Aging & Mental Health最新文献

Objectives: Old age is the stage of life when people are the most vulnerable to existential experience. These concerns intensify in late adulthood when individuals become increasingly prone to reflection and inclined to evaluate their lives. The study aimed to explore how older people who are active learners dealt with their existential concerns.

Method: The study was based on the qualitative approach and grounded theory. The data collection methods were narrative interviews and semi-structured interviews. Eighteen interviews were conducted. The narrators were students of Universities of the Third Age.

Results: An in-depth analysis of the collected empirical material revealed three themes that helped us understand how study participants differentiated their ways of dealing with self-perception of aging, effectiveness, and performing developmental tasks. This also allowed us to distinguish three main strategies educationally active older adults used to cope with existential concerns: repression, escape, and engagement.

Conclusion: The study's results indicate that confrontation or avoidance of existential problems can be perceived as a factor contributing to developing an older person's identity in two different ways. On the one hand, the readiness to face existential concerns leads to maturity in old age, a high level of social adaptation, supporting others, and, at the same time, focusing on oneself while ignoring existential concerns, which may contribute to held age identities that are younger than actual age.

Objectives: In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club-Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months.

Method: Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months.

Results: Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources).

Conclusion: Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.

Objectives: Managing agitation and other behaviours that challenge is a significant dementia care challenge. The priority is to find effective non-pharmacological interventions as drug treatments can have significant side effects. This review evaluates the effectiveness of structured physical activity on agitation in dementia.

Method: Our rapid review searched four electronic databases, Cochrane CENTRAL, MEDLINE, CINAHL and Embase, for interventional studies using a structured physical activity programme in people with dementia and studied the effect of this activity on behaviours that challenge. Study quality was assessed using CASP criteria and data was narratively synthesised.

Results: We included 13 studies in this review (four rated as high quality), involving a total of 1546 participants. Results were analysed according to exercise type, frequency and intensity of the intervention. Exercise is effective in reducing agitation and studies with higher adherence to exercise demonstrated more positive effects on agitation and behaviours that challenge.

Conclusion: Physical activity can be effective in reducing agitation in older adults with dementia. Further research is needed to clarify the type of intervention that is most beneficial. Strategies to make physical activity more acceptable and available to people with dementia need to be established.

Objectives: Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives.

Method: Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets.

Results: A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives.

Conclusion: The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.

Objectives: Post-diagnostic support is a significant factor in facilitating personal recovery following a diagnosis of dementia, but access is often inconsistent and insufficient. Recovery Colleges offer peer-led, co-produced courses that can support people to have meaningful lives and have been adapted for use in the context of dementia. A realist review was conducted to understand the application and sustainability of Recovery College dementia courses.

Method: An iterative, five-step process combined literature published to 2023 with knowledge from stakeholders with lived and professional experience of dementia involved with Recovery College dementia courses (PROSPERO registration CRD42021293687).

Results: Thirty-five documents and discussions with 19 stakeholders were used to build the initial programme theory comprising of 24 context-mechanism-outcome configurations. Reoccurring factors included: attending to aspects of co-production and course delivery to ensure they promoted inclusion and were not compromised by organisational pressures; how stigma impacted access to course opportunities; and embedding personal recovery principles throughout course development to be relevant for people living with dementia and those who support them.

Conclusion: People struggling to reconcile their future alongside dementia need practical and emotional support to access and benefit from Recovery College dementia courses, ways to achieve this will be explored through a realist evaluation.

Objectives: The occurrence of behavioral and psychological symptoms of dementia (BPSD) are associated with adverse outcomes but have largely been studied in populations outside of acute care. The current study examines (1) the prevalence of BPSD during acute hospitalization and (2) if BPSD are predictive of adverse patient outcomes.

Methods: A secondary analysis of Family-centered Function-focused Care (Fam-FFC) data including 461 patients with dementia/care partner dyads assessed at hospital admission, discharge, 2 months, and 6 months post-discharge, was conducted. Prevalence of BPSD (Neuropsychiatric Inventory-Questionnaire total and Frontal, Hyperactivity, Mood, and Psychosis sub-categories), associations with patient and care partner characteristics, and prediction of adverse events (falls, emergency room [ER] visits, hospitalizations, injury) were examined.

Results: BPSD were highly prevalent (93.9% admission, 86.7% discharge). The most common symptom cluster at admission was Hyperactivity (76.7%) followed by Mood (72.3%) and Psychosis (71.9%), and Frontal (25.9%). Higher admission Hyperactivity was associated with ER admissions at 2 months, higher discharge Hyperactivity was associated with ER admissions and hospitalizations at 2 months, and change in Psychosis was associated with ER admissions at 2 months.

Conclusions: These findings highlight BPSD during hospitalization as potentially modifiable risk factors of adverse outcomes.

Objectives: The relationship between social isolation, loneliness, and tooth loss and cognition in older people is poorly understood. We examine how social isolation and cognitive performance are associated prospectively among older adults, as well as how tooth loss and loneliness are related to this association.

Methods: Using data from 26,168 participants aged ≥50 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we explored the association between social isolation, loneliness, tooth loss and cognition. We used bootstrapping with resampling strategies for testing a moderated mediating model.

Results: Higher social isolation was associated with poorer cognitive performance (B = -0.20, 95% CI = -0.03, -0.01; R² =0.60), an association mediated by the respondent's number of missing teeth (B = -0.001, 95% CI = -0.002, -0.001). Higher levels of social isolation were associated with a greater number of missing teeth, and a higher number of missing teeth was linked with poorer cognition. We also found that loneliness moderated the relationship between social isolation and both the number of missing teeth (B = -0.11, p  = 0.047) and cognitive performance.

Conclusion: In later life, social isolation and loneliness are associated with shoddy oral health and poor cognitive status. Clinicians and policymakers should be aware of both the association between social isolation and feelings of loneliness on dentition and oral health and their relationship to the cognitive status of older adults.

Objectives: This study aimed to understand which character strengths are most important for people living with dementia and therefore which strengths-based psychological interventions could be most meaningful and acceptable.

Methods: A participatory design, utilising Delphi methodology, was incorporated into an iterative three stage framework: (1) literature reviewed for Positive Psychology (PP) interventions and patient public involvement to define the character strengths; (2) modified Delphi (N = 10) identified which character strengths are most important for living with dementia; (3) focus groups (N = 14) explored which PP interventions are most acceptable and meaningful. Qualitative data from the focus groups was analysed using thematic analysis.

Results: Love, kindness and humour were deemed the most important character strengths for living with dementia. Qualitative data from the focus groups was captured in three superordinate themes: (1) lack of opportunity not capacity; (2) key considerations of PP interventions for people living with dementia; and (3) potential benefits of PP interventions.

Conclusions: Love, kindness and humour come naturally to people with dementia, but people may lack social opportunities to use these strengths. Therefore, a PP intervention promoting positive emotion, social relationships and connection to one's values appears most meaningful and acceptable as this may provide a social context to use and maintain these strengths.

Objectives: Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa.

Method: The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure.

Results: The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness.

Conclusion: One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness.

Objectives: Care-related beliefs are considered risk factors for decreased mental health in family caregivers of people with dementia. However, their exact role in the caregiver stress process remains unclear. Hence, we tested a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia.

Method: A cross-sectional study was conducted using baseline data from a caregiver intervention trial (N = 322). Within Bayesian moderated mediation analysis, we examined mediation of effects of objective demands (severity of dementia, challenging behavior, caregiving intensity, caregiving duration) on depression and anxiety via subjective caregiver burden and moderation by care-related beliefs in four domains (dysfunctional caregiving standards, dysfunctional attitudes towards dementia, functional self-care-related beliefs, functional acceptance-related beliefs).

Results: The relation between objective demands and subjective burden was amplified by dysfunctional caregiving standards and dysfunctional attitudes towards dementia and mitigated by functional self-care-related beliefs. Further, functional acceptance-related beliefs attenuated the effect of subjective caregiver burden on depression.

Conclusion: The study provides preliminary evidence for a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. The results indicate that the four-domain model of care-related beliefs is a valuable framework for future research and may serve as a heuristic model for cognitive-behavioral therapy in this population.