Aging & Mental Health最新文献

Objectives: Investigate whether the coexistence of pain and depressive symptoms is a risk factor for cognitive decline in individuals aged 50 or older.

Method: Longitudinal trajectory study involving 4,718 participants from the English Longitudinal Study of Ageing (ELSA). Joint pain was self-reported, and intensity was classified as mild, moderate/intense. Depressive symptoms were investigated using the Centre for Epidemiologic Studies Depression Scale (CES-D-8 ≥ 4). The sample was divided into six groups: no pain and no depression (NP/NDe), mild pain and no depression (MP/NDe), moderate/intense pain and no depression (M-IP/NDe), no pain and depression (NP/De), mild pain and depression (MP/De), and moderate/intense pain and depression (M-IP/De). The outcome of interest was performance in memory, executive function, and global cognition. Generalised linear mixed models were used to analyse performance in the cognitive domains and global cognition score as a function of pain and depressive symptoms during 12 years of follow-up.

Results: Over time, individuals with M-IP/De had a greater memory decline (-0.038 SD/year, 95%CI: -0.068 to -0.007) and the global cognition score (-0.033 SD/year, 95%CI: -0.063 to -0.002) than those with NP/NDe.

Conclusion: The coexistence of moderate/intense pain and depressive symptoms is a risk factor for the decline of global cognition and memory.

Objectives: Frontotemporal Degeneration (FTD) is a common cause of early onset dementia with symptoms often presenting before 65 years of age and adding tremendous burden on caregivers. FTD caregiving research describes patient behavioral symptoms such as apathy and disinhibition as primary sources of poor caregiver psychological health; however, little attention has been paid to other common patient behaviors, such as loss of empathy. To better understand the relationship between empathy loss and FTD caregiver outcomes, this integrative review aimed to address the question: How does the loss of empathy in a person living with FTD (PLwFTD) impact the caregiver?

Method: Quantitative and qualitative articles were found in PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus and were assessed for quality using the Crowe Critical Appraisal Tool (CCAT). Through constant comparative analysis, articles were assessed to abstract common themes in the literature.

Results: From 333 citations, 8 qualitative and 8 quantitative studies published between 2010 and 2022 were included. Three main themes were uncovered: 1) caregiver emotional reactions to the PLwFTD; 2) caregiver psychological distress; 3) changes in the relationship.

Conclusion: This review emphasizes the detrimental impact of empathy loss on FTD caregivers. Understanding these underexplored consequences is critical in understanding the well-being of caregivers and promoting ways to support caregivers.

Objectives: This pilot test of the 4Ms-Behavioral Health (4Ms-BH) training program was designed to assess knowledge gains, clinical behavior change, and acceptability among mental health clinicians and compile lessons to guide widespread implementation of the framework. The ultimate future goal is to improve care for older adults by expanding the 4Ms framework for behavioral health providers.

Method: Fifteen mental health clinicians from Community Mental Health Centers in three states completed eight hours of live session training over six months: one three-hour introduction followed by five monthly application sessions. Clinicians completed knowledge and clinical behavior measures before and after training, along with follow-up discussion regarding acceptability and sustainability.

Results: Although knowledge gains were not significant in the overall 4Ms knowledge assessment, knowledge in the Medication and Mobility domains improved at 17% and 15%, respectively. Participants completing the program demonstrated an increased frequency of clinical behaviors pertinent to older adult care with large effect sizes in each of the 4Ms assessment and action activities from pre-training to post-training (Cohen's d range = 0.82 - 1.66, p ≤ 0.01).

Conclusion: The 4Ms-BH framework was well-received by participants, who demonstrated some significant knowledge gains and clinical behavior change. These pilot data suggest that this framework has strong potential to effectively train mental health clinicians with little geriatric training.

Objectives: We performed a systematic review and meta-analysis to examine the prevalence and antecedents/consequences of chronic loneliness and social isolation (i.e. enduring or persistent experience that extends over a certain period of time) among older adults. Moreover, we conducted a meta-regression to explore sources of heterogeneity.

Method: A search was conducted in four electronic databases. We included observational studies that reported prevalence and, where available, antecedents/consequences of chronic loneliness or chronic social isolation amongst older adults. Key characteristics of the studies were extracted.

Results: Across 17 studies included in the meta-analysis, the estimated prevalence of chronic loneliness was 20.8% (95% CI: 16.1-25.5%), including 21.7% among women (95% CI: 16.1-27.4%) and 16.3% among men (95% CI: 10.6-21.9%). One study reported chronic social isolation (13.4%) and found that chronic social isolation predicted higher depression scores. Meta-regressions indicated that loneliness was less prevalent when assessed with single-item measures. Regarding antecedents/consequences, spousal loss can contribute to chronic loneliness which in turn may contribute to adverse health-related outcomes.

Conclusion: About one in five older adults experiences chronic loneliness reflecting the need to address chronic loneliness. More longitudinal research is needed on chronic loneliness and social isolation, particularly from low and middle-income countries.

Objectives: This study identifies patterns of antidepressant prescribing and subsequent hospital admissions from 2010 to 2018 amongst older adults in Northern Ireland (NI).

Method: Participants comprised all General Practitioner (GP)-registered adults aged fifty-five years and above on 01/01/2010 (n = 386,119). Administrative data linkage included demographic information; antidepressant prescribing data from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant prescribing (from 2010 to 2018).

Results: RMLCA identified four latent classes: decreasing antidepressant prescribing (5.9%); increasing antidepressant prescribing (8.0%); no-antidepressant prescribing (68.7%); and long-term antidepressant prescribing (17.5%). Compared with those in no-antidepressant prescribing class, persons in the remaining classes were more likely to be female and younger, and less likely to live in either rural areas or less-deprived areas. Compared with no-antidepressant prescribing, those with increasing antidepressant prescribing were 60% and 52% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 11% and 8% higher in 2019 and 2020, respectively. Similarly, those with long-term prescriptions were 70% and 67% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 14% and 9% higher in 2019 and 2020, respectively.

Conclusion: Findings show that approximately 26% of the NI hospital admissions population were impacted by sustained or increasing antidepressant prescribing. Because of their increased likelihood of hospitalization, these individuals may benefit from psychosocial support and social prescribing alternatives to psychopharmacological treatment.

Objectives: Post-traumatic stress disorder (PTSD) and subjective cognitive decline (SCD) are independent risk factors for Alzheimer's disease (AD) and dementia, but the association of their interaction on AD biomarkers have yet to be characterized. This study aimed to examine the impact of PTSD on the association between SCD and tau and amyloid positron emission tomography (PET) as well as global cognition in older Veterans.

Method: This study included 87 Vietnam-Era Veterans without dementia (42 with PTSD; 45 without PTSD) from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative. All participants had both tau and amyloid PET imaging as well as cognitive testing. SCD was measured using the Everyday Cognition questionnaire.

Results: While SCD was associated with tau PET, amyloid PET, and global cognition, PTSD moderated these associations for tau and amyloid PET levels. Specifically, Veterans without PTSD had a stronger positive relationship between SCD and AD biomarkers when compared to those with PTSD.

Conclusion: Higher SCD was associated with greater tau and amyloid burden and worse cognitive performance across the sample, though the tau and amyloid associations were stronger for Veterans without PTSD. Results highlight the potential benefit of comprehensive clinical assessments including consideration of mental health among older Veterans with SCD to understand the underlying cause of the cognitive concerns. Additionally, more work is needed to understand alternative mechanisms driving SCD in older Veterans with PTSD.

Objectives: COVID-19 lockdowns were introduced to control the pandemic, however, they resulted in a global disruption of daily life and of individual and global health. Reduced accessibility of health services, unavailability of food and drugs, and mental health challenges had a huge impact on older people and on people living with disabling conditions such as Parkinson's disease (PD). We assessed whether and to what extent the more disabled and vulnerable people with Parkinson's (PwP) were affected by lockdowns.

Method: We analysed responses collected through a web-based survey of PwP according to their self-sufficiency [self-sufficient (SS); nearly self-sufficient (nSS); non-self-sufficient, cared for by family (NSS/F); non-self-sufficient, needs professional care (NSS/PC)].

Results: Fears due to COVID-19 and difficulties with food supply were highest in NSS/F PwP. Difficulties with the supply of Parkinson's medication or other drugs were apparently not an issue, while problems accessing primary care physicians and neurologists were similar across all patient groups. On the contrary, difficulties with daily and motor activities were higher in NSS/F and NSS/PC PwP. PwP symptoms worsened in all groups, with NSS/F and NSS/PC participants experiencing the worst deterioration. Notably, the deterioration of PwP symptoms was specifically related to changes in daily and motor activities, with participants who reported less engagement in daily and motor activities experiencing the worst deterioration.

Conclusion: Findings strongly support the need for decision-makers and healthcare providers to carefully re-evaluate the risk-benefit ratio of limiting healthcare accessibility for PwP, since evidence shows that lockdown measures primarily impact the groups who are most fragile and vulnerable.

Objectives: This study investigates factors associated with the person with dementia and the caregiver to identify those associated with an increased risk of transition to a care home.

Method: IDEAL data were collected at baseline and at 12- and 24-month follow-up for 1545 people with dementia and 1305 caregivers. Modified Poisson regressions with an offset for 'person years at risk' were used. Person with dementia factors explored were personal characteristics, cognition, health, self- and informant-rated functional ability, and neuropsychiatric symptoms. Caregiver factors explored were personal characteristics, stress, health, and quality of the dyadic relationship.

Results: A 5% people moved into care. Risk of moving into a care home was higher among people with dementia who were ≥80 years, among people with Parkinson's disease dementia or dementia with Lewy bodies, and among those without a spousal caregiver. Poorer cognition and more self-rated or informant-rated functional difficulties increased the risk of moving into care.

Conclusion: Factors related to increased dementia severity and greater disability are the primary influences that place people with dementia at greater risk of moving into a care home. Strategies that help to maintain everyday functional ability for people with dementia could help delay people with dementia moving into care.

Objectives: This study aimed to compare the effects of laughter yoga and music intervention on depression, anxiety, and stress in aged individuals referred to Rafsanjan health centers.

Method: In this 3-arm randomized clinical trial, 91 depressed aged participants aged 60-75 years, referred to Rafsanjan health centers, were randomly assigned to intervention and control groups. The study followed a parallel group design with an allocation ratio of 1:1. The laughter yoga intervention was conducted twice a week for eight weeks, and music intervention consisted of 30-min sessions twice a week for eight weeks. The control group received no intervention ('No treatment' concurrent control). Assessments for depressive symptoms (primary outcome), anxiety, and stress were conducted at baseline, post-intervention, and one month after the intervention.

Results: A total of 84 patients were analyzed in three groups included the laughter yoga intervention (n = 31), music intervention (n = 25), or control group (n = 28). Repeated measures ANOVA revealed a significant decrease in depressive and anxiety symptoms (p < 0.001) from pre-test to post-test and one-month follow-ups. The greatest impact of the intervention programs on stress was observed immediately after the intervention, but stress increased one month after the intervention programs (p = 0.125).

Conclusion: Both laughter yoga and music interventions proved effective in improving depression, anxiety, and stress in aged individuals. However, laughter yoga intervention demonstrated a superior effect and better acceptance among elders.

Objectives: Older spouses are a significant part of family caregivers of patients with Alzheimer's disease (AD) and need support. Evidence suggests that different factors influence the support of older spousal caregivers. However, there is little evidence about these factors in developing countries like Iran. This study aimed to identify the factors affecting the support of Iranian older spousal caregivers of people with AD.

Method: This qualitative study used Graneheim and Lundman's conventional content analysis approach. Through purposive sampling, 10 caregivers, three family members, and three professionals were recruited from various cognitive clinics and centers. In-depth and semi-structured interviews were used to collect data and continued until conceptual saturation was achieved.

Results: Two themes were derived from the data as factors affecting support, which included (1) caregiver's support-seeking (complexity of the patient's condition, caregiver's geriatric health, the burden of caring for a spouse with AD, marital bond quality, caregiver's support-phobic beliefs, caregiver's awareness of care) and (2) capacities of support resources (supportive family, supportiveness of society, formal systems' capability to provide support services).

Conclusion: The present study provided practical information about the factors influencing the support of older spousal caregivers. Healthcare providers and policymakers can use these concepts to improve the support process by strengthening caregivers' support-seeking motivation and enhancing capacities in support resources.