Aging & Mental Health最新文献

Objectives: Concealment, in any form, can have a lasting negative impact on the health of individuals. This study draws on participant concealment experiences from a study on lifetime health experiences of older lesbians and gay men in the UK.

Method: Constructivist grounded theory was used to develop a substantive theory that explains the impact of concealing and revealing on the lives of eighteen participants, nine women and nine men (age range of 50-86) in the UK.

Results: Almost from the time of realising that they were 'different' the need to conceal was significant. This manifested the process of 'masking', as a protective measure and the need to fit in with society. As a result of these experiences scarring occurred that was primarily psychological. 'Coming out' was a major step and involved 'selective revealing', which was interwoven with the experience of living in a supportive community, whilst also coming to terms with oneself, and for some, becoming an activist.

Conclusion: Findings highlight the consequences of concealment while pointing to the transformative potential of affirming environments. This research extends understanding of the lived realities of older lesbian and gay individuals, emphasising both the impact of societal oppression and the resilience required to navigate it.

Objectives: Care refusal behaviours in dementia represent meaningful expressions of autonomy, yet validated assessment tools for Portuguese-speaking populations remain absent. The Refusal of Care Informant Scale (RoCIS) measures care refusal expressions during personal care interactions. This study aimed to conduct cross-cultural validation of the RoCIS for European Portuguese populations, establishing psychometric properties in nursing home settings.

Method: This cross-sectional study employed systematic translation and psychometric evaluation using classical test theory and Rasch analysis. A sample of 183 older adults living with dementia from 12 Portuguese nursing homes was assessed using the Portuguese RoCIS alongside validated measures, including the Cohen-Mansfield Agitation Inventory, Neuro-psychiatric Inventory-Questionnaire, Barthel Index, and Functional Assessment Staging Tool.

Results: The Portuguese RoCIS demonstrated internal consistency (Cronbach's α = 0.834; 95% CI: 0.796-0.867). Rasch analysis confirmed item reliability (0.91) and unidimensionality. Convergent validity was established through significant correlations with agitation (r = 0.523, p < 0.001) and neuropsychiatric symptoms (r = 0.427, p < 0.001). Known-groups validity showed significant discrimination across cognitive dependency levels (F(2,180) = 3.410, p = 0.035).

Conclusion: The Portuguese RoCIS represents the first cross-cultural validation beyond the original country of development, providing strong evidence for the scale's international applicability and supporting relationship-centred dementia care globally.

Objectives: Older adults residing in nursing home (NH) settings are at risk of loneliness, a complex and multi-dimensional concept that adversely affects health. To effectively identify and address loneliness, it is crucial to enhance the understanding of the social, psychological, cultural, and environmental factors associated with loneliness.

Method: A scoping review was conducted to examine the current evidence. Thematic analysis was employed to identify factors influencing (dimensions of) loneliness, which were ranked on proximity to loneliness.

Results: Based on 38 research papers, 27 factors related to loneliness were identified, of which 13 were sufficiently representative. A minority of these factors were directly linked to the social, emotional and existential dimensions of loneliness. The most frequently mentioned factors were categorised into the domains of health and functioning, stress-coping, social contact, and relationship quality.

Conclusion: Loneliness is best addressed within the immediate social environment of NH settings, and staff play a crucial role in fostering a sense of belonging. Moreover, residents' experiences and needs regarding loneliness and its dimensions must be thoroughly assessed and discussed, particularly for those suffering from dementia. Furthermore, our review emphasises the urgent need for comprehensive, inclusive, and consistent research on loneliness in NH settings.

Objectives: Caregivers may experience treatment burden as they care for persons living with dementia and diabetes. This study aims to adapt and validate the Treatment Burden Questionnaire (TBQ) for use among caregivers.

Method: For this cross-sectional study, we pooled data of caregivers enrolled in the Enhanced Quality in Primary Care for Elders with Diabetes and Dementia study (N = 311). The original patient-focused 15-item TBQ scale was adapted to measure caregiver-related burden. We assessed face validity for each item, performed item analysis, and computed the scale's internal consistency (Cronbach alpha). We also performed principal component analysis (PCA) and correlation to assess the construct and convergent validity, respectively.

Results: All 15 items in the caregiver TBQ demonstrated face validity, had high acceptability, with a Cronbach alpha of 0.89. The PCA identified three domains-medication monitoring burden, healthcare access burden, and social care burden. Subscale domain reliability was 0.86, 0.77, and 0.77, respectively. The three subscales exhibited significant small to moderate correlations with the stress thermometer, Medical Outcomes Study, and physical and mental health Patient-Reported Outcomes Measurement Information System scores.

Conclusion: The caregiver TBQ is a reliable and valid tool that captures domains of medication monitoring, healthcare access, and social care burden.

Objectives: . Feeling lonely is associated with worse health as people get older, yet its relation to physical function is unclear. This study examined the association between loneliness and performance-based measures of physical function.

Methods: . Participants (age range: 34-103 years; N > 33,000) were from six established cohorts: Five were from the United States and one was from the United Kingdom. Participants were assessed on loneliness, demographic factors, disease burden, physical inactivity, gait speed, grip strength, lower limb strength, and standing balance.

Results: . Higher loneliness was associated with a higher likelihood of slow gait speed (k = 6; pooled odds ratio [OR] = 1.25; 95% CI= 1.16;1.35, p < 0.001), weak grip strength (k = 5; OR= 1.19; 95% CI= 1.09;1.30, p < 0.001), weak lower limb strength (k = 5; OR= 1.19; 95% CI= 1.13;1.27, p < 0.001), and balance impairment (k = 3; OR= 1.29; 95% CI= 1.23;1.36, p < 0.001). These associations were independent of disease burden and physical inactivity. There was little consistent evidence that sociodemographic factors moderated these associations.

Conclusion: The present study provides replicable evidence that loneliness is associated with worse performance across multiple domains of physical function.

Objectives: Financial exploitation (FE) vulnerability in older adults is a growing public health concern and may signal future cognitive decline. This study investigated the associations between FE vulnerability and cognitive reappraisal and whether this varies by anxiety and depressive symptoms.

Method: One hundred and fifty-two older adults without dementia completed the Perceived Financial Vulnerability Scale (PFVS), Emotion Regulation Questionnaire-Cognitive Reappraisal subscale, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Hierarchical regressions tested associations between FE vulnerability, reappraisal, and anxiety and depression levels. Moderation analyses evaluated whether mood symptomatology influenced the PFVS-reappraisal link, followed by simple slopes and Johnson-Neyman analyses. Models were adjusted for age, sex, race, education, and income.

Results: FE vulnerability was associated with cognitive reappraisal ($\beta$=-0.33, p = 0.047) and anxiety ($\beta$=0.34, p < 0.001). The PFVS-reappraisal association was moderated by anxiety ($\beta$=0.21, p = 0.005) and depressive symptoms ($\beta$=-0.12, p = 0.033). Greater reappraisal was linked to reduced PFVS at lower anxiety ($\beta$=-0.52, p = 0.012) and higher depression ($\beta$=-0.53, p = 0.020). Johnson-Neyman analyses identified significance for anxiety scores (GAD-7) between 1 and 6 and depression scores (PHQ-9) above 4.

Conclusion: FE vulnerability was associated with cognitive reappraisal and moderated by anxiety and depression. Emotion regulation interventions may reduce FE vulnerability, particularly among older adults with lower anxiety or higher depressive symptoms.

Objectives: Commensality is central to social life - supporting social relations and even happiness - while eating alone is linked to poorer mental and physical health. This study examines whether eating alone and engagement in social activities are associated with loneliness and self-rated health among community-living older adults in Sweden.

Method: Data from a national cross-sectional survey of 695 adults aged 70-75 years were used to assess both the frequency and subjective experience of eating alone and engagement in social activities. Using logistic regression and interaction analysis, the associations with loneliness and self-rated health were examined.

Results: The frequency and subjective experience of eating alone were both associated with loneliness. The association between eating alone and loneliness was not dependent on whether eating alone was perceived as bothersome. Lower engagement in social activities was associated with loneliness and lower self-rated health. No associations between the frequency and subjective experience of eating alone and self-rated health were observed.

Conclusion: In this sample, the proportion of loneliness was high in groups bothered by eating alone, indicating specific subgroups for whom eating alone can be problematic. More research is needed to understand the issue of eating alone - and who it affects. This could help guide the development and implementation of policies targeting groups vulnerable to loneliness and poor health.

Objectives: As the prevalence of dementia and depression continues to increase globally, understanding the interplay between these conditions becomes important for effective diagnosis, treatment, and tailoring of interventions. We investigate the relationship between depressive symptoms and cognitive impairment and the potential role of sociodemographic characteristics, among care home residents in Australia, Germany, the Netherlands, Norway, Türkiye, and the United Kingdom.

Method: The study used baseline data from an international cluster-randomised controlled trial comprising 1021 residents with dementia and depressive symptoms in 86 care home units. The relationship between cognitive impairment and depressive symptoms was investigated using linear mixed effects models, with country, age, sex, marital status, and education level as possible predictors.

Results: Higher severity of cognitive impairment was related to more severe depressive symptoms in all countries. The association was especially strong in Türkiye. Marital status was a significant predictor for depressive symptoms and education level predicted cognitive ability.

Conclusion: Findings confirm that lower cognitive ability is associated with more depressive symptoms across different contexts in a large international sample. As thresholds to long-term care are likely to be set even higher in the future, interventions to alleviate depressive symptoms among older adults with dementia become even more important.

Objectives: The study aimed to determine the association between perceived stress and chronic diseases, as well as between stress and mortality.

Methods: Data from the Costa Rica Longevity and Healthy Aging Study (CRELES) (N = 2,743) were used. Multiple logistic regression models were employed to analyze the relationship between stress and chronic diseases, while Cox models were used to determine the association between stress and mortality.

Results: Stress related to the health of close relatives is associated with an increased risk of developing cardiovascular events and cataracts. Financial stress was associated with twice the risk of developing hypertension. No significant differences in mortality due to stress were found.

Discussion: The results suggest that stress influences the development of diseases that could lead to mortality, emphasizing the need for further research on the relationship between stress perception, physical health, mental health, and mortality.

Objectives: The aim is to compare the General Practitioners' (GPs) Knowledge, Practices, and Perceptions regarding early diagnosis and management between urban and rural areas.

Method: A cross-sectional study was conducted in 2024-2025 using a structured questionnaire in Kazakh and Russian. Data were collected anonymously via Google Forms with support from local health authorities. To reach the minimum sample size of 384 physicians, two reminder notifications were sent to aid recruitment. The questionnaire was reliable (Cronbach's alpha 0.918). Data were analyzed using chi-squared tests (p < 0.05).

Results: The survey included 789 GPs, with 402 from urban and 387 rural areas. Rural GPs were less likely to consider early diagnosis valuable compared to urban GPs. Rural GPs noted greater challenges with caregiver support, including psychological difficulties (p = 0.032) and financial issues (p = 0.045), along with a lack of institutional resources (p = 0.045). Both urban and rural GPs expressed a need for additional dementia training (74.9%, p = 0.068), with rural GPs preferring practical and seminar-based formats over online courses.

Conclusion: Rural GPs face more challenges in dementia care, contributing to inequlities in service delivery. Thus, targeted interventions, as enhanced training and improved support systems, are essential to address these disparities and better support GPs.