Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society最新文献

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur up to the age of 18 years. Such trauma often results in chronic psychological stress that is associated with negative health outcomes across the lifespan. The aim of this study is to investigate associations between ACEs and health outcomes in older adults.

Methods: The present study is a cross-sectional design. Socio-demographic information on patients' age, gender, marital status, living status, and education level were collected. Furthermore, a comprehensive geriatric assessment and ACE scale were conducted. The ACE scale consisted of 10 questions that were categorised as psychological, physical, and sexual abuse, as well as neglect. The relationship between detailed comprehensive geriatric assessment parameters and ACE were analyzed.

Results: There were 276 (mean age 77.9 ± 7.3 years, and 74.3% female) patients included in the study. The prevalence of ACEs was 43.1%, with psychological ACE being the most common. Female gender, number of medications, the presence of insomnia and dysphagia were higher in older patients who experienced at least one ACE than those without ACE (P < 0.05). In multivariate analyses, only the relationship between insomnia and ACE persisted (odds ratio 1.83, 95% CI 1.12-3.01; P < 0.05).

Conclusions: ACEs were detected in approximately one in every two older adults. Those with ACEs were 1.8 times more likely to experience insomnia. Therefore, when evaluating an older patient with insomnia, ACEs should be evaluated and insomnia should also be questioned in older patients who have experienced ACE.

Introduction: This study focuses on how news of neglect and abuse about elderly individuals is given in digital media and the perception toward elderly individuals.

Methods: Eight national newspapers in Turkey were included in the study for the sample. The news texts were obtained from the digital archives of the newspapers and the term 'elderly' was selected as the keyword to accurately search the texts.

Result: The researcher analyzed and divided the collected data into the following categories on elder abuse and neglect: the victim's characteristics, data of the person who inflicted neglect and abuse, the incident's nature and consequences, and the negative concepts mentioned in the incident. The content analysis showed that the related statements and information provided by the media were based on negative concepts and included personal data, including visuals, about the victim.

Conclusions: The findings of the study suggest that elderly individuals, who are a disadvantaged group, are highly exposed to neglect and abuse, and most of them have suffered as they live alone and lack support systems. This study indicated that the media has the potential to raise awareness about neglect and abuse inflicted on the elderly, but it should act more diligently and responsibly.

Aim: To investigate the predictors of post-stroke delirium (PSD) in the old ischaemic stroke patients, and develop a nomogram to predict the risk of PSD.

Methods: A cross-observational study was conducted. The old ischaemic stroke patients in a tertiary hospital in South China were recruited and randomly divided into the train group and test group. Multivariate logistic regression analysis was performed in the train group to screen out predictors of PSD, and develop a nomogram. The receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test (H-L test) and decision curve analysis (DCA) were used to evaluate the nomogram. The internal validation was performed in test group.

Results: The incidence of PSD was 21.1% (105/497). Coronary heart disease (CHD), indwelling catheter, physical restraint, and neutrophil-to-lymphocyte ratio (NLR) were significantly associated with PSD. The area under the ROC curve of the nomogram was 0.885 in the train group, and 0.865 in the test group. The calibration curves of the two groups were close to the standardised line. The P-values of H-L test were over 0.05. The DCA presented some net benefits in the two groups.

Conclusion: CHD, indwelling catheter, restraint, and NLR were strongly associated with PSD in the old. A nomogram with good prediction effect and advisable clinical applicability was developed.

Objective: To explore the influence of education level on scores in the Mandarin Chinese version of the Rowland Universal Dementia Assessment Scale (RUDAS) among stroke patients and to provide guidance regarding the application and optimisation of the RUDAS.

Methods: A total of 235 stroke patients were census sampled for an evaluation of cognitive function using the Mandarin Chinese version of the RUDAS. A test was carried out to analyze the differences in RUDAS scores between sexes, and one-way analysis of variance and the Scheffe multiple comparison test were used to analyze the differences in RUDAS scores between age groups and between education levels. SPSS 22.0 software was used for statistical analysis. Differential item functioning (DIF) analysis was performed using logistic regression. If P < 0.05, then an item was considered to exhibit DIF.

Results: The overall education levels of the stroke patients were moderate. There was no significant difference in RUDAS scores based on education level or sex, but there was a difference between age groups. There were three items that exhibited DIF: square, internal line and external line.

Conclusion: RUDAS scores were not strongly influenced by education level, and most items were suitable for screening among stroke patients with different education levels. However, when drawing a cube, differences in education level should be taken into consideration.

Background: The purpose of this study was to reveal inter- and intra-rater reliability of the detailed evaluation of cognitive function by assistive robot for older adults.

Methods: We investigated the inter-rater and test-retest reliability. Neurobehavioral Cognitive Status Examination was conducted twice for each participant using an assistive robot and the examiner respectively (Experiment 1). The order of these two tests was randomly selected and the interval between them was 1 week. In Experiment 2, we investigated the test-retest reliability of the first robot test and this additional robot test was conducted approximately 6 weeks after Experiment 1.

Results: Fifty-one (13 men and 38 women, mean age: 80.5 ± 5.6 years) participants went through Experiment 1 and 29 of those (eight men and 21 women, mean age: 80.4 ± 4.8 years) completed Experiment 2. In Experiment 1, the interclass coefficient (ICC) in orientation was in the high range and its Cronbach's α was 0.919, rated as excellent internal consistency. On the other hand, other items did not show positive results. In Experiment 2, the ICCs in orientation, attention, and repetition were in the adequate range, while other items showed marginal or low range.

Conclusions: Orientation was supposed to be utilised for figuring out initial symptoms of dementia. In the future, as robot functions become more high-tech, a partner robot might be able to measure the symptoms and severity of dementia.

Background: Stressful life events greatly increase the risk of depression, which affects about 22% of older persons in northeast Malaysia. But how emotional distress manifests itself in reaction to these stressful events differs from person to person. Therefore, this study aims to delve into the nuances of emotional expression among older adults with depression symptoms in northeast Malaysia, alongside their help-seeking behaviours and utilisation of professional support.

Methods: Using a qualitative interpretative phenomenological approach, we conducted in-depth face-to-face interviews with participants, guided by Kleinman's explanatory model of illness. Nineteen older adults who screened positive for depression were included in the research.

Results: None of the participants explicitly acknowledged experiencing depression. However, they articulated their distress through three primary themes: 'Life is miserable,' 'Depression is a sign of weakness,' and 'Belief in pre-determination.' Remarkably, despite screening positive for depression, participants demonstrated a lack of awareness regarding available professional mental health services. Moreover, they expressed a reluctance to seek such services, citing reasons related to stigma and misconceptions. The predominant themes that emerged concerning help-seeking behaviours were 'Self-efficacy,' 'Social support,' and 'Formal assistance from non-mental healthcare professionals.'

Conclusion: The expression of emotion among older adults is restricted by socio-cultural influences. Thus, there is a need to improve mental health literacy among older adults in Malaysia, and their preferred source of support such as religious leaders and non-mental healthcare physicians.

Background: Alzheimer's disease (AD) is associated with impairments in not only memory but also visuospatial cognitive function. Despite its adverse effects on the quality of life, patients with early-stage AD are often neglected. Emerging evidence suggests that patients with AD exhibit increased vulnerability of myelin, a crucial component for neuronal conduction and survival. To test our hypothesis that myelin damage was associated with cognitive deficits in AD, we examined correlations of myelin integrity, quantified by T1-weighted/T2-weighted (T1w/T2w) ratios, with visuospatial cognitive abilities and compared them between patients with AD and cognitively normal (CN) individuals.

Methods: Fifty-seven patients with AD and 22 CN subjects were enrolled in this study. To assess subjects' visuo-constructive abilities, we employed the Rey-Osterrieth Complex Figure Copy Test (ROCFT-c) paired with analysis of T1- and T2-weighted magnetic resonance imaging brain images. Voxel-based associations between T1w/T2w ratios and ROCFT-c scores in the AD group were assessed, controlling for age and handedness (voxel threshold uncorrected P < 0.001, cluster threshold uncorrected P < 0.05). Additionally, we compared the T1w/T2w ratios of these identified brain regions between the AD and CN groups.

Results: The voxel-based analysis demonstrated positive correlations between T1w/T2w ratios and ROCFT-c scores in the right middle temporal gyrus and right praecuneus in patients with AD who exhibited significantly lower T1w/T2w ratios in the right middle temporal gyrus (P = 0.038) and a trend toward lower T1w/T2w ratios in the right praecuneus (P = 0.055).

Conclusions: Our results demonstrated a strong association between reduced myelin integrity in the right middle temporal gyrus and right praecuneus and visuospatial cognitive dysfunction in patients with AD. These findings are believed to shed light on the neural basis of visuospatial processing in patients with AD, underlining the necessity for developing objective biomarkers for assessing patients' visuospatial cognitive function.

Background: Postoperative cognitive dysfunction (POCD) is a postoperative complication of the central nervous system, especially in elderly patients. Growing evidence shows a close relationship between the kidney and cognition. This study aimed to evaluate the relationship between the subsequent risk of POCD and indicators related to the kidney.

Methods: A total of 93 eligible patients (≥65 years old) undergoing elective total hip replacement were enrolled. Before and 1 day after surgery, blood samples were collected from enrolled patients. Mini-Mental State Examination and Montreal Cognitive Assessment were conducted 1 day before surgery and 1 week after surgery or at discharge. The receiver operating characteristic curve was used to examine the predictive value of the estimated glomerular filtration rate (eGFR) for POCD. Univariate and multiple logistic regression models were used to analyze the risk factors of POCD.

Results: Thirty patients (32.26%) were assessed for POCD 1 week after surgery. The preoperative eGFR level in the POCD group was significantly lower than in the non-POCD group (P < 0.001). The area under the curve of eGFR was 0.739 (95% CI, 0.630-0.848; P < 0.001). The multivariable logistic regression analysis results showed that preoperative eGFR was independently associated with POCD (odds ratio = 0.965, 95% CI = 0.935-0.996, P = 0.028) after adjustment for mixed factors.

Conclusion: Low eGFR is associated with an increased risk of POCD in patients undergoing elective total hip replacement surgery. Low eGFR is an effective predictor of incident POCD.

Background: Chronic pain may be an important factor influencing cognitive impairment; however, there is limited research on that link in older adults with disabilities. We aimed to determine the association between chronic pain and cognitive impairment in older adults with disabilities.

Methods: This 24-month prospective cohort study involved 143 Japanese older adults (≥65 years of age) with long-term care insurance. Chronic pain was defined as pain persisting for ≥3 months, and cognitive impairment was defined as a Mini-Mental State Examination score ≤ 23. We employed logistic regression analysis with chronic pain as the independent variable and cognitive impairment as the dependent variable after propensity score matching (PSM).

Results: Sixty-six participants were selected using PSM, and logistic regression analysis showed that chronic pain was significantly associated with cognitive impairment (odds ratio: 4.103, 95% confidence interval: 1.455-11.567, P = 0.008).

Conclusion: To prevent cognitive impairment in older adults with disabilities, the management of chronic pain should be considered, as they are related.

Background: Elder self-neglect (ESN) is usually ignored as a private problem and impairs the health outcomes of older adults. It is essential to construct a robust and efficient tool for risk prediction which can better detect and prevent self-neglect among older adults.

Methods: This study included 2494 study participants from the Ma'anshan Healthy Ageing Cohort (MHAC). First, the group-based trajectory model (GBTM) was used to estimate ESN development trajectory groups. Then, feature selection methods were used to select variables; after that, we compared six machine learning models (Decision Tree Classifier (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM) and XGBoost (XGB)). In addition, Synthetic Minority Oversampling Technique (SMOTE) is used to address the data imbalance problem.

Results: The results show that the ESN can be defined as two trajectory groups (rising and stable). After feature selection, the final model contains eight predictors. The area under the curve (AUC) of the raw dataset was 0.637-0.769. In the dataset with SMOTE, the AUC was 0.635-0.765 and RF was the optimal model. The top five most important characteristics were quality of life, psychological resilience, social support, education, and income.

Conclusions: The RF developed in this study may be considered a simple and scientific aid in the risk prediction of self-neglect among community-dwelling old adults.