American Journal of Geriatric Psychiatry最新文献

Objectives: Currently, there are increasing instances of forced displacement due to extreme circumstances such as armed conflicts. Under threatening conditions, certain factors, such as displacement, can decrease one's well-being. On the other hand, specific capabilities and resources such as digital engagement, may serve as coping mechanisms. This study examines the associations between digital engagement and the well-being of older adults during armed conflict situations, comparing displaced persons to those who were not displaced.

Methods: Ninety-three displaced and 150 nondisplaced older Israeli adults aged 60 and above completed an online or paper questionnaire two months after the beginning of the Israel-Hamas war on 7th of October 2023. Measurements included indicators of well-being (loneliness, depressive symptoms, subjective health, and sense of control), rocket threat, digital engagement, digital ageism, and socio-demographic characteristics.

Results: Displaced older adults reported lower subjective health, higher levels of loneliness, and a diminished sense of control, compared to those not displaced. Following the war, individuals who were displaced reported using fewer digital devices, exhibited different patterns of use, and reported twice as many limitations in using technology. A hierarchical regression analysis revealed that various aspects of digital engagement were associated with different well-being components, mitigating the initial negative effects of displacement on loneliness and subjective health.

Conclusions: This study highlights the importance of digital engagement as a potential protective factor for the well-being of older adults during extreme circumstances such as armed conflicts.

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.