International Journal of Geriatric Psychiatry最新文献

Objectives

We aimed to identify factors associated with the use of physical restraints in geriatric care facilities housing older adults with dementia during the COVID-19 pandemic in Japan.

Methods

A cross-sectional anonymous online survey was conducted from January to February 2023 in special nursing homes (SNHs) for older adults with moderate to severe dementia and group homes (GHs) for those with mild to moderate dementia. The survey gathered information on facility characteristics, the presence of residents with dementia infected during COVID-19 clusters, and the use of physical restraints. Additional items addressed challenges encountered during a cluster outbreak, difficulties in managing residents with dementia infected with COVID-19, measures implemented for these residents, and considerations when residents were unable to isolate in their rooms owing to wandering. Multiple logistic regression analysis was used to identify factors associated with physical restraint use.

Results

Data from 286 SNHs and 151 GHs were analyzed, all of which housed residents with dementia infected during COVID-19 clusters. Among them, 49 SNHs (17.1%) and 14 GHs (9.3%) reported using physical restraints. In SNHs, multiple logistic regression analysis identified wandering, worsening dementia symptoms, and ongoing infections as significant factors associated with restraint use. In GHs, difficulty communicating the situation to other residents and families was notably associated with restraint implementation.

Conclusions

The use of physical restraints in facilities caring for older adults with moderate to severe dementia may be associated with worsening dementia symptoms during the COVID-19 pandemic in Japan. These findings underscore the need for improved staff training and the development of care strategies aimed at minimizing restraint use during infectious disease outbreaks.

Objectives

Late-life depression is the most common mental disorder in older adults. As symptom progression and risk factors are not well understood, this study focuses on longitudinal symptom progression and time-varying risk factors.

Methods

Longitudinal data of adults aged 60+ were drawn from six waves (2008–2023) of the German Aging Survey (DEAS), with the largest analytic sample in 2014 (n = 6515). At each wave participants were classified as having “no” (0–9), “minor” (10–17) or “major” (18–45) depressive symptoms (DS) based on the German Center for Epidemiologic Studies Depression Scale (CES-D). Persistent DS were defined as PDS (at least minor DS) or majorPDS (major DS) across two consecutive waves. Weighted transition probabilities between DS stages were calculated across all person-years. Linear fixed effects regression with cluster-robust standard errors was used to identify time-varying determinants of DS.

Results

In 2014, the prevalence rate was 17.4% [16.6%–18.1%] for minor DS, 7.2% [6.6%–7.8%] for major DS, 12.2% [11.3%–13.1%] for PDS and 2.5% [2.0%–3.1%] for majorPDS. Estimates were similar across all six waves. Minor DS frequently persisted (37.3% [34.1%–40.6%]) or progressed to major DS (11.7% [9.6%–14.2%]). Major DS persisted in 38.6% [31.1%–46.7%] and remitted to minor DS in 31.8% [25.9%–38.3%] of cases. Transition to widowhood (β = 0.67, p < 0.05), worsening of physical functioning (β = −0.06, p < 0.01), increasing loneliness (β = 1.02, p < 0.01), worsening of sleep quality (β = 0.78–4.40, p < 0.01) and decreasing BMI (β = −0.08, p < 0.01) were associated with increases in DS.

Conclusions

DS are common in later life and are frequently persistent. Minor DS often persist or worsen, underscoring their role as a key risk factor. Major DS frequently remits only partly. Early, targeted interventions could be informed by modifiable determinants that may also help to allocate scarce mental health resources effectively.

Aims

To evaluate the feasibility and preliminary effects of the nudges-based semi-supervised resistance exercise program in older adults with mild cognitive impairment (MCI).

Design

A Pilot Historical-Control Study.

Methods

Participants in the intervention group received a 12-week semi-supervised resistance exercise with nudges. The historical control group consisted of participants from a prior study by our team who received fully-supervised resistance training. Propensity score matching was performed to generate matched pairs. The primary outcome was the feasibility, including recruitment rate, retention rate, adherence, labor resource costs and participants' perceptions regarding nudges' usefulness. The secondary outcomes were cognitive function and physical function.

Results

A total of 30 participants in the intervention group and 33 participants in the historical control group completed the program. The recruitment rate for the intervention group was 47.22%, and the retention rate was 88.24%. In the historical control group, the recruitment rate was 59.02%, and the retention rate was 91.67%. Following 1:1 propensity score matching, the adherence rates for the intervention and control groups were 96.59% and 91.85%, respectively, with no significant difference observed (Z = 1.309, p = 0.191). The intervention group required 15.25 healthcare professional labor hours (344.65 RMB), lower than the control group (24 h; 542.4 RMB). Most nudges were assessed as beneficial; however, certain ones were deemed ineffective, and some that initially showed promise diminished impacts over time. Both groups exhibited significant improvements in cognitive and physical functions from pre-to post-intervention, with no significant differences between the groups (p > 0.05).

Conclusion

The semi-supervised resistance exercise program with nudges is a viable alternative compared to fully-supervised mode. Large-scale randomized controlled trials should be conducted to validate these findings.

Objectives

To identify distinct social isolation profiles and their associations, both direct and stress-moderating, with depressive symptoms using objective and subjective indicators of social isolation among older adults in a low-income community.

Methods

Latent class analysis and multivariable regression were conducted with data from 881 individuals aged 60 years or above residing in public rental housing in the Chin Swee area of Singapore.

Results

Four profiles emerged: “well-connected and less lonely” (27.9%), “structurally isolated but less lonely” (56.4%), “somewhat isolated and moderately lonely” (11.3%), and “severely isolated and highly lonely” (4.4%). The latter two profiles demonstrated significantly greater depressive symptoms than the former two. Additionally, the “somewhat isolated and moderately lonely” profile showed heightened vulnerability to stressors, exhibiting stronger associations between life stressors and depressive symptoms compared with the “well-connected and less lonely” profile.

Conclusions

Subjective loneliness, more so than objective structural isolation, is pivotal in shaping older adults' mental health and stress vulnerability within low-income settings. Interventions should consider decoupling loneliness from social isolation, tailoring support to the specific needs associated with different social isolation profiles.

Introduction

Neuropsychiatric symptoms (NPS) are highly prevalent from mild cognitive impairment (MCI) to Alzheimer's dementia (AD). Understanding the link between NPS and regional brain changes can provide insight into neural correlates of disease progression.

Methods

This cross-sectional study analyzed 1536 older adults from the National Alzheimer's Coordinating Center comprising 860 healthy controls, 389 patients with MCI, and 287 patients with AD. The NPSs were evaluated with the Neuropsychiatric Inventory (NPI), which measures severity in four domains: mood, psychosis, frontal, and total symptoms. Magnetic resonance imaging quantified regional gray matter volumes (GM), cerebrospinal fluid volume (CSF), and white matter hyperintensity (WMH) volumes to see their correlations with NPS.

Results

All volumes showed the smallest in dementia, the intermediate in MCI, and the largest in healthy controls. Higher total NPI scores were significantly associated with smaller volumes of hippocampal and gray matter volumes and larger cerebrospinal fluid volume, with the strongest correlations in the dementia group. By domain, NPI-mood symptoms were correlated with reduced hippocampal, temporal, and frontal volumes. NPI-psychosis symptoms also correlated with frontotemporal regions, but less extensively. Mood symptoms were most strongly linked to temporolimbic atrophy.

Conclusion

The study supports associations between emerging neuropsychiatric manifestations and accumulating structural brain damage along the pathological cascade.

Objectives

Indoor air pollution related to household solid fuel use for heating and cooking and social disconnection including loneliness and social isolation are reported to increase the risk of mild cognitive impairment (MCI), but their joint associations have not yet been examined. This study aimed to explore their joint associations with MCI.

Methods

Data were from five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS) among 5314 cognitively intact participants aged ≥ 60 years at baseline. Cox proportional hazards models were applied to explore the associations of household solid fuel use and social disconnection with MCI.

Results

During the 9-year follow-up, 644 (12.5%) participants experienced MCI. Participants exposed to both solid fuel use and social disconnection (HR = 1.417, 95% CI = 1.149–1.747) had higher risk of MCI than those exposed to one factor alone (HR = 1.195–1.218, 95% CI = 0.944–1.572). There were significant additive interaction (RERI = 0.274, 95% CI = 0.065–0.482) and multiplicative interaction (p for interaction = 0.017) between household fuel types for heating and loneliness. The association of loneliness with higher risk of MCI was not significant in both subgroups, but the values of HR in the solid fuel use subgroup (HR = 1.142, 95% CI = 0.997–1.307, p = 0.055) were higher than that in the clean fuel use subgroup (HR = 0.853, 95% CI = 0.695–1.046, p = 0.126).

Conclusion

Household solid fuel use and social disconnection may be independently and jointly associated with MCI. These findings implicate that social and health strategies should address the reduction of solid fuel use and improvement of social connections to maintain cognitive function among older adults.

Objective

Apathy occurs in one-third of patients after stroke and is particularly common in small vessel disease (SVD) stroke. Apathy is known to be associated with reduced ability to engage in everyday life activities, including neurorehabilitation. Apathy has been associated with increased caregiver burden and distress in other neurological diseases, but there is little data on stroke. We aimed to evaluate whether distress is higher and quality of life (QoL) lower in apathetic stroke patients and their caregivers.

Methods

We conducted a cohort study on patients with symptomatic SVD and their caregivers. We recruited 40 patient-caregiver pairs (20 with apathy and 20 without) and assessed apathy, patient disability, QoL, cognition and depression. We assessed apathy-related caregivers' distress, caregiver burden, mood and quality of life. Statistical tests were performed to compare the apathetic and control groups. Univariate correlations and multiple linear regressions were used to assess relationships between apathy and measures of quality of life, burden, distress and mood.

Results

Apathy was a strong predictor of caregiver distress (β = 0.11, p < 0.001), burden (β = 0.7, p < 0.001) and depression (β = 0.12, p < 0.001). In contrast, physical disability was not an independent predictor of caregiver burden. Apathy was also a strong predictor of patient QoL (β = −0.67, p < 0.001) and depression (β = 0.49, p < 0.001).

Conclusion

Apathy is a major independent predictor of caregiver burden. Caregivers of apathic patients experience increased distress, burden and lower mood. Patients with apathy also experience lower mood and worse QoL. The major effect of apathy on caregivers suggests targeting them should be an important component of the treatment of apathy in patients with stroke.

Objectives

A national survey was conducted in the Italian Day Care Centers hosting people with dementia (DCCs). This national survey aimed to describe the characteristics, the organizational structure and the opening period during the COVID-19 pandemic of the DCCs.

Methods

A list of all national DCCs was provided by representatives from each Italian region.

The online questionnaire consisted of two main parts: a profile section (location, access) and a data collection form (organization, services, treatments, activities, and any discontinuation of the services due to the COVID-19 outbreak).

Results

A total of 1084 DCCs were included in the study after verifying their actual capacity to accommodate persons with dementia. Overall, 443 facilities (41%) completed the profile section and 300 (27,7%) also completed the data collection form. Most of the DCCs participating in the survey were privately owned facilities affiliated with the Regional Health Service (88.5% vs. 11.5% of public facilities). The imbalance in favor of private facilities was present in all three Italian macro-areas, particularly in the North, where almost all facilities were private (private vs. public, North 97.1% vs. 2.9%, Center 65.5% vs. 34.5%; Southern and Islands 75.5% vs. 24.5%). Only one-fifth of the facilities exclusively admitted people with dementia. As regards the pandemic period, only 6% of facilities remained always open in 2020, in 2021 the percentage increased, with 48% of the facilities reported as open.

Conclusions

This paper presents an overview of the current situation of DCCs in Italy, showing still considerable heterogeneity based on geographic location. The survey finally highlights how the COVID-19 pandemic emergency has impacted the activities of these types of facilities.

Objective

Little is known about the association between frequency of laughter and loneliness—in particular based on longitudinal data. Therefore, our aim was to examine how the onset and the end of frequent laughter is associated with changes in loneliness amongst older people in Japan.

Methods/Design

Longitudinal data were taken from the Japan Gerontological Evaluation Study (JAGES, waves 6 and 7 with n = 5262 observations, mean age was 74.4 years, SD: 5.8 years). The widely used and psychometrically sound UCLA-3 was used to quantify loneliness. Frequency of laughing served as key independent variable. Asymmetric linear fixed effects regressions were used, adjusting for several time-varying covariates.

Results

After adjusting for several sociodemographic, lifestyle-related and health-related time-varying factors, there was a significant association between the onset of frequent laughing and decreases in loneliness (β = −0.18, p < 0.05). Age and sex did not moderate this association. In contrast, the cessation of frequent laughter was not significantly associated with changes in loneliness.

Conclusions

Starting frequent laughter may help to avoid negative consequences such as loneliness among older adults in Japan. This may emphasize the importance of finding ways to start laughing frequently. Efforts to reduce loneliness are important because it is in turn associated with outcomes such as morbidity and mortality.