Clinical Gerontologist最新文献

Objectives: To investigate indicators of potentially hazardous alcohol use among older adults living in a region with high substance use stigma.

Methods: Patients at a university-affiliated geriatrics clinic in the Deep South of theUS completed behavioral health screenings including self-reported alcohol use, symptoms of depression or anxiety, and cognitive functioning between 2018 and 2022.

Results: Participants (N = 278) averaged 76.04 years of age (SD = 9.25), were predominantly female (70.9%), and non-Hispanic white (84.5%), with an averageof 6.08 comorbid diagnoses (SD = 2.86). Race/ethnicity, age, and symptoms of anxiety were associated with alcohol use and hazardous alcohol use, with non-Hispanic whites, younger individuals, and those with more anxiety symptoms reporting more alcohol use. Notably, alcohol use and hazardous alcohol use were associated with cognitive functioning in the dementia range.

Conclusion: Self-reported alcohol use is low in geriatric primary care in the Deep South, US, differs by race/ethnicity, and is predictive of cognitive impairment when alcohol use is hazardous. Issues of trust and stigma may play a role in self-report ofstigmatized behaviors.

Clinical implications: Self-reported alcohol intake must be considered within the cultural context of regional stigma. Recommendations to address this are provided.

Objectives: We investigated the association between adverse childhood events, personality disorders and multimorbidity in older adults.

Methods: This is a cross-sectional analysis in a population of older adults including 40 people with a personality disorder and 75 healthy controls. The Childhood Traumatic Events Scale was used to assess adverse childhood events. Multimorbidity was defined as the presence of 2 or more predetermined chronic somatic and psychiatric disorders. Logistic regression analysis was used to assess the association between adverse childhood events, personality disorders and multimorbidity.

Results: No significant association was found between adverse childhood events and multimorbidity (OR = 1.03, 95% CI = 0.96-1.09). The presence of a personality disorder was significantly associated with multimorbidity (OR = 12.95, 95% CI = 4.28-39.14).

Conclusions: Overall, we did not find an association between adverse childhood events and multimorbidity in older adults. Multimorbidity was more prevalent in subjects with personality disorders compared to healthy controls.

Clinical implications: The findings suggest that personality disorders are associated with both mental and physical health challenges, underscoring the importance of integrated care approaches to address both aspects in clinical practice.

Objectives: The purpose of this pilot study was to evaluate the implementation feasibility and to establish preliminary efficacy of LDCare - a remotely delivered, manualized, multi-component intervention developed to support long-distance family caregivers (LDCs) of older adults with dementia.

Methods: The study design was a one-arm pre-post-intervention trial involving 40 LDCs - those living at least two hours away from their care recipient - who experienced significant caregiver burden. Feasibility was evaluated in terms of three indicators: recruitment capability, intervention acceptability and suitability. Preliminary efficacy of LDCare for reducing burden, strains, and depression from pre- to immediate post intervention was determined. Feasibility indicators were tracked over time, and participants completed pre-intervention and immediate post-intervention assessments.

Results: LDCs were recruited within the planned timeframe. The acceptability of LDCare was excellent, as demonstrated by high study retention (90%) and overall intervention adherence (95%) rates. The suitability of LDCare for addressing LDCs' needs was rated high. Wilcoxon Signed-Rank tests revealed statistically significant decreases in caregiver burden, strains, and depression from pre- to immediate post-intervention.

Conclusions: LDCare demonstrated high feasibility and preliminary efficacy among burdened LDCs.

Clinical implications: LDCare has potential for scalability and eventual integration within service offerings of caregiver support organizations.

Objectives: Proponents of integrated healthcare systems suggest that such system can improve healthcare experience for individuals with dementia by amalgamating personal and structured resources.

Methods: We assessed systematically available evidence on the current state of integrated healthcare systems viewed in terms of different levels and dimensions of integration, emphasizing multiple stakeholders' simultaneous perspectives. Studies were eligible for inclusion if they (1) evaluated a health system, (2) adopted a network or integrated care model, (3) cared for individuals with dementia, and (4) provided real-world data.

Results: Our review included 31 studies. Main components of the healthcare system included care mediation, multidisciplinary care, primary care integration, long-term care, community-based service, digital technology, and one undefined. Most studies involved meso-level integration (n = 23), followed by micro-level (n = 12) and macro-level integration (n = 5).

Conclusions: Key factors that promote an integrated healthcare system for dementia include supportive organizational structure, multidisciplinary collaboration, effective leadership, clear roles, streamlined referral, and community involvement. Macro-level integration should be considered with greater emphasis in conjunction with both meso- and micro-level integration.

Clinical implications: Successful development of comprehensive integrated healthcare network will require thoughtful implementation and transition across all levels of the system.

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.