International psychogeriatrics最新文献

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.

Objectives: Urban-rural differences in depression are evident among older adults in China but not in the United States. By comparing the two countries, this study aims to explore strategies for promoting regional equality in depression in China.

Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were utilized. Longitudinal data were used to describe urban-rural differences in depression prevalence among older adults in China (2011-2020) and the United States (2010-2020). Cross-sectional data from 2018 (CHARLS: 9840 participants; HRS: 10,381 participants) were used to identify key modifiable factors. A random forest algorithm was employed to determine the most important factors influencing depression, and comparisons between the two countries were made to identify modifiable factors. Multivariate logistic regression was used to analyze the relationship between these key modifiable factors and depression. A mediation model was applied to assess the mediating role of key modifiable factors in the relationship between residence and depression.

Results: 1) From 2011 to 2020, Urban-rural differences in depression prevalence among older adults were observed in China, but not in the United States. 2) In both China and the U.S., the top five factors ranked by importance were activities of daily living disability (ADLs), instrumental activities of daily living disability (IADLs), pain levels, self-reported health (SRH), and age. However, Urban-Rural Differences in ADLs, IADLs, and SRH were present in China but not in the United States. 3) ADLs, IADLs, and SRH collectively mediated 31.6 % (95 % CI: 0.268 - 0.360) of the relationship between residence and depression scores among older adults in China.

Conclusion: Urban-rural differences in physical health status (ADLs, IADLs, and self-reported health) among older adults in China are associated with Urban-Rural Differences in depression. The absence of such inequalities in the U.S. may offer insights for developing policies to promote regional equality in depression among older adults in China.

Objectives: This study investigated the cross-sectional associations between participants' scores on five cognitive domains and global cognition and their scores on a multidimensional measure of self-perceptions of aging. This study also investigated whether 12-year change in the same cognitive domains and global cognition was associated with self-perceptions of aging.

Design: Cross-sectional and longitudinal secondary analyses of a cohort study.

Participants: Participants were 103 individuals (mean age at 12-year follow-up = 87.43 years; SD = 3.60; 60.2 % women) enrolled in the Sydney Memory and Aging Study (MAS) with 12-years of follow-up data.

Measurements: Cognitive domains assessed over 7 waves were attention processing speed, language, executive function, visuospatial abilities, and memory. Self-perceptions of aging were assessed only at wave 7 using the three subscales of the Laidlaw' Attitudes to Aging Questionnaire: psychological growth, psychosocial loss, and (positive) physical change.

Results: After having adjusted for age, sex, marital status, occupation when working, depressive symptoms, and numbers of physical health conditions and for multiple comparisons there were no significant cross-sectional associations between cognitive abilities and global cognition and the subscales of the Attitudes to Aging Questionnaire. After having adjusted for baseline cognition, age, sex, marital status, occupation when working, depressive symptoms, and numbers of physical health conditions there were no significant longitudinal associations between change in cognitive abilities and in general cognition and the subscales of the Attitudes to Aging Questionnaire.

Conclusions: Cross-sectional and change scores on cognitive tasks and global cognition do not have an effect on Attitudes to Aging after having controlled for depressive symptoms.

To examine the prevalence of treatment indications for antidepressants and assessed temporal trends in antidepressant prescribing for depression among adult patients in primary health care facilities (PHFs) in China. Descriptive study of antidepressant prescriptions written by primary care physicians. Setting participants: Patients aged 18 years and above in 67 PHFs in Dongcheng district in Beijing between 1 January 2014 and 31 December 2022. Deidentified information including patient demographics,antidepressants prescribed,and corresponding diagnoses were extracted from the prescribing system. The primary outcome was the treatment indications for all antidepressants prescribed between 2014 and 2022. Prescriptions were classified as on-label or off-label depending on whether the drug was approved for the indication by China's National Medical Products Administration by September 2022. A total of 42379 antidepressant prescriptions were identified between 2014 and 2022. Only 21.21 % of antidepressant prescriptions were indicated for depression. Anxiety disorders (31.43 %), insomnia (20.07 %), pain(19.12 %) and digestive system disorders (16.34 %) are also frequently prescribed antidepressants by physicians. For these indications, the most frequently prescribed antidepressant was flupentixol/melitracen and sertraline.For 36.32 % of all antidepressant prescriptions,physicians prescribed a drug for an off-label indication,especially insomnia and pain.Physicians also prescribed antidepressants for several indications that were off-label for all antidepressants, including digestive system disorders and migraine. This study found compound antidepressants are widely prescribed and used off-label indications.There is a need for more evidence to evaluate the clinical outcomes associated with off-label antidepressant indications for older adults to optimise prescribing decisions at PHFs.

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.