Aging & Mental Health最新文献

Objectives: Acute hospital staff identify that supporting patients with dementia is challenging. This study implemented a communication skills training programme for preventing and responding to distress in patients with dementia in acute hospitals and assessed its impact.

Method: A mixed-methods, multiple case study in six wards across three English acute hospitals. Observational, interview, and staff survey data was collected immediately pre, post and 1-3 months post training. The 7-h training programme consisted of two half-days separated by a reflective period of 2-4 wk. It was delivered face-to-face by local clinical educators, and comprised interactive content and discussion-based learning including multi-media PowerPoint presentations, video resources, a reflective diary and skills practice.

Results: 145 staff attended the training. Delivery was feasible, however challenges with training organisation and releasing staff occurred. Staff reported the training as engaging, relevant to their role, and valued opportunities for reflection and skills implementation between sessions. A statistically significant improvement was found immediate post-training on staff communication knowledge (CI 0.01-1.2) and confidence in caring for people with dementia (CI 4.9-7.3). Staff reported a range of learning which most planned to implement in practice. Some reported challenges applying specific communication principles to wider practice situations. Evidence of impacts on observed patient agitation and staff communication practices was challenging to provide.

Conclusion: Although challenging, it is feasible to deliver dementia communication skills training in acute hospital settings Communication training can lead to perceived increases in staff knowledge and confidence to support distress in this population.

Objectives: Social isolation and loneliness are modifiable yet under-studied factors that may exacerbate the effect of diabetes on cognitive impairment. This study aimed to investigate the effects of social isolation and loneliness on the initial levels and changes in cognitive function in older adults with diabetes.

Method: This study conducted secondary data analysis using data from the Health and Retirement Study (HRS). Data from 1416 participants aged 50 and over with diabetes who participated in six waves of the HRS over 10 years were analyzed. Latent growth modeling was employed within a structural equation modeling framework.

Results: Higher levels of social isolation in older adults with diabetes were linked to lower initial levels of total cognitive function and diminished backward counting ability, whereas no such association was found for loneliness. However, neither social isolation nor loneliness showed associations with a faster decline in total cognitive function and its subdomains.

Conclusion: To mitigate the heightened risk of cognitive impairment among older adults with diabetes, it is crucial to identify modifiable factors that can prevent cognitive decline. Healthcare providers should be attentive to older adults with diabetes who are socially isolated and lonely to deter the progression of cognitive impairment and dementia.

Objectives: Experiences of daughter caregivers are underrepresented in the broader caregiving literature, with studies commonly focusing on spousal caregivers. We aimed to explore challenges experienced by daughter caregivers, reporting varying severity of depressive symptoms, of a parent with dementia in Sweden. This study is situated within a wider research program to inform the development of psychological support for this underserved caregiver group.

Method: Following a semi-structured topic guide, we interviewed 23 daughter caregivers. We used reflexive thematic analysis to analyze the interviews. We did not compare and contrast challenges expressed by daughter caregivers experiencing different levels of depression severity; however, symptom severity is reported to contextualize findings.

Results: We generated one overarching theme, Changing Roles and Expectations Over Time, and four themes: Caregiver Role - Expectations; Puzzle of Life - Balancing Roles; Relationship with the Parent - Reciprocity, and Anticipating the Inevitable - Loss and Grief. Daughter caregivers reported challenges balancing multiple roles, difficulties prioritizing their own well-being, relationship difficulties with their parent, and anticipatory grief, with challenges changing over the dementia trajectory.

Conclusion: Future research should explore support needs across specific phases of the dementia trajectory to inform the development of tailored psychological support.

Objectives: Previous research indicates that burnout is higher among sandwich generation than among caregivers of children only and parents only. This study sought to identify the strongest predictors of burnout in different groups of caregivers. Further, this study aimed to confirm previous findings on the differences between caregivers of children only, parents only, and both children and parents (i.e. the sandwich generation).

Method: Participants (N = 415) recruited from Prime Panels answered questions related to burnout and psychosocial variables. Correlational analyses, a one-way ANOVA, and two multiple linear regressions were completed.

Results: Predictors of burnout differed between caregiving groups. In sandwich generation caregivers, positive and negative relationship quality were significant predictors of caregiver burnout. In parent-only caregivers, unique predictors of burnout included insomnia, distress tolerance, and neuroticism. In child-only caregivers, depressive symptoms and negative relationship quality significantly predicted caregiver burnout. Caregiver burnout and both positive and negative quality of the caregiving relationships differed significantly between the groups. Caregiver burnout was significantly higher in sandwich generation and parent-only caregivers compared to child-only caregivers. Positive relationship quality was highest among child-only caregivers, followed by sandwich generation and parent-only caregivers. Negative relationship quality was highest among sandwich generation, followed by parent-only caregivers and child-only caregivers.

Conclusion: Individuals caring for parents, especially those in the sandwich generation, face unique challenges including higher levels of burnout and depressive symptoms. Relationship quality is important in predicting burnout among individuals caring for parents.

Objectives: Efforts to improve quality of life (QOL) in dementia depend on its accurate conceptualization and assessment. We employed a data-driven network approach to examine the structure of relationships between individual QOL items. This approach allowed us to capture the complexity and multidimensional nature of QOL from the perspective of the person with dementia and their carer.

Method: Participants with dementia (n = 128) and carers completed the Quality of Life in Alzheimer's Disease questionnaire (QOL-AD), and measures of depressive symptoms, cognition, and functional abilities of the person with dementia, and carer burden. Gaussian graphical models with regularized partial correlations of QOL-AD items were estimated and compared, and item communities were detected.

Results: Central elements that emerged in both self and carer-reported networks included Ability to do Things for Fun, Energy, and Life as a Whole. Memory and Money were less central. Distinct differences were also evident between self- and carer-networks. Whilst Self as a Whole was relatively more central in the self-reported network, Ability to Do Chores and Family were more central in the carer-reported network. Moreover, different communities were detected in the networks, corresponding to domains including socioeconomic, daily, self-referential, and instrumental functioning, with differential correlations to key clinical outcome variables.

Conclusion: QOL in dementia is inherently multidimensional and differs when assessed from the viewpoint of the person living with dementia versus their carer. Network approaches offer the granularity required to ensure that targeted interventions can be tailored toward these complementary perspectives.

Objectives: Using data from the Health and Retirement Study (1992-2020), this study investigates how cognitive function and its longitudinal changes influence trajectories of depressive symptoms among oldest-old adults.

Method: Latent growth curve modeling (LGCM) was applied to examine changes in cognitive function and depressive symptoms across five time points (ages 90, 92, 94, 96, and 98+). The analytic sample consisted of 289 participants at baseline (age 90), with sample sizes ranging from 289 to 231 across subsequent age groups. In comparison, we conducted an additional LGCM longitudinal analysis for participants at an earlier baseline at age 60 (N = 17036), following them from 60 to 70 (n = 11915) and 80 years (n = 8942).

Results: The unconditional LGCM (without covariates) showed that higher baseline cognitive function was significantly associated with lower baseline depressive symptoms (β = -0.304, p < 0.001), but did not predict changes in depression over time. In the conditional model (including gender, education, self-rated health, and activities of daily living as covariates), higher education was associated with higher cognitive functioning but also with higher depression at baseline. In contrast, better ADL functioning and better perceived health significantly predicted higher cognitive functioning and lower depression at baseline. The intercept of depression predicted its own slope (β = -0.934, p < 0.001), indicating that Individuals with higher initial depressive symptoms experience a slower increase (or less worsening) in depression over time. For the 60-80 group, the intercept of cognition significantly predicted the intercept of depression (β = -0.380, p < 0.001), consistent with the 90-98+ group. However, longitudinal associations differed across age groups, indicating distinct developmental patterns between mid-to-late and very late adulthood.

Conclusion: This study emphasizes that although cognitive and emotional health are interrelated at baseline, changes in one domain do not reliably predict changes in the other among the oldest-old adults population. Instead, education, physical functioning, and self-rated health emerged as key predictors of both cognitive and emotional well-being. These findings highlight the importance of multidimensional assessments and targeted support to promote resilience and quality of life in extreme old age.

Objectives: Subjective cognitive decline (SCD) is an early indicator of cognitive impairment and dementia risk. Sleep quality, essential for cognitive health, often deteriorates with age. Intraindividual changes in sleep quality may be linked to concurrent changes in subjective cognition; this dynamic 'coupling effect' could inform strategies for prevention before objective impairments emerge but remains unexamined longitudinally. We investigated this interplay in older adults over multiple years.

Method: Utilizing the 'nlme' R package, we analyzed nine waves of sleep quality and subjective cognition data from the Transitions in Health and Relationships study (n = 131, ages 59-94 at baseline, 63% female) in hierarchical multilevel models, with random intercepts and slopes.

Results: Multilevel models indicated changes in sleep quality were positively associated with concurrent changes in subjective cognition, independent of baseline sleep quality, and sociodemographic covariates.

Conclusion: Findings highlight the importance of monitoring within-person sleep quality changes as a potential indicator of SCD in older adults. Further studies may help identify pathways to support cognitive health in aging populations.

Objectives: Although more older adults are living with autism spectrum disorder (ASD), research has focused mainly on younger individuals. Emerging evidence suggests that racial/ethnic disparities may further hinder timely diagnosis and care for older adults with ASD. This scoping review maps existing research on these disparities among older adults with ASD.

Method: A systematic database search was conducted from 01/15/2025 to 01/30/2025 across PubMed, PsycINFO, and Scopus. The PCC (Population, Concept, Context) framework was used to identify peer-reviewed, data-based studies published in English that focused on adults aged 60 years and older with ASD and explicitly addressed racial/ethnic disparities.

Results: Eight of 4,179 articles met the inclusion criteria. All included studies were observational, with the majority (n = 7) conducted in the United States. Racial/ethnic minority older adults with ASD face persistent disparities across the ASD care continuum. Black, Hispanic, and Asian/Pacific Islander older adults were less likely to be dually eligible for Medicare and Medicaid compared to their White counterparts. Additionally, racial/ethnic minority older adults with ASD showed a higher burden of physical and psychological comorbidities but lower likelihood of receiving treatment for their comorbidities. Racial/ethnic minority older adults with ASD had lower rates of outpatient service utilization and reduced access to supportive accommodations compared to their White counterparts.

Conclusion: Current research on racial/ethnic disparities among older adults with ASD remains limited; this research gap highlights an urgent need for more inclusive, population-specific studies to advance understanding and promote equity at the intersection of aging, autism, and healthcare access.

Objectives: Loneliness and stress are determinants of late-life health, yet their within-person dynamics are insufficiently characterized.

Method: We extracted loneliness, stress, depressive symptoms, social contacts, self-rated health (SRH) and sociodemographics constituted covariates from three waves (2017, 2021, 2023) of the German Ageing Survey (DEAS). Linear mixed-effects models regressed stress on loneliness adjusted for covariates. To disentangle within- and between-person effects, predictors were decomposed into person-mean and person-mean-centered components. Interaction effects tested moderation by gender, depressiveness and SRH.

Results: Loneliness predicted stress within (ß =0.30, p < 0.001) and between persons (ß =0.39, p < 0.001). Random-slope variance indicated inter-individual heterogeneity (SD = 0.247); intercept-slope correlation (r = -0.815) suggested flatter slopes among high-stress individuals: individuals with lower baseline stress showed greater stress upon loneliness while high stress leads to a blunted stress response. This effect was moderated by depressiveness but not by gender or SRH: at high loneliness levels, the contribution of depressiveness to stress is diminished.

Conclusion: Increases in loneliness induce stress beyond depression and SRH on both intraindividual and interindividual levels: when individuals feel lonelier, they experience stress, and those who are chronically lonelier report overall higher stress levels. Targeting loneliness alongside stress-management strategies may reduce stress burden and improve well-being in aging populations.

Objectives: With population aging and rising colorectal cancer (CRC), existential distress, defined as a profound psychological suffering associated with threats to meaning, identity, and purpose, has emerged as a critical yet underexplored aspect of older adults' cancer experience. This study explored the lived experience of existential distress among older Iranian adults with CRC.

Method: A qualitative descriptive phenomenological design was employed. Seventeen adults (≥65 years) with confirmed CRC were purposively recruited from a cancer center in northern Iran. Data were obtained through in-depth semi-structured interviews and analyzed with Colaizzi's seven-step method.

Results: Participants included 10 men and 7 women with a mean age of 68.94 ± 3.78 years, with diverse education, occupation, illness duration, and treatment. Three themes emerged: Inadequate Self-Realization, Confronting Uncertainty and Death, and Disruption of Meaningful Relationships. Inadequate self-realization involved diminished inner value and guilt for perceived family burdens. Confronting Uncertainty and Death encompassed being lost, fear of the unknown, and pervasive death presence. Disruption of Meaningful Relationships reflected stigma, social humiliation, and self-imposed isolation.

Conclusion: Older Iranians with CRC endure layered existential suffering shaped by personal beliefs and sociocultural values. Findings guide supportive cancer care addressing existential and spiritual needs, alongside physical care, highlighting psychosocial dimensions for culturally informed interventions.