International psychogeriatrics最新文献

Objectives: There are currently major inconsistencies in the methodological approaches used to index social frailty. The present study aimed to better understand which of these approaches may be most valuable in predicting older adult's physical health and psychological wellbeing.

Design: One hundred and thirty-three participants aged 60-90 years completed five measures commonly used to index social frailty, along with five measures of physical health, and psychological wellbeing. Social frailty was not only assessed at the scale level but was also considered in terms of both the objectivity (versus subjectivity) of each scale item, and at the social concept level (whether each item captured lifestyle, living alone, loneliness, social activities, social network, social role, social support, or sociodemographic characteristics).

Results: As predicted, subjective social frailty accounted for the largest share of explained variance of psychological wellbeing in older adults, relative to objective indicators and key demographics. However, contrary to hypotheses, objective social frailty failed to uniquely predict physical health. Further analyses revealed that the predictive value of subjective social frailty was driven primarily by feelings of loneliness.

Conclusions: The present study provides novel insights into how operationalizations of social frailty vary in terms of their relationship with important indicators of real-life function. The findings have direct implications for the development of targeted interventions focused on reducing social frailty in late adulthood.

Objectives: Many older adults experience mental health challenges and loneliness which negatively affect other health aspects. This data is largely lacking in older transgender adults. This study aimed to determine differences in depressive symptoms, anxiety and loneliness between older transgender individuals receiving gender-affirming hormone therapy (GHT), and cisgender (non-transgender) individuals, and to assess the contribution of financial, psychological, somatic, and social-contact related factors.

Design: Cross-sectional.

Setting: Gender identity clinic; general population.

Participants: Seventy-two transgender women and 39 transgender men (56-84 y) receiving GHT for ≥ 10 y, age-matched 1:3 with cisgender women and men from the general population.

Measurements: Depressive symptoms, anxiety and loneliness were assessed with questionnaires. Differences were compared using linear regression analyses with log-transformed variables, and back-transformed for presentation. Additionally, models were adjusted for financial, psychological, somatic and social-contact related factors.

Results: Transgender women scored higher than cisgender women and cisgender men, respectively, on depressive symptoms (1.92, 95 % confidence interval (CI) 1.52-2.42; 2.66, CI 2.11-3.37), anxiety (1.43, CI 1.17-1.75; 1.89, CI 1.54-2.32) and loneliness (2.42, CI 1.96-2.97; 2.32, CI 1.92-2.82). Transgender men scored higher than cisgender men on depressive symptoms (2.10, CI 1.50-2.94), anxiety (1.67, CI 1.27-2.19) and loneliness (1.50, CI 1.16-1.93), and higher than cisgender women on loneliness (1.57, CI 1.20-2.05). These differences were largely explained by differences in financial, psychological, somatic and social-contact related factors.

Conclusions: Mental health outcomes and loneliness are compromised in older transgender individuals compared to cisgender individuals, particularly in transgender women. The socio-economic, psychological and somatic risk factors identified warrant further research and awareness.

Objectives: Interventions to prevent dementia among older adults with high-risk conditions such as Mild Cognitive Impairment (MCI) or Major Depressive Disorder (MDD) are highly needed. This study assessed the feasibility, adherence, safety, and clinical effects of home-based Cognitive Remediation (CR) with transcranial Direct Current Stimulation (tDCS) delivered by study partners in these populations.

Design: Open-label study.

Participants: Patients with a diagnosis of MCI, MDD in remission (rMDD), or both, were enrolled as a couple with their study partners.

Intervention: Home-based CR+tDCS, five days/week for eight weeks and then CR online with one week of CR+tDCS boosters every six months for up to two years.

Methods: Nineteen couples were enrolled. Cognitive testing was administered at baseline, after the 8-week phase, and then yearly from baseline for up to two years. Measures of feasibility, adherence and safety and clinical and cognitive outcomes were collected.

Results: Study partners experienced increased perceived competence in delivering the intervention [F (1, 164) = 18.87, p < 0.001]. Eighty percent of the 8-week sessions were completed by 84 % of the patients; 56 % of the patients completed the 2-year intervention. Improvement in global cognition was observed in patients [F (3, 15.1) = 4.04, p = 0.027], and in quality of life in study partners [F (3, 30.6) = 6.18, p = 0.002].

Conclusions: This study demonstrates that home-based CR+tDCS is feasible and safe in patients with MCI or rMDD, and could improve cognition in patients and quality of life in study partners. Randomized controlled trials are needed to confirm these findings.

Background: Neuropsychiatric symptoms such as agitation and/or psychosis impact most individuals with dementia during their illness, leading to reduced quality of life, distress, more rapid clinical decline, and an increased risk of institutionalization. Widely used pharmacological approaches have modest benefits and are associated with significant adverse events.

Methods: A narrative review was conducted to examine the evidence for the benefits of non-pharmacological treatments for agitation and psychosis in people with dementia, with a focus on operationalized approaches that could readily be introduced into clinical practice. In the absence of substantial evidence pertaining to non-pharmacological treatments of psychosis, the review was supplemented with a secondary analysis of an existing WHELD/BPST dataset.

Results: There is substantial evidence that simple non-pharmacological treatment approaches, such as personalized activities with social interaction, are effective in the treatment of agitation or enabling the reduction of psychotropic medication without worsening of agitation. Examples are presented of several operationalized approaches suitable for clinical implementation. In contrast, the treatment response of psychotic symptoms in people with dementia to non-pharmacological approaches is less clear cut. There is emerging evidence that although currently used non-pharmacological approaches do not directly improve psychosis in people with dementia, they do improve quality of life and concurrent neuropsychiatric symptoms such as apathy and agitation.

Discussion: Although best practice guidelines universally recommend non-pharmacological interventions as the first-line treatment for neuropsychiatric symptoms, implementation has been limited. Several tools, such as Brief Psychosocial Therapy, are described which may help bridge this gap into clinical practice.

Background: Family caregivers of people with Alzheimer's disease often find their caregiving role intensely encompassing, which could lead to other areas of their experience being constrained or to "role captivity." The impact of role captivity on family members warrants further exploration. This study aimed to investigate the experiences of role captivity among family caregivers of people with Alzheimer's disease and analyze the causes of role captivity.

Methods: Semi-structured interviews with family caregivers of people with Alzheimer's disease in the neurology and geriatrics departments of a hospital in Hunan Province, China, were conducted from May 2024 to August 2024. The data were analyzed using a reflexive thematic analysis.

Results: Fifteen family caregivers of people with Alzheimer's disease were interviewed. Three themes were identified: 1) complex and shifting emotional experiences; 2) social, work, and lifestyle changes within role captivity; and 3) role captivity formation shaped by caregiving responsibilities and family finances.

Conclusion: Amongst family caregivers in our study, role captivity was a prominent concern. It can be manifested through internal emotional impact and external social, work, and life changes. The analysis found that lack of family support, too much caregiving responsibility falling on the family caregiver, and financial strain were significant contributors to role captivity. Suggestions were made for primary care having an important role in managing diseases and reducing disease burden.