). Sleep quality, fatigue, depression, and anxiety were assessed at the baseline after the intervention and at 25-weeks follow-up.

Results: All symptoms were better in the MBSR group than in controls immediately after the intervention and at the follow-up. Mediation analysis suggested that anxiety rather than depression mediated the effect of MBSR on sleep quality.

Conclusions: These findings validated the long-term effects of MBSR on the sleep quality of family caregivers for individuals with AD and demonstrated that MBSR improved sleep quality by alleviating anxiety.

Clinical implications: MBSR could be integrated into targeted intervention programs for family caregivers for individuals with AD to enhance their sleep quality and emotional well-being.

Objectives: To evaluate the effectiveness of an Acceptance and Commitment Therapy (ACT)-based cognitive intervention on quality of life (QOL) and cognitive function among older adult residents with mild cognitive impairment (MCI) in residential care.

Methods: A randomized controlled trial was conducted with 215 older adults residents from six senior care facilities in southern Spain, allocated to an intervention group (n = 103) and a control group (n = 112). The intervention group participated in ACT-based cognitive training sessions twice weekly for 12 weeks. Assessments were conducted at baseline, post-intervention, and six months post-intervention. Structural equation modeling (SEM) examined relationships among intervention exposure, cognitive outcomes, emotional well-being, and QOL.

Results: The intervention group demonstrated significant improvements in cognitive function (MMSE +2.1 points, p < .001) and QOL (QOL-AD + 4.1 points, p < .001), while the control group showed slight declines. SEM analysis (χ² = 98.45, df = 72, p < .01; CFI = .94; RMSEA = .04) identified psychological flexibility (β = .35, p < .001) and social engagement (β = .21, p < .01) as significant predictors of QOL, explaining 42% of its variance (R² = .42).

Conclusions: ACT-based interventions effectively enhance QOL and cognitive function in older adult residents with MCI. Psychological flexibility and social engagement are key contributors to improved outcomes.

Clinical implications: Integrating structured ACT-based cognitive interventions in long-term care settings may support mental resilience, well-being, and cognitive health in older populations.

Objectives: Care recipients and caregivers share similar stressors and living environments and may thus present concordance in health-related outcomes, yet their sleep interdependence remains understudied. This study examined sleep interdependence among care dyads.

Methods: Longitudinal data from the National Health and Aging Trends Study and National Study of Caregiving were analyzed, including 2,204 dyads (2015 baseline; 2017 follow-up). Sleep disruptions were assessed as trouble falling back asleep. Cross-lagged panel models examined concurrent/longitudinal sleep interdependence; multiple group analyses ascertained whether the relationships differed by caregiving contexts (dementia/non-dementia) and living arrangements (co-residing/living apart).

Results: A stable actor effect emerged: Care recipients' and caregivers' sleep disruptions in 2015 predicted their own sleep disruptions in 2017. No cross-lagged partner effects were significant (p > .05). There was a significant synchronous partner effect in 2017 (β = 0.118, 95% CI = 0.048, 0.187). These relationships remained significant for dementia-care and co-residing dyads but not for non-dementia or living-apart care dyads.

Conclusions: This first longitudinal dyadic study identified sleep interdependence among care dyads, highlighting the importance of early intervention to reduce sleep disruptions. Targeted support for dementia caregivers and co-residing dyads is critical.

Clinical implications: Sleep hygiene interventions should leverage the interconnectedness of sleep within caregiving relationships.