International psychogeriatrics最新文献

Background: Adverse Childhood Experiences (ACEs) have long-term effects on health, but the mechanisms remain unclear.

Objective: To investigate the association between ACEs and health status, exploring the potential mediating roles of activities of daily living (ADL) and chronic diseases.

Participants and setting: 9575 middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: Longitudinal analysis of 4 waves (2013-2018) data. ACEs were derived from 2014 self-report life history survey. Latent growth curve modeling assessed the mediating effect of ADL and chronic diseases on the relationship between ACEs and self-rated health (SRH).

Results: Among the 9575 individuals (mean [standard deviation, SD] age, 58.12 [8.73] years; 5174 [54.04 %] were females), the average ACEs score was 2.27 (SD = 1.75). Individuals with higher ACEs reported lower baseline SRH (β = -0.156, P < .001) and greater decline over time (β = -0.075, P < .001). Mediation analysis indicated that both baseline and longitudinal changes in ADL and chronic diseases (intercept and slope) partially mediated the association between ACE and the intercept of SRH, while ADL (intercept and slope) and chronic diseases (slope) fully mediated the association between ACE and the slope of SRH.

Conclusions: ACEs were associated with poorer health status and accelerated decline, partially mediated by impaired ADL and increased chronic diseases. Interventions targeting ACE reduction, enhancing ADL, and managing chronic diseases could effectively improve the health of middle-aged and older adults.

Objectives: According to the sociocultural stress-and-coping model for family caregivers, caregiving stressors contribute directly to caregivers' distress. In addition, there is another path to explain this distress, as several cultural (e.g., familism) and cognitive variables (e.g., dysfunctional thoughts) have important intermediate roles in the pathway from stress to distress. In particular, coping variables appear to play important intermediary roles in this pathway. The aim of this study was to provide longitudinal support to this two-paths stress and coping model.

Methods: Participants were 304 dementia family caregivers who were interviewed yearly during a 4-year period (5 assessment points). Sociodemographic variables, stressors, familism, dysfunctional thoughts about caregiving, cognitive fusion, leisure engagement, ambivalence, guilt and depressive symptoms were measured. The paths established by the sociocultural stress and coping model were tested.

Results: Greater cognitive fusion, greater reaction to BPSD, increased ambivalence, increased guilt, and reduced engagement in leisure activities were associated with greater experience of depressive symptoms. However, cultural and cognitive variables (i.e., familism and dysfunctional thoughts) did not show a direct association with depressive symptoms but were associated with increased cognitive fusion and reduced engagement in leisure activities. Overall, the stress-and-coping model explained 52.45 % of the variance in depressive symptoms through the 4-year study period.

Discussion: This study provides longitudinal support to the two-paths proposed by the sociocultural stress and coping model. Specifically, cultural and cognitive factors are more distally related to caregiver outcomes via their association with coping variables, which in turn appear proximally related to caregiver distress (i.e., depressive symptoms).

Objectives: Depression is a chronic disorder that significantly affects functional decline in older adults, especially those with type 2 diabetes (T2D). Ethnic groups may experience different depression risks and severities, yet the effect of ethnicity on depression trajectories and specific dimensions in older adults with T2D remains largely unexamined. We examined the longitudinal associations of ethnicity with depression and its specific dimensions over time in older Ashkenazi and non-Ashkenazi Jews with T2D.

Design: Generalized estimating equations (GEE) models were employed to analyze the longitudinal associations of ethnicity with numbers of depressive symptoms and specific depression dimension, adjusting for sociodemographics, cognition, T2D characteristics, and cardiovascular risk factors.

Setting: Community-dwelling older adults from the longitudinal Israel Diabetes and Cognitive Decline (IDCD) study.

Participants: 902 Ashkenazi and non-Ashkenazi Jews, mean age= 72.3 years.

Measurements: The Geriatric Depression Scale-15 (GDS-15) and its five dimensions: Dysphoric Mood, Withdrawal Apathy-Lack of Vigor, Anxiety, Hopelessness, and Memory Complaint.

Results: At baseline, Ashkenazi Jews reported significantly lower GDS-15 scores compared to non-Ashkenazi Jews. They exhibited lower scores in Dysphoric Mood and Hopelessness dimensions. GEE models confirmed these findings, showing Ashkenazi Jews had significantly lower total GDS-15 scores (β = 0.86, 95 % CI 0.75-0.99; p = 0.03), Dysphoric Mood (β = 0.76 (0.52-0.90], p = 0.006), Hopelessness (β = 0.74 [0.58-0.95], p = 0.017) and lower rates of clinical depression (OR= 0.68 [0.52-0.90], p = 0.006). These data offered no evidence of a difference in trends between the Ashkenazi and non-Ashkenazi groups on depression trajectories.

Conclusions: Ethnicity is associated with the longitudinal trajectories of depression and its specific dimensions in older adults with T2D. Further investigation of contributing factors, including social determinants of health, is essential.