Aging & Mental Health最新文献

Objectives: We aimed to identify lonely older U.S. military Veterans' social connection needs and barriers, to inform interventions to improve connection.

Methods: Semi-structured qualitative interviews were conducted with older Veteran men who screened positive for loneliness on the 3-item UCLA loneliness scale. Interviews assessed Veterans' current social connections, barriers to social connection, desired changes or improvements to connection, and efforts Veterans have made so far to improve connection and their impacts. Team-based rapid qualitative analysis was used.

Results: Twelve interviews were completed and analyzed. There was significant variety in types of current social connection experiences, barriers to connection, desired changes, and efforts to improve connection that Veterans identified. Barriers to connection included difficulty relating to others due to military background or different interests; functional and sensory impairments; and mental health challenges. Veterans expressed desires for improvement in close confidants and romantic relationships, personal growth, social activities, and social networks. Veterans reported making a variety of efforts to improve connections, with mixed results.

Conclusions: Older Veteran men report heterogeneous and unique social connection needs and barriers for which they struggle to find support. These findings can guide development of multidimensional, flexible interventions to improve social connection in older Veteran men.

Objectives: Previous studies link early childhood and current parent-child relationship quality to caregiving burden in mid-to-late-stage dementia dyads. However, little is known about how midlife parent-child relationships affect caregiver burden in early-stage cognitive impairment. Using Parker's parental bonding framework, this study examined early and current relationship factors in mitigating caregiver burden in adult children.

Method: In a cross-sectional survey study, participants (n = 144 adult children of parents living with early-stage cognitive impairment) completed the Parental Bonding Inventory to assess "care" and "overprotection," which were combined to conceptualize "optimal parenting." The Perceived Partner Responsiveness Scale assessed perceived parental support, and the Zarit Burden Interview assessed caregiver burden.

Results: Participants who identified more early care, less overprotection, and optimal parenting from their parents reported greater current perceived support from their parents, but not greater caregiving burden. Greater current perceived support, however, was associated with lower burden.

Conclusion: Supporting parental bonding theory, current greater parent-child relationship quality was associated with greater early parental relationship quality and lower burden. Surprisingly, early parent-child relationship quality was not associated with burden. Future research identifying factors that buffer caregiver burden, e.g. current perceived parental support, can inform targeted interventions to support midlife adults caring for parents living with early-stage cognitive impairment.

Objectives: This study examines the relationship between cognitive synchrony and social participation and whether income moderates this relationship among married couples.

Method: Longitudinal data from 1,029 married couples from the Health and Retirement Study collected from 2004 to 2020 were analyzed. Synchronized cognitive trajectories were estimated by modeling husbands' and wives' cognitive growth curves together. An Actor-Partner Interdependence Model with moderation was then used to examine how each spouse's trajectories and their synchrony linked to both partners' social participation, and whether these links differed by household income.

Results: Two spouses' cognitive function aligned at baseline, changed in parallel over time, and fluctuated together across survey waves. However, significant results for synchronized trajectories were limited, with only residual synchronization predicting husbands' social participation. Husbands' social participation was shaped by both partners' cognition trajectories, whereas wives' participation was predicted by their own trajectories. The link between cognitive synchrony and social participation was stronger in higher-income couples.

Conclusion: Cognitive functioning plays a more salient role in shaping husbands' participation in social participation than that of wives, and the role is more pronounced in higher-income couples. The findings offer unique income moderation and gender-specific insights into dyadic health research.

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.