Aging & Mental Health最新文献

Objectives: To explore the hospital-related adverse events endured by people with dementia and assess their association with negative outcomes related to hospital care.

Method: A scoping review was undertaken in October 2023. Primary studies published in peer-reviewed journals in English, Spanish, or Portuguese were included. The databases PubMed, Web of Science, CINAHL, and Scopus were searched.

Results: Of the 1976 retrieved studies, 16 were included. Adverse events were more frequent among people with dementia compared to people without dementia. In studies with non-surgical and surgical patients, the most frequently reported were falls, delirium, and infections, while in studies exclusively conducted with surgical patients, these were postoperative delirium, infections, and other complications. The link between adverse events and negative outcomes was explored in only three studies and indicated that those who experienced adverse events had longer hospital stays, higher risk of mortality, and higher readmission rates within 90 days.

Conclusion: Although we were unable to establish a direct link between adverse events and hospital outcomes due to the exploratory nature of this review, the findings suggest that mitigating such events could help improve outcomes among hospitalized people with dementia. Hospital safety measures appear to be insufficient to protect this group.

Objectives: Awareness refers to the ability to recognize deficits associated with disease progression. This study aimed to investigate the pattern of impairment of domains of awareness over three-time points and examine the relationship between domains and clinical aspects of Alzheimer's Disease (AD).

Method: We selected 158 people with mild-to-moderate AD and their caregivers. After 24 months, forty-one completed the evaluation. We examined five domains of awareness using the Assessment Scale of Psychological Impact of the Diagnosis of Dementia (ASPIDD): cognitive functioning and health condition, functional activity impairments, emotional state, social functioning and relationships, and disease itself.

Results: We conducted a post-hoc analysis to understand impairment patterns across domains. Between moments 1 and 3, most domains showed significant impairments over time, except the ASPIDD emotional state, which remained stable. Principal Component Analysis indicated that ASPIDD emotional state and ASPIDD social functioning are similar; both were related to neuropsychiatric symptoms and caregiver burden during moments 1 and 2. Cognitive and functional factors impacted all domains during moment 3.

Conclusion: The pattern of impairment in the domains of awareness is not a linear process since some domains did not decline over time. Each domain was influenced by different clinical aspects related to the disease.

Objectives: Insomnia prevalence increases with age. Although cognitive behavioral therapy (CBT) for insomnia is the first-line treatment, limited accessibility leaves many older adults with few effective treatment options. This study assessed the efficacy of digital CBT (dCBT) for treating insomnia, anxiety, and depression symptoms in adults aged 65 and older.

Method: Data from three published randomized controlled trials of dCBT for insomnia (Sleepio) versus controls were combined for those aged 65+ with insomnia disorder (N = 315). Insomnia, anxiety, and depression scores were standardized into z-scores for comparison. Mixed-effects models estimated the treatment effect on insomnia, depression, and anxiety outcomes at post-treatment (8-10 wk) and follow-up (24 wk). Chi-squared tests of Sleep Condition Indicator (SCI-8) scores evaluated post-treatment insomnia remission rates between groups.

Results: Compared with controls, dCBT generated significantly greater improvements at post-treatment and follow-up in insomnia (gs ≤ -1.88, ps < 0.001) and depression (gs ≤ -0.44, ps ≤ 0.001) and significantly greater improvements in anxiety at post-treatment (g = -0.33, p < 0.001). dCBT generated higher post-treatment insomnia remission rates (60% vs. 16%, p < 0.001).

Conclusion: dCBT can effectively improve symptoms of insomnia, anxiety, and depression in adults aged 65+. Digital CBT may serve as an accessible means for older adults to receive guideline-concordant treatment at scale and avoid adverse side effects from common pharmacologic interventions.

Objectives: Globally, increasing numbers of people are living with multiple long-term conditions. When dementia is a co-occurring condition, contact with services is complicated due to cognitive difficulties and is often achieved as a dyad (person-carer). This realist review aimed to explain how dyads living with dementia alongside other long-term conditions are enabled to access and navigate health and care systems.

Method: An iterative, three-stage approach synthesised evidence from empirical studies and stakeholders with lived and professional experience (ethics reference 23/LO/0829).

Results: Evidence from 61 studies and stakeholders (30 participants, 68 consulted) built and refined five programme theories for how health and care systems can achieve continuity of support, anticipate adverse events and maintain quality of life. Belief that concerns would be listened to and acted upon led dyads to seek assistance. Time and permission to discuss priorities, prognosis and acceptable levels of burden enabled uncertainties to be managed as a shared endeavour. The collective capacity of the dyad was enhanced by peer support, expertise they accrued and professionals who helped anticipate points of change.

Conclusion: Despite years of system changes, structural factors still create excessive burdens for dyads accessing services and constrain professionals' ability to respond to complex needs.

Objectives: Physical functional limitations come with aging that impact social relationships and participation (SRP). This study aimed to investigate whether SRP mediates the association between functional limitations and MWB in frail older adults.

Method: We used survey data collected from 338 frail older adults in Norway between 2017 and 2019. Older adult's functional limitation was measured by activities of daily living (ADL). Linear regressions were used to estimate the effect of ADL and SRP on MWB, and the effect of ADL on SRP. A structural equation model (SEM) was used to decompose the total effect of ADL on MWB into direct and indirect (via SRP) effects.

Results: We found that both ADL and SRP significantly predicted MWB. The effect of ADL on SRP was also statistically significant (β = 0.265; p < 0.01). The direct effect of ADL was higher (β = 0.763; p < 0.01) than its indirect effect (β = 0.383; p < 0.01). The proportion of the total effect that is mediated was about 34%. Analyses from the longitudinal framework showed similar results.

Conclusion: Healthy aging can improve MWB directly or indirectly through better SRP. Our findings may have important implications for the design of health policies for older adults by further focusing on maintaining and investing in SRP.

Objectives: This study was conducted with the aim of developing a scale to measure 'retirement psychology' in order to better understand the impact of the retirement process on individuals' psychological states.

Method: A total of 437 retired people took part in the study. The Retirement Psychology Scale was developed in five stages. In the first stage, items were generated through interviews with retired individuals and validity and reliability tests were conducted. Exploratory and confirmatory factor analyses were then carried out to test the validity and reliability of the scale.

Results: The analyses revealed that the scale consists of four dimensions: negative impact, positive impact, relaxation and economic dimension, with a total of 37 items. This study provides a scientific tool for identifying and measuring the potential impact of the retirement process on individuals' psychological states.

Conclusion: The developed scale can contribute to a more comprehensive understanding of the psychological effects of the retirement process and its aftermath. Investigating the impact of retirement on individuals' quality of life and happiness is of both individual and societal importance, and this study can be seen as an important step in this regard.

Objectives: Long-term caregiving can lead to a high caregiver burden for caregivers of community-dwelling people with dementia in Asia's low- and middle-income countries (LMICs). It is essential to assess the level of caregiver burden and its factors in such settings to understand the impact on caregivers' well-being.

Method: A systematic review was conducted based on the PRISMA. Articles were identified from seven databases published from 2000 to November 2023. Each article's methodological quality was assessed with an appraisal checklist developed by the Joanna Briggs Institute.

Results: 64 studies with 12 measurement tools were identified from 9 countries. Only 20% of studies using 22-item ZBI show caregivers experienced no or little burden while caring for their care recipients. The mean 22-item ZBI score ranged from 24.5 in Turkey to 34.7 in India, while the mean CBI score varied from 24.0 in Thailand to 47.8 in China. Patient, caregiver characteristics, and caregiving context are associated with caregiver burden.

Conclusion: Dementia caregivers in Asian LMICs exhibit a wide variation in caregiver burden. Programs that promote protective factors and address modifiable factors are imperative to mitigate burdens and enhance caregivers' quality of life in these settings.

Objectives: This systematic review aimed to examine the impact of elder abuse, specifically neglect, physical and financial abuse on mental health outcomes among older adults in the United States. It also sought to identify intervention strategies and highlight gaps in the existing literature.

Method: A comprehensive search was conducted using PubMed, PsycINFO, ProQuest, and Google Scholar for articles published from 1990 onwards. After applying predefined inclusion and exclusion criteria, 23 studies were selected from an initial pool of 251 articles. Data extraction focused on abuse types, prevalence rates, mental health outcomes, and methodological approaches. Studies were categorized based on abuse type and associated mental health outcomes. This review was registered with PROSPERO (ID: CRD42024561162).

Results: Physical abuse was consistently associated with increased risks of depression and anxiety, with cultural factors influencing reporting rates. Financial abuse often led to emotional distress, social isolation, and compounded mental health challenges. Neglect was closely tied to loneliness and deteriorating well-being. Methodological limitations, including reliance on cross-sectional designs and self-reported data, were prevalent among the reviewed studies. These limitations underscore the need for longitudinal research to establish causality.

Conclusion: Elder abuse significantly impacts mental health, particularly through physical, financial, and neglectful abuse. Effective prevention strategies should include caregiver support, financial education, multidisciplinary approaches, and tailored interventions. Future research should prioritize longitudinal studies to explore causal relationships and quantify the broader social and economic impacts of elder abuse. Addressing these gaps is critical to improving prevention, support systems, and policy frameworks aimed at safeguarding older adults' mental health and well-being.

Objectives: Ageism occurs across the world, with negative consequences for individuals and societies. In 2016, WHO received a mandate from its Member States to lead the global campaign to combat ageism. To monitor, evaluate, and build evidence for reducing ageism, the availability of a brief, reliable and valid set of indicators of ageism experiences that can be used globally is essential.

Method: Building on previous reviews, the current review examines existing measures of ageism with a specific focus on suitability for meeting this need. Given the urgent need for indicators in the context of the global campaign to combat ageism, a rapid review methodology was adopted.

Results: Results suggested that no measure met all desired criteria; however, the WHO ageism experiences scale was the most promising of available measures due to its focus on ageism as a multi-dimensional construct encompassing stereotypes, prejudices, and discrimination and self-directed, interpersonal, and institutional elements and the explicit consideration of cross-cultural universality in its development. Other promising measures included ESS Round 4 items along with its CIS and VQ variants, the Everyday Ageism Scale, the Perceived Ageism Questionnaire (PAQ), and the Ageism Survey.

Conclusion: Further cross-setting validation of this scale is recommended.

Objectives: Examine the feasibility, acceptability, and preliminary effects of the Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs) on dementia caregivers' anxiety, depression, caregiver burden, suffering, and anticipatory grief.

Method: A 2-arm pilot randomized trial with dementia caregivers ≥ 21 years old with clinically elevated anxiety or anxiety-related functional interference. Two cohorts were recruited at the beginning and end of the first year of the COVID-19 pandemic. Intervention participants received 6 telephone sessions delivered by a non-licensed interventionist and control participants received readings and a list of dementia caregiver support groups in their area. Outcomes were measured at baseline, post-intervention, and at 3 and 6 months. Feasibility was measured by enrollment rates, completion rates, and adherence to TACTICs by interventionists. Acceptability was measured with participant satisfaction surveys.

Results: TACTICs was feasible and acceptable with 96% enrollment, 98.6% adherence, 65.5% completion, and a mean satisfaction score of 9.35 out of 10 (SD 0.91). The TACTICs group showed clinically relevant reductions in anxiety post-intervention (SRM 4.1, 95% CI [2.4,5.8]), however reductions were not significantly different from the control group (p = 0.98).

Conclusion: Implementation of TACTICs during the COVID-19 pandemic was feasible and acceptable. The preliminary outcomes were not as strong as expected. The results will inform the design of future trials with larger samples.