Clinical Gerontologist最新文献

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: 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.

Objectives: A biopsychosocial model of self-harm risk factors in older adults was explored, distinguishing between direct and indirect self-harm.

Methods: A cross-sectional, matched pair sample was drawn from a community-dwelling sample of 625 adults aged 60 years and over, including 44 participants with and 44 without self-harm. Mean age was 68.7 years (age range = 60-91). Data were gathered using a survey composed of validated instruments and additional self-developed items.

Results: From our total sample, 8.2% had engaged in self-harm at age 60 and over. Indirect methods (e.g. substance misuse, not eating) were most common. The presence of a mental disorder, emotional loneliness, cognitive and physical frailty, and a lack of resilience were identified as potential risk factors. Those who have engaged in direct or both types of self-harm exhibit higher levels of these factors. A stepwise regression model showed that only emotional loneliness and mental disorder(s) were significantly associated with self-harm in old age.

Conclusions: Investigating self-harm (subtypes) among community-dwelling older adults is vital, especially in those with a mental disorder and emotional loneliness.

Clinical implications: Clinicians should be vigilant for self-harm in older adults, particularly for indirect methods and among those with a mental disorder and who experience emotional loneliness.

Objectives: This cross-sectional study examined the relationships among caregiver burden, anxiety, and key psychological flexibility processes - cognitive fusion, experiential avoidance, and values-driven actions - in family caregivers of individuals with dementia.

Methods: Data were collected from 191 caregivers in the United States. Structural equation modeling was used to assess direct and indirect relationships among caregiver burden, anxiety, and key psychological flexibility processes.

Results: The model showed excellent fit. Caregiver burden had a significant direct effect on anxiety (59.1% of the total effect), while indirect effects accounted for 40.9%. Cognitive fusion was the only significant mediator between caregiver burden and anxiety, accounting for 20.8% of the total effect. Additionally, experiential avoidance - both alone and when preceded by cognitive fusion - significantly mediated the relationship between caregiver burden and reduced engagement in values-driven actions.

Conclusions: These findings highlight cognitive fusion as a key mechanism linking caregiver burden to anxiety. Furthermore, both cognitive fusion followed by experiential avoidance and experiential avoidance alone appear to influence the relationship between caregiver burden and values-driven actions.

Clinical implications: Clinicians may consider implementing skills training targeting cognitive fusion and experiential avoidance to mitigate the negative impact of caregiver burden on anxiety and values-driven actions.

Objectives: The aim of the present study was to investigate possible sex predictors in the severity of NPS in a large cohort of patients with AD and to assess the role of severity in sex-related differences in NPS.

Methods: Four hundred and twenty-four participants (295 women, mean age 78.4 ± 8.3 years, mean disease duration 7.4 ± 8.5 years) were included with a diagnosis of AD according to NINCDS/ADRDA criteria. Clinical data and presence of NPS were collected from family interview, medical records, and patient interview and examination. Dementia severity was assessed using the Clinical Dementia Rating Scale (CDRS) extended version.

Results: CDRS score was available for 407 participants (mean score 2.6 ± 1.1); 407 (22.1%) patients had CRDS = 1, 104 (25.5%) had CRDS = 2, 127 (31.2%) had CRDS = 3, 64 (15.7%) had CDRS = 4 and 22 (15.4%) had CDRS = 5. Apathy (85.7%), agitation or restlessness (75.1%) and paranoia (59.4%) were the most common NPS. Higher CDRS scores were associated with several neuropsychiatric features, including apathy, wandering and physical aggression. In the sex-stratified analysis, NPS were associated with more severe AD only in men.

Conclusions: Our findings suggest relevant sex differences in NPS with increasing severity.

Clinical implications: A timely and targeted behavioral management could improve treatment outcome.

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: 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.