Aging & Mental Health最新文献

Objectives: Informal caregivers often seek additional support. Partner in Balance (PiB), a blended self-management program for informal caregivers of persons with dementia, presents a promising avenue for providing cost-effective support. This study aims to evaluate the cost-consequence of PiB compared to usual care.

Method: A cost-consequence analysis from a healthcare perspective was conducted within a randomized waiting-list controlled trial in the Netherlands, involving 78 informal caregivers. Intervention and healthcare costs (selection of the Resource Utilization in Dementia (RUD)), along with caregiver utility scores (ICECAP-O), were assessed over 8 weeks. Bootstrapping and sensitivity analyses tested result robustness.

Results: Compared to standard care, PiB incurred significantly higher costs (€2,027 vs. €805; p = 0.013) at 8 weeks, with the largest cost differences found for intervention and nursing home costs. PiB's caregivers reported better, though not statistically significant, utility scores (0.82 vs. 0.76; p=0.073). Sensitivity analyses supported the robustness of these findings.

Conclusion: PiB presents a promising approach to supporting caregivers of persons with dementia, indicating higher initial costs but benefits in caregiver utility. However, the study presented too many limitations to make a confident reimbursement recommendation for the caregiver program. Therefore, we recommend awaiting further research assessing the long-term cost-effectiveness and broader societal impacts of PiB before deciding on its potential reimbursement.

Objectives: This study explores what prompts individuals working in non-medical occupations with frequent contact with older adults to suspect cognitive problems and take action.

Method: A survey was developed through consultation and pre-testing. Dutch-speaking adults were recruited from occupation groups that regularly engage with older people. Quantitative data were analyzed descriptively. Qualitative data were analyzed using manifest content analysis and directed content analysis guided by the I-Change model.

Results: Of 156 participants, most worked in household care, hairdressing, municipalities, or libraries. In professional settings, 103/130 participants (79%) reported having suspected dementia in at least one client or colleague, of whom 59/103 (57%) took action. In community settings, 35/128 participants (27%) had suspicions, with 16/35 (46%) acting. Actions included mentioning their concerns with the person and/or family or informing a healthcare professional or their supervisor at work. Awareness was influenced by 'knowledge', 'risk perception', and 'perceived cues'. Factors influencing motivation to act were 'attitude' (e.g. feeling responsible or valuing offering help), 'social support' (e.g. encouragement from employers), and 'self-efficacy'. Determinants for action were 'skills' and 'barriers'.

Conclusion: People who suspect dementia in someone they know often feel a responsibility to act. Broader samples are needed for future research to improve generalizability.

Objectives: Psychological resilience plays a critical role in overcoming age-related challenges and maintaining emotional well-being in older adults. This study aimed to test a model examining how perceived social support, positivity, and loneliness are associated with psychological resilience in older adults.

Method: The sample consisted of 264 community-dwelling older adults residing in Türkiye (139 females, 52.7%) aged between 60 and 83 (M_age = 66.80, SD = 5.24). Participants completed the Multidimensional Scale of Perceived Social Support, Positivity Scale, Loneliness Scale for Elderly, and Brief Resilience Scale.

Results: The findings revealed that positivity was significantly associated with psychological resilience, while greater family support, higher positivity, and lower loneliness were associated with higher levels of resilience. Additionally, serial mediation analysis showed that positivity and loneliness sequentially mediated the relationship between perceived social support and psychological resilience. Specifically, greater perceived social support enhanced positivity, which reduced loneliness and, in turn, strengthened psychological resilience.

Conclusion: Overall, the findings highlight the role of positivity and social support in psychological resilience among older adults and underscore loneliness as a key mechanism in resilience processes in later life.

Objectives: Adequate and stable housing has implications for the health and wellbeing of older people. However, affordable housing options are becoming elusive and dominant models of home ownership are in decline with uncertain health consequences for older populations. Supporting older adults to age safely in their community has many health benefits such as improved quality of life and increased social connectedness and reduces dependency and healthcare costs.

Method: This qualitative evidence synthesis examines 15 international studies to assess impact of housing insecurity on the health and wellbeing of older people. A reflexive thematic analysis (Braun & Clarke, 2021) identified five interlinked themes building upon each other to create contextual depth of understanding of how health is impacted by housing insecurity in older age.

Results: To summarise findings, psychosocial health and wellbeing benefit from safe, secure housing which promotes autonomy, dignity and social engagement. Poor housing conditions and inability to install modifications negatively impact health and the ability to live independently for longer. Increasing housing costs and lifecourse financial uncertainty both precipitate deteriorating health and wellbeing, potential relocation and constitute barriers to ageing in place and were most evident for marginalised social groups. Housing insecurity was mitigated by strong social attachments or attempting to be an ideal tenant/neighbour but there is some evidence that smoking or alcohol are used as coping mechanisms.

Conclusion: In conclusion, housing insecurity negatively impacts mental health whereas adequate housing supports older adults to live independently and promotes positive mental health and wellbeing.

Objectives: Questionnaire- and performance-based functional assessments for older adults evaluate distinct constructs and may be differentially influenced by cognition or mood. Depression may decrease motivation, impair cognition, and/or bias self-reports of function. The present study evaluated everyday function through multiple methods in a diverse sample of community-dwelling older adults to elucidate depression-cognition-function relations.

Method: 121 older adults with healthy cognition or mild cognitive impairment completed the Geriatric Depression Scale (GDS-15), cognitive tests, and two everyday function measures: the performance-based Naturalistic Action Test (NAT) and the Instrumental Activities of Daily Living - Compensation (IADL-C) Questionnaire. Study partners also completed the IADL-C. Multivariate regressions examined the influence of total depressive symptoms, global cognition, and their interaction on functional outcomes. Exploratory models investigated apathy- and affect-related depressive symptom influences on function.

Results: Global cognition predicted all functional measures. Total depressive symptoms predicted only self-reported function, driven by 'apathy' symptoms. NAT error score was influenced by affect-related symptoms and an apathy-cognition interaction.

Conclusion: Functional measures are differentially influenced by mood. Self-reports are influenced by apathy symptoms and related motivational changes. Relations between mood and performance-based tasks may depend on symptom types, performance-based variables, and interactions with cognition. Comprehensive assessments should include multiple everyday function measures.

Objectives: The Collaborative Care Model (CoCM) is an evidence-based model designed for primary care and has shown improved late-life depression outcomes. This study explored the perspectives of a non-specialist workforce, community health workers (CHWs), on adapting CoCM to community organizations by expanding CHW roles to include that of behavioral health care manager (BHCM).

Method: Guided by the Theoretical Framework of Acceptability, we conducted semi-structured interviews with CHWs from community-based and clinical settings across five states.Participants discussed their attitudes, perceived self-efficacy, and recommendations regarding four BHCM tasks: administering behavioral health measures, using a patient registry, collaborating with mental health specialists and primary care providers, and delivering psychosocial interventions. Thematic analysis was used to analyze the data.

Results: CHWs expressed interest, support, and perceived self-efficiacy, with traiing and supervision, for the proposed role expansion, and cited alignment with their mission and community needs. Their strengths included community trust, linkage, and knowledge of resources as a workforce. Collaborating with mental health specialists was viewed as a model strength, but collaboration with primary care providers was a potential barrier.

Conclusion: Findings support the acceptability of developing a BHCM workforce among CHWs, but understanding the perspectives of other stakeholders would be warranted for CHW role redesign.

Objectives: A post-hoc, mixed methods analysis of a randomized controlled trial of a 12-month psychosocial and psychoeducational telehealth intervention to support dementia caregivers of cognitively impaired relatives living in residential long-term care settings (the Residential Care Transition Module/RCTM) was conducted to identify and test potentially new mechanisms and outcomes of the RCTM.

Method: Two hundred and forty caregivers were randomly assigned to the RCTM treatment condition or to usual care as the control group and were administered quarterly surveys. Participants in the treatment condition provided qualitative data on perceptions of intervention benefits on follow-up surveys and semi-structured interviews conducted after the 12-month intervention (n = 30). New mechanisms and outcomes identified in the qualitative analysis were mapped onto existing items and scales (e.g. single items from the Short Sense of Competence Questionnaire) and re-analyzed quantitatively using general linear models.

Results: The mixed methods analysis suggested that dementia caregivers in the RCTM group were more confident in their ability to obtain information about and arrange services (e.g. legal and financial planning, long-term care ombudsman) than controls and were less likely to report annoyance with care recipients' behaviors.

Conclusion: The mixed methods results advance our understanding of the RCTM's potential efficacy, and the adoption of similar methodologies may yield greater insights into how and why dementia care interventions are beneficial, even in the face of initial null findings.

Objectives: Poor sleep quality and depressive symptoms are common among institutionalized older adults. While their association is well-established, the psychosocial mechanisms underlying this link remain underexplored. This study explores the mediating effect of perceived family functioning on the association between sleep quality and depressive symptoms among older adults in Chinese nursing homes.

Method: A cross-sectional survey was conducted with 269 older adults from six nursing homes in Xi'an and Chongqing, China. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Geriatric Depression Scale (GDS), and the Family APGAR Index. Mediation was tested using PROCESS macro (Model 4) with 5000 bootstrap samples, controlling for demographic variables.

Results: Poor sleep quality was positively associated with depressive symptoms (β = 0.7079, p < 0.01) and negatively with perceived family functioning (β = -0.2294, p < 0.01). Perceived family functioning was inversely related to depressive symptoms (β = -0.5208, p < 0.01). The indirect effect was significant (β = 0.1195), indicating 14.4% partial mediation.

Conclusion: Perceived family functioning partially mediates the link between sleep quality and depression. Interventions aimed at improving both sleep hygiene and perceived familial support may be effective strategies for reducing depressive symptoms in this vulnerable population.

Objectives: Longstanding clinical wisdom in geriatrics asserts that depressive symptom presentation varies between older and younger adults. However, these observations are based on data from one to two decades ago. The shifting demography across different birth cohorts necessitates an updated examination.

Method: This retrospective cross-sectional study analyzed interview data from the 2017 to 2020 waves of the National Health and Nutrition Examination Survey. Depressive symptoms were assessed from 8325 participants aged 18 and older via the 9-item Patient Health Questionnaire (PHQ-9). PHQ-9 scores were used to classify a subset of participants with symptoms of a major and/or minor depressive episode based on DSM-5-TR criteria. Participants were categorized into four age groups (youngest, young/middle-aged, older, and oldest old adults) to test associations of age with depressive symptom endorsement.

Results: Membership in the oldest age group (age 76 and older) was associated with lower endorsement of depressed mood relative to the youngest and young/middle-aged adults among those reporting symptoms of a major depressive episode. We did not find any age group differences in somatic or other symptom endorsement for those with either major or minor depressive symptoms.

Conclusion: Analyses of more recently collected data are required to maintain a dynamic life course perspective in the geriatric mental health literature. These analyses are one such attempt at updating the literature on depressive disorder phenomenology among adults in the United States.

Objectives: Exposure to ageism is believed to trigger fight-or-flight responses, compel certain behaviors, and make people self-conscious about their age, cumulatively increasing long-term health risks. This study investigated relationships between everyday ageism, self-reported acute stress responses following experiences with ageism, and health.

Method: Analyses employed cross-sectional data from the Experiences of Aging in Society project (2021-2023, N = 236, Mage 65, 72% women) and parallel mediation models. Health outcomes were number of chronic physical health conditions and having a mental health condition.

Results: Most participants reported behavioral (95.7%) and psychological (66.1%) responses to ageism experienced in the past 12 months, while fewer reported aging-conscious (56.8%) and physiological (36.0%) responses. Higher everyday ageism levels were associated with greater report of all four stress responses (p-values < 0.001). More everyday ageism predicted greater likelihood of having a mental health condition via its indirect effect on physiological stress responses. Other acute stress responses were associated with health but did not mediate everyday ageism-health associations.

Conclusion: Asking older adults about their acute stress responses to ageism is a promising strategy in research investigating mechanisms implicating ageism in poor health outcomes. In clinical practice, this may increase self-awareness and adoption of healthy strategies to manage ageism-related responses and coping.