American Journal of Geriatric Psychiatry最新文献

Objectives: To validate the Depression, Anxiety, and Apathy (DA3) scale for assessing symptoms of depression, anxiety, and apathy in community-dwelling mid- and late-life adults with and without cognitive impairment.

Design: Cross-sectional psychometric validation study.

Setting: Community-based longitudinal study of brain health.

Participants: A total of 252 participants (mean age, 68.8 ± 9.4 years; 68.5% women; 71.3% non-Hispanic White; 66.8% cognitively normal) completed the study.

Measurements: The DA3 scale was compared with established measures of mood including the Hospital Anxiety and Depression Scale (HADS), Apathy Scale (AS), Generalized Anxiety Disorder-7 (GAD7), Patient Health Questionnaire-8 (PHQ8), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Psychometric properties were assessed using reliability and validity measures, confirmatory factor analysis (CFA), and Mokken scale analysis.

Results: The DA3 demonstrated strong internal consistency (Cronbach's alpha, 0.670-0.781). CFA supported a three-factor model corresponding to distinct depression, anxiety, and apathy dimensions, with excellent goodness-of-fit. Mokken analysis confirmed acceptable-to-strong scalability (H coefficients, 0.36-0.54). The DA3 subscales demonstrated strong convergent validity with established measures (e.g., HADS, AS, GAD-7, and PHQ-8). Cut-off scores of five on each subscale achieved optimal agreement with gold standard measures. Performance of the DA3 was consistent across sociodemographic, neuropsychological, and cognitive subgroups.

Conclusions: The DA3 is a unitary, brief, valid, and reliable tool for assessing depression, anxiety, and apathy in community-dwelling older adults, including those with cognitive impairment. Its strong psychometric properties support its use in both clinical and research settings. Future studies should examine its longitudinal utility to better understand its role in tracking mood symptoms over time.

Objective: To assess the survival of older patients with schizophrenia using clozapine, compared with other atypical antipsychotics (AAPs) provided by the Brazilian National Health System, in a 16-year follow-up.

Design, setting, participants: This is an open retrospective cohort study based on administrative data records, with 83,284 patients aged 60 years and older, diagnosed with schizophrenia and to whom AAPs were dispensed between 2000 and 2014.

Measurements: The Kaplan-Meier method was used to estimate the cumulative probability of survival and the Cox proportional hazards model was adjusted to assess the risk factors via the hazard ratio (HR).

Result: Overall survival was 18.0% after a 16-year follow-up, with half the patients dying within 6.2 years. Risk factors for death were being male, residing in Southeastern Brazil, having a history of hospitalization for pneumonia, and using quetiapine. Prescribing clozapine to older adults with schizophrenia was associated with a lower risk of death when compared to nonclozapine AAPs.

Conclusion: This study is one of the few published in the current literature that evaluates survival in older individuals with schizophrenia who use atypical antipsychotics. Clozapine had a protective effect on death when compared to other nonclozapine AAPs.

Objectives: Psychological resilience is the ability to cope with adversity and stressful situations, and it is considered a protective factor against cognitive impairment. This study compared resilience, personality, cognitive, and neuropsychological profiles of older adults with mild cognitive impairment (MCI) and a comparison group without cognitive impairment. Moreover, we evaluated clinical and personality predictors of psychological resilience in both groups.

Design: Observational cross-sectional study.

Setting: Data were collected among outpatients followed up at the Memory Clinic of the Complex Operative Unit of Geriatric of the University Hospital "Federico II", in Naples (Italy).

Participants: We enrolled 43 individuals with MCI and 70 older adults from the community.

Measurements: Participants completed neuropsychological and clinical assessments, the Resilience scale, and the revised Eysenck Personality Questionnaire.

Results: MCI scored significantly lower on psychological resilience and executive/attentional abilities, had more psychopathological symptoms, and scored higher on neuroticism, introversion, and psychoticism compared to the comparison group. In regression models, neuroticism was the only consistent predictor of psychological resilience across the MCI and comparison groups.

Conclusions: This study found lower resilience and a less adaptive personality profile in MCI. Neuroticism emerged as a key predictor of resilience, pointing to the importance of this personality trait for interventions aimed at enhancing resilience, mental health, and quality of life.

Objective: We assessed social connection, self-efficacy, and coping as mediators in a peer support intervention for depressed low-income and minoritized older adults.

Methods: Convergent mixed methods analysis of data collected in an RCT with at-risk older adults (N = 149) comparing the effectiveness of PEERS, an 8-week peer support, self-care intervention on depression to telephone calls providing social interaction for the control group. Assessments occurred at baseline, postintervention, and every 3 months up to 12 months. Mediation effects of loneliness, self-efficacy, and coping were analyzed using longitudinal mixed effects modeling after z-score standardization, complemented by semi-structured interviews. We report results in regression coefficients, i.e. in standard deviation units.

Results: Loneliness had an indirect effect on depression in both intervention (-0.32 [95% CI: -0.48, -0.19]) and control groups (-0.16 [95% CI: -0.27, -0.04]). Self-efficacy had an indirect effect of -0.17 (95% CI: [-0.24, -0.05]) at postintervention and -0.20 (95% CI: [-0.30, -0.08]) at 12 months for the PEERS group. Adaptive coping had an indirect effect with -0.15 (95% CI: [-0.26, -0.06]) at postintervention and -0.15 (95% CI: [-0.32, -0.04]) at 12 months for the PEERS group, No evidence of mediation for self efficacy nor coping was found for the control group. Qualitative results indicated reduced loneliness, improved coping and behavior change among intervention participants. Control group participants reported social support from telephone calls but did not mention improved self-efficacy and coping skills.

Conclusions: Social engagement and peer support intervention have a common pathway, e.g. alleviation of loneliness in reducing depression, but the PEERS intervention can also decrease depression by improving self-efficacy and adaptive coping.

Objectives: To investigate the association between social relationships and their changes with frailty among older adults, and whether genetic risk modifies these associations.

Methods: This study included 11,559 older adults (mean age 80.1 years) from the Chinese Longitudinal Healthy Longevity Survey. Social relationships were categorized into three dimensions: social activities, social networks, and social support, each classified as favorable or unfavorable groups. Changes in social relationships were assessed at two time points. The polygenic risk score (PRS) was constructed using 59 single-nucleotide polymorphisms associated with frailty. Cox proportional hazards models were used to assess the effects of social relationships and their changes, and PRS on frailty. Two-sample Mendelian randomization identified causal associations.

Results: During a median follow-up of 5.4 years, 4773 participants developed frailty. Unfavorable social relationships, particularly in social activities and social networks, were associated with increased frailty risk, with stronger effects in those with high genetic risk. Mendelian randomization revealed their harmful effects on frailty. An additive interaction between social relationships and genetic risk on frailty was observed. Combined unfavorable social relationships and high genetic risk increased frailty risk by 39% (HR: 1.39, 95% CI: 1.23-1.57). Persistent unfavorable relationships further increased frailty risk by 58% in those with high genetic risk (HR: 1.58, 95% CI: 1.27-1.97).

Conclusion: Unfavorable social relationships increase frailty risk, particularly for individuals with high genetic susceptibility. Persistent unfavorable relationships further increase this risk over time, with the highest frailty risk observed in those with both persistent unfavorable social relationships and high genetic risk.

Background: This study examined the impact of an educational program on depressive symptoms, cognitive function, social support, quality of life, and physical frailty among community-dwelling older adults with frailty or prefrailty.

Methods: In this 12-month multicenter randomized controlled trial, 199 frail/prefrail community-dwelling older adults were allocated into the intervention (n = 109) or the control (n = 90) group. The 6-month educational intervention focused on guidelines for physical activity, nutrition, cognition, and psychosocial well-being, while participants in the control group maintained their usual healthcare attendance. Changes in depressive symptoms (15-item Geriatric-Depressive-Scale, GDS-15), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ), social support (Duke-University of North Carolina Functional Social Support Questionnaire, Duke-UNC-11), quality of life (3-level EuroQoL five-dimensional questionnaire visual analog scale, EQ-VAS, and index, EQ-Index), physical frailty (Short Physical Performance Battery, SPPB, and Fried's criteria) were evaluated after six months of intervention and six months of follow-up.

Results: After the follow-up, the intervention group improved the GDS-15 score (p <0.001), Duke-UNC-11 score (p <0.001), quality of life (EQ-VAS: p = 0.001, EQ-Index: p = 0.010), SPPB score (p <0.001), and reduced Fried's criteria (p <0.001) compared to the control group, which worsened Duke-UNC-11 score (p = 0.012) and EQ-Index (p <0.001). No significant changes in cognitive function were observed. Lastly, all significant changes in study variables after follow-up were significantly correlated with each other (p <0.05), indicating an interrelated evolution.

Conclusions: This 6-month educational program improved depressive symptoms, social support, quality of life, and physical frailty in community-dwelling frail and prefrail older adults, as observed after a 6-month follow-up.

Objective: To investigate the association between thyroid-stimulating hormone (TSH) levels and depression in older adults.

Design: Prospective cohort study with an 11-year follow-up period.

Setting: Community-dwelling participants from the ASPirin in Reducing Events in the Elderly (ASPREE) randomized controlled trial and its follow-up observational study in Australia.

Participants: About 9,050 adults aged ≥70 years with baseline TSH measurements and depression assessments. Participants with thyroid cancer, baseline depression, or thyroid-altering medications were excluded.

Measurements: Depression was assessed annually using the Center for Epidemiological Studies Depression Scale (CES-D-10) using a cut score of 12, and hospital admission records. TSH was measured at baseline and year 3, categorized as low (<0.34 mU/L), normal (0.34-3.75 mU/L), or high (>3.75 mU/L).

Results: Cross-sectional analyses found no significant association between TSH levels and depression at baseline (p = 0.79) or year 3 (p = 0.054). Longitudinal analyses revealed no relationship between baseline or time-varying TSH levels and incident depression over the follow-up period (HR = 1.0, 95% CI: 0.96-1.05).

Conclusions: TSH levels are not associated with prevalent or incident depression in older community-dwelling adults. These findings should guide screening approaches for depression in older adults.

Objectives: Due to a longstanding focus on early to middle adulthood, research into the clinical needs of older adults with personality disorders remains limited. This study sought to further understandings into the potentially unique needs of this population.

Methods: Analyses compared comorbid psychiatric diagnoses, settings of utilized mental health treatment, and sociodemographic variables among older (aged 65+, n = 11,426) and younger (aged 18-35, n = 57,847) adults diagnosed with a personality disorder who received state-funded mental health care in the United States in 2022.

Results: Older adults with personality disorder diagnoses were more likely to have comorbid psychotic and delirium/dementia disorder diagnoses, less likely to have comorbid trauma and stressor, anxiety, and attention-deficit/hyperactivity disorder diagnoses, and less likely to experience homelessness than younger adults with personality disorder diagnoses.

Conclusions: Findings highlight the importance of interventions to address co-occurring cognitive disorganization among older adults experiencing personality disorder pathology.