Pub Date : 2025-08-21DOI: 10.1016/j.jagp.2025.08.005
Nili Solomonov Ph.D.
{"title":"A Journey Toward Therapeutic Change in Depression: An Early Career Scientific Autobiography","authors":"Nili Solomonov Ph.D.","doi":"10.1016/j.jagp.2025.08.005","DOIUrl":"10.1016/j.jagp.2025.08.005","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1358-1366"},"PeriodicalIF":3.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-20DOI: 10.1016/j.jagp.2025.08.004
Robert Kohn M.D.
The UN has produced various declarations addressing the human rights of older persons. The UN does not have a specific treaty or convention regarding human rights of older persons as part of its human rights system. Recently the Open-ended Working Group on Ageing has recommended to the General Assembly to adopt a binding convention on human rights for older persons. There has been progress already at the regional level. The European Convention of Human Rights Article 23 has been ratified by less than half the countries. The African Charter on Human and Peoples’ Rights is the first human rights instrument to include older persons as a distinct group. In November 2024 a protocol on older persons human rights was adopted. The Organization of American States adopted the Inter-American Convention on Protecting the Human Rights of Older Persons, the first human rights document specific to older persons and the only legally binding instrument. Although progress has been made on focusing on human rights on older persons, a binding UN international convention on human rights of older persons would be a tool to improve dignified mental healthcare.
{"title":"The Current State of International Human Rights of Older Persons","authors":"Robert Kohn M.D.","doi":"10.1016/j.jagp.2025.08.004","DOIUrl":"10.1016/j.jagp.2025.08.004","url":null,"abstract":"<div><div>The UN has produced various declarations addressing the human rights of older persons. The UN does not have a specific treaty or convention regarding human rights of older persons as part of its human rights system. Recently the Open-ended Working Group on Ageing has recommended to the General Assembly to adopt a binding convention on human rights for older persons. There has been progress already at the regional level. The European Convention of Human Rights Article 23 has been ratified by less than half the countries. The African Charter on Human and Peoples’ Rights is the first human rights instrument to include older persons as a distinct group. In November 2024 a protocol on older persons human rights was adopted. The Organization of American States adopted the Inter-American Convention on Protecting the Human Rights of Older Persons, the first human rights document specific to older persons and the only legally binding instrument. Although progress has been made on focusing on human rights on older persons, a binding UN international convention on human rights of older persons would be a tool to improve dignified mental healthcare.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1322-1330"},"PeriodicalIF":3.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-20DOI: 10.1016/j.jagp.2025.08.003
Jingyuan Xu 须静媛 M.Sc. , Hanneke J.A. Smaling M.Sc., Ph.D. , Miharu Nakanishi Ph.D. , Shiri Shinan-Altman Ph.D. , Lukas Radbruch M.D. , Jan Gaertner M.D. , Wilco P. Achterberg M.D., Ph.D. , David R. Mehr M.D., M.S. , Jenny T. van der Steen M.Sc., Ph.D.
Objectives
Euthanasia for people with dementia is controversial and clinicians should decide how to respond to euthanasia requests. The authors aimed to investigate clinicians’ perspectives on the acceptability of euthanasia for people with dementia, and differences between countries and personal characteristics potentially associated with acceptability.
Design, Setting, Participants, Measurements
Cross-sectional vignette study as part of the CONT-END studies, in which the authors conducted interviews with clinicians from the Netherlands, Switzerland, Germany, USA, Japan, and Israel online or in-person, and logistic regression analyses to assess associations with acceptability.
Results
Participants included 202 physicians and three nurse specialists who assumed similar medical responsibilities. Acceptability was higher in the Netherlands (66%) than in other countries (23%–44%, OR 0.16–0.41, p = 0.003–0.03). Dutch clinicians were more often willing to perform euthanasia upon request of a person with dementia (58%) than clinicians in other countries (18%–34%, OR 0.16–0.17, p = 0.007–0.03), except for Israel (40%, OR 0.48, p = 0.07). Two coping styles, planning (OR 0.77, 95% CI [0.59, 1.00]) and religious coping (OR 0.71, 95% CI [0.60, 0.84]), were associated with lower acceptability of euthanasia. Being religious (OR 0.47, 95% CI [0.24, 0.93]), training in palliative care (OR 0.48, 95% CI [0.26, 0.91]), and using emotional social support as coping style (OR 0.77, 95% CI [0.62, 0.95]) were associated with lower willingness to perform euthanasia upon request of a person with dementia.
Conclusions
Clinicians’ perspectives on the acceptability of euthanasia for people with dementia varied across countries and individuals, with diversity related to coping styles, training in palliative care, and religion.
{"title":"Acceptability of Euthanasia for People With Dementia: Perspectives of Clinicians From Six Countries","authors":"Jingyuan Xu 须静媛 M.Sc. , Hanneke J.A. Smaling M.Sc., Ph.D. , Miharu Nakanishi Ph.D. , Shiri Shinan-Altman Ph.D. , Lukas Radbruch M.D. , Jan Gaertner M.D. , Wilco P. Achterberg M.D., Ph.D. , David R. Mehr M.D., M.S. , Jenny T. van der Steen M.Sc., Ph.D.","doi":"10.1016/j.jagp.2025.08.003","DOIUrl":"10.1016/j.jagp.2025.08.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Euthanasia for people with dementia is controversial and clinicians should decide how to respond to euthanasia requests. The authors aimed to investigate clinicians’ perspectives on the acceptability of euthanasia for people with dementia, and differences between countries and personal characteristics potentially associated with acceptability.</div></div><div><h3>Design, Setting, Participants, Measurements</h3><div>Cross-sectional vignette study as part of the CONT-END studies, in which the authors conducted interviews with clinicians from the Netherlands, Switzerland, Germany, USA, Japan, and Israel online or in-person, and logistic regression analyses to assess associations with acceptability.</div></div><div><h3>Results</h3><div>Participants included 202 physicians and three nurse specialists who assumed similar medical responsibilities. Acceptability was higher in the Netherlands (66%) than in other countries (23%–44%, OR 0.16–0.41, p = 0.003–0.03). Dutch clinicians were more often willing to perform euthanasia upon request of a person with dementia (58%) than clinicians in other countries (18%–34%, OR 0.16–0.17, p <em>=</em> 0.007–0.03), except for Israel (40%, OR 0.48, p = 0.07). Two coping styles, planning (OR 0.77, 95% CI [0.59, 1.00]) and religious coping (OR 0.71, 95% CI [0.60, 0.84]), were associated with lower acceptability of euthanasia. Being religious (OR 0.47, 95% CI [0.24, 0.93]), training in palliative care (OR 0.48, 95% CI [0.26, 0.91]), and using emotional social support as coping style (OR 0.77, 95% CI [0.62, 0.95]) were associated with lower willingness to perform euthanasia upon request of a person with dementia.</div></div><div><h3>Conclusions</h3><div>Clinicians’ perspectives on the acceptability of euthanasia for people with dementia varied across countries and individuals, with diversity related to coping styles, training in palliative care, and religion.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1263-1274"},"PeriodicalIF":3.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.jagp.2025.08.001
Ronesh Sukhdeo H.B.Sc. , Jocelyn K. Tamura M.D. , Christine E. Dri B.H.Sc. , Roger S. McIntyre M.D.
Ketamine has emerged as a promising treatment for major depression, though its efficacy and safety remain incompletely characterized in older adults. This systematic review synthesizes current evidence for ketamine in geriatric depression. A search of PubMed, EMBASE, and PsycINFO was conducted. Prospective clinical trials were included, with age restriction to participants ≥60 years applied at full-text review to capture subgroup data. Thirteen studies met inclusion criteria, comprising 757 adults. Studies examined intranasal (n = 5), intravenous (n = 4), subcutaneous (n = 1), and oral (n = 1) ketamine formulations, as well as ketamine combined with ECT (n = 2). Antidepressant efficacy findings were mixed; with preliminary findings of symptomatic improvement in this difficult to treat disease state, although not all studies reported out positive outcomes. Adverse events were generally mild to moderate and discontinuation due to side effects was rare. Cognitive outcomes were mostly stable or improved, though long-term studies noted small declines in reaction time. Ketamine as an ECT anesthetic did not enhance antidepressant outcomes. Evidence certainty was very low to low; findings were limited by small samples, open-label designs, and inconsistent age-stratified reporting.
{"title":"Ketamine and Esketamine for Late-Life Depression: A Systematic Review of Efficacy, Safety, and Tolerability","authors":"Ronesh Sukhdeo H.B.Sc. , Jocelyn K. Tamura M.D. , Christine E. Dri B.H.Sc. , Roger S. McIntyre M.D.","doi":"10.1016/j.jagp.2025.08.001","DOIUrl":"10.1016/j.jagp.2025.08.001","url":null,"abstract":"<div><div>Ketamine has emerged as a promising treatment for major depression, though its efficacy and safety remain incompletely characterized in older adults. This systematic review synthesizes current evidence for ketamine in geriatric depression. A search of PubMed, EMBASE, and PsycINFO was conducted. Prospective clinical trials were included, with age restriction to participants ≥60 years applied at full-text review to capture subgroup data. Thirteen studies met inclusion criteria, comprising 757 adults. Studies examined intranasal (n = 5), intravenous (n = 4), subcutaneous (n = 1), and oral (n = 1) ketamine formulations, as well as ketamine combined with ECT (n = 2). Antidepressant efficacy findings were mixed; with preliminary findings of symptomatic improvement in this difficult to treat disease state, although not all studies reported out positive outcomes. Adverse events were generally mild to moderate and discontinuation due to side effects was rare. Cognitive outcomes were mostly stable or improved, though long-term studies noted small declines in reaction time. Ketamine as an ECT anesthetic did not enhance antidepressant outcomes. Evidence certainty was very low to low; findings were limited by small samples, open-label designs, and inconsistent age-stratified reporting.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 84-102"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1016/j.jagp.2025.07.012
David Adler M.D.
{"title":"Reflections on 50 Years of Teaching and Service: My Professional Life Story","authors":"David Adler M.D.","doi":"10.1016/j.jagp.2025.07.012","DOIUrl":"10.1016/j.jagp.2025.07.012","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1354-1357"},"PeriodicalIF":3.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.jagp.2025.07.007
Ahjeetha Shankar B.S. , Emmanuel E. Garcia Morales Ph.D. , Jeannie-Marie Leoutsakos Ph.D., M.H.S. , Valerie T. Cotter Dr.N.P., C.R.N.P. , Milap A. Nowrangi M.D. , Sevil Yasar M.D., Ph.D. , Constantine G. Lyketsos M.D., M.H.S. , Esther S. Oh M.D., Ph.D. , Carrie L. Nieman M.D., M.P.H.
Objective
Hearing loss is a common comorbidity among persons living with dementia (PLWD), affecting >90% of individuals. Sensory impairments have been associated with an increased risk of neuropsychiatric symptoms (NPS), while hearing aid use may be protective.
Method
We analyzed cross sectional data from the National Alzheimer’s Coordinating Center’s Uniform Data Set. We estimated the association between functional hearing loss and number or severity of NPS in a negative binomial regression with robust variance adjusting for demographic and clinical characteristics. In the subsample with hearing loss, we estimated the association between hearing aid use and number or severity of NPS. Selection bias for hearing aid use was addressed using nearest neighbor matching (NNM) based on respondent demographic characteristics.
Result
10,054 participants were included with a mean age of 75 (SD 8) years. 2,416 (24%) self-reported functional hearing loss with 3.4 (standard deviation [SD] 2.5) mean total number of NPS and mean NPS severity of 5.1 (SD 4.9). In fully adjusted models, hearing loss was not associated with more NPS (predicted prevalence difference (PPD):0.09; 95% confidence interval (CI):-0.06,0.25) or more severe (PPD = 0.25; 95% CI:-0.06,0.56) NPS. In PLWD reporting hearing loss, 1,325 (54.8%) reported hearing aid use. After well-balanced matching, in adjusted models, hearing aid use was associated with fewer (PPD:-0.71; 95% CI:-0.93,-0.50) and less severe NPS (PPD:-1.79; 95% CI:-2.23,-1.34).
Conclusion
Hearing aid use may represent an underutilized, nonpharmacological intervention to address NPS. These findings suggest that hearing care may represent a promising nonpharmacological strategy to explore in managing NPS.
{"title":"Hearing Loss, Hearing Aid Use, and Neuropsychiatric Symptoms Among Persons Living With Dementia: Findings From NACC","authors":"Ahjeetha Shankar B.S. , Emmanuel E. Garcia Morales Ph.D. , Jeannie-Marie Leoutsakos Ph.D., M.H.S. , Valerie T. Cotter Dr.N.P., C.R.N.P. , Milap A. Nowrangi M.D. , Sevil Yasar M.D., Ph.D. , Constantine G. Lyketsos M.D., M.H.S. , Esther S. Oh M.D., Ph.D. , Carrie L. Nieman M.D., M.P.H.","doi":"10.1016/j.jagp.2025.07.007","DOIUrl":"10.1016/j.jagp.2025.07.007","url":null,"abstract":"<div><h3>Objective</h3><div>Hearing loss is a common comorbidity among persons living with dementia (PLWD), affecting >90% of individuals. Sensory impairments have been associated with an increased risk of neuropsychiatric symptoms (NPS), while hearing aid use may be protective.</div></div><div><h3>Method</h3><div>We analyzed cross sectional data from the National Alzheimer’s Coordinating Center’s Uniform Data Set. We estimated the association between functional hearing loss and number or severity of NPS in a negative binomial regression with robust variance adjusting for demographic and clinical characteristics. In the subsample with hearing loss, we estimated the association between hearing aid use and number or severity of NPS. Selection bias for hearing aid use was addressed using nearest neighbor matching (NNM) based on respondent demographic characteristics.</div></div><div><h3>Result</h3><div>10,054 participants were included with a mean age of 75 (SD 8) years. 2,416 (24%) self-reported functional hearing loss with 3.4 (standard deviation [SD] 2.5) mean total number of NPS and mean NPS severity of 5.1 (SD 4.9). In fully adjusted models, hearing loss was not associated with more NPS (predicted prevalence difference (PPD):0.09; 95% confidence interval (CI):-0.06,0.25) or more severe (PPD = 0.25; 95% CI:-0.06,0.56) NPS. In PLWD reporting hearing loss, 1,325 (54.8%) reported hearing aid use. After well-balanced matching, in adjusted models, hearing aid use was associated with fewer (PPD:-0.71; 95% CI:-0.93,-0.50) and less severe NPS (PPD:-1.79; 95% CI:-2.23,-1.34).</div></div><div><h3>Conclusion</h3><div>Hearing aid use may represent an underutilized, nonpharmacological intervention to address NPS. These findings suggest that hearing care may represent a promising nonpharmacological strategy to explore in managing NPS.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1230-1239"},"PeriodicalIF":3.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.jagp.2025.07.016
Philip D. Harvey Ph.D.
{"title":"The Woodstock Generation has a Smartphone: Can Communication About Psychedelic Therapy Affect the Willingness on the Part of Older People to Attempt Treatment?","authors":"Philip D. Harvey Ph.D.","doi":"10.1016/j.jagp.2025.07.016","DOIUrl":"10.1016/j.jagp.2025.07.016","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1260-1262"},"PeriodicalIF":3.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.jagp.2025.07.015
Tor Arnison Ph.D. , Axel Nordenskjöld M.D., Ph.D.
{"title":"Response to “The Evidence Base for Electroconvulsive Therapy (ECT) in Geriatric Depression”","authors":"Tor Arnison Ph.D. , Axel Nordenskjöld M.D., Ph.D.","doi":"10.1016/j.jagp.2025.07.015","DOIUrl":"10.1016/j.jagp.2025.07.015","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 1","pages":"Pages 136-137"},"PeriodicalIF":3.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-27DOI: 10.1016/j.jagp.2025.07.005
Barry W. Rovner M.D., Robin J. Casten Ph.D.
{"title":"In-Basket Notes to Increase Recognition of Mild Cognitive Impairment","authors":"Barry W. Rovner M.D., Robin J. Casten Ph.D.","doi":"10.1016/j.jagp.2025.07.005","DOIUrl":"10.1016/j.jagp.2025.07.005","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"34 2","pages":"Pages 252-253"},"PeriodicalIF":3.8,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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