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

Background: We aimed to screen self-neglect in older adults before and after the COVID-19 pandemic, to evaluate the effect of the pandemic on self-neglect, and to evaluate the relationship between self-neglect and geriatric syndromes in this study.

Methods: Older adults ≥65 years old and without dementia who applied to a single-centre geriatric outpatient clinic between December 2023 and May 2024 were included in the study. We performed self-neglect screening for the pre- and post-pandemic era with the Istanbul Medical School Elder Self-Neglect questionnaire. Additionally, comprehensive geriatric assessment data and quality of life data with the Euro-Quality of Life 5D-3L scales were evaluated.

Results: A total of 104 patients, with a mean age of 76.8 ± 5.9 years and 70% female, were included in the study. Self-neglect was detected in 19 patients (18.3%) at the post-pandemic period. The older adults with self-neglect were more frail, more dependent, more depressed, had higher risk of sarcopenia, also had more common polypharmacy and urinary incontinence (all P < 0.05). Also, quality of life was found to be more impaired in the self-neglect group (P < 0.001). In multivariate Cox regression analysis, being dependent and having a high risk of sarcopenia were associated with self-neglect in the post-COVID-19 period (odds ratio (OR): 0.15; CI: 0.03-0.83; P = 0.030 and OR: 1.45; CI: 1.01-2.09; P = 0.048, respectively.).

Conclusion: Self-neglect in older adults is an important part of comprehensive geriatric assessment and should be screened with validated methods. As it is significantly related with other geriatric syndromes, it suggests that interventions in geriatric syndromes may prevent self-neglect.

Background: Previous studies have shown that chronic multimorbidity is associated with frailty in older adults. However, the mechanisms of this association are unclear. This study aimed to determine the mediating role of pain and depressive symptoms in the relationship between chronic multimorbidity and frailty.

Methods: We examined the relationship between chronic multimorbidity, pain, depressive symptoms, and frailty in a cross-sectional survey of 501 older adults (48.5% male, median age = 74 years).

Results: There was a positive correlation between chronic multimorbidity and frailty in older adults. In addition, pain and depressive symptoms mediated the relationship between chronic multimorbidity and frailty both independently and serially. The total indirect effect of the three mediation paths was 36%.

Conclusion: Active treatment of the primary conditions of older adults, supplemented by attention given to physical and mental health issues such as pain and depressive symptoms, could prevent the development of frailty in older adults.

Loss of memory is the main feature of dementia, accompanied by personality changes. Alzheimer's disease (AD) is the most prevalent type of dementia globally and a major contributor to disability and mortality in older individuals. Most notably, the neurological damage caused by AD is irreversible, but the current market still lacks effective medications for the treatment of dementia. Numerous research studies have indicated that the inflammatory response is significantly involved in the development of cognitive impairment, and elevated C-reactive protein (CRP) levels in healthy people increases the likelihood of future AD. CRP is a nonspecific indicator of inflammation. In clinical practice, CRP has long been proven to be one of the risk factors and powerful predictors of neurodegenerative diseases. Given the accessibility and cost-effectiveness of CRP testing, it is reasonable to anticipate its utilisation for early screening and monitoring the progression of AD in the future. This review therefore focuses on the specific relationship between CRP and various types of dementia and explores how CRP contributes to cognitive impairment.

Background: Few studies have examined the characteristics of the decline in physical activity levels in Parkinson's disease (PD) patients from the perspective of a 24-h behavioural profile, including sleep.

Objective: To identify factors related to the rest and activity patterns in PD patients by assessing the Rest-Activity Rhythm.

Methods: The participants were 20 patients with Parkinson's syndrome (PS group) and 20 healthy elderly community residents (control group). The nonparametric rest-activity rhythm parameters were measured by a wristwatch-type activity monitor worn by the study subjects on the non-dominant hand continuously for at least 5 days. To assess the specific symptoms of PS in the patients, the scores on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) were collected from the medical records.

Results: In the PS group, a negative correlation was found between the relative amplitude and score for part I of the MDS-UPDRS, that is, non-motor symptoms (r = -0.51, p < 0.05). Additionally, binomial logistic regression analysis revealed two regression models, with Model I showing a significant association with the highest physical activity level over the 24-h profile (odds ratio, 0.96; 95% confidence interval [95% CI], 0.94-0.99; p = 0.002) and Model II showing a significant association with a fragmented rhythm (odds ratio, 1.04; 95% CI, 1.01-1.07; p = 0.004).

Conclusion: These results suggest that rehabilitation of PD patients should include increasing their physical activity levels while minimising intermittency of the rest and activity patterns, and that attention should be paid to non-motor symptoms in addition to motor symptoms.

Background: Although loneliness has been associated with reduced physical activity, the association between exercise habits and loneliness remains unclear.

Methods: This study examined whether exercise habits are associated with loneliness among older adults by sex. This study included 10 152 individuals. The University of California Los Angeles Loneliness Scale was used to measure loneliness, with a score of 44 or more defined as loneliness. Information on exercise habits during the year was obtained using a questionnaire on whether participants performed 14 types of exercise. Binomial logistic regression analysis was conducted, with loneliness as the dependent variable and exercise habits as the independent variable.

Results: Overall, 3591 people (35.4%) were lonely, with more males (43.9%) experiencing loneliness than females (28.3%) (P < 0.05). Binomial logistic regression analysis stratified by sex showed that the following exercise types were associated with loneliness among males (odds ratio (95% confidence interval): golf, 0.77 (0.67-0.89); gymnastics, 0.86 (0.75-0.99); exercise circle, 0.77 (0.65-0.91); and team games, 0.76 (0.63-0.90), P < 0.05). In contrast, no association was found between exercise habits and loneliness among females (P > 0.05).

Conclusions: Loneliness was reduced among males through certain exercise practices. Group exercise interventions may effectively prevent loneliness among males, who are more likely to feel lonely than females.

Background: Pain is highly prevalent but challenging to assess in individuals with dementia. Non-cognitive symptoms, such as behavioural and psychological symptoms of dementia (BPSD) and undetected pain, can severely impair functionality and degrade the quality of life for Alzheimer's disease patients. This study aims to examine the relationship between pain and BPSD in patients with Alzheimer's disease.

Methods: A hospital-based, cross-sectional study using a convenience sampling technique was conducted with Alzheimer's disease patients attending an outpatient clinic at a tertiary care geriatric centre. Participants' cognitive impairment was assessed using the Mini-Mental State Examination (MMSE), pain severity was evaluated with the Numeric Rating Scale (NRS) and Pain Assessment in Advanced Dementia (PAIN-AD) scale, and BPSD was measured using the Behavioural Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Over 6 months, 50 participants who met the inclusion and exclusion criteria were included.

Results: The median age of the participants was 69 years, with a median MMSE score of 16. All participants experienced some level of pain and exhibited at least one BPSD. Statistical analysis revealed a significant association between both subjective and objective pain and behavioural and psychological symptoms. A strong correlation was also observed between NRS and PAIN-AD scores with affective disturbances and anxieties.

Conclusion: Common occurrence of pain and BPSD in Alzheimer's disease among the Indian population underscores the importance of pain assessment and management for enhancing patient well-being.

Objective: This study sought to examine whether reminiscence therapy based on memories of hard work is more effective than reminiscence therapy based on memories of enjoyment for promoting positive reminiscence (i.e., quality of reminiscence) associated with the prevention or reduction of depressive symptoms in community-dwelling older people.

Methods: The participants were 26 community-dwelling older people (three men and 23 women) aged 65 or older who attended an elder citizens' club and a salon. Participants were randomly assigned to either the reminiscence therapy based on memories of hard work (recalling things they thought they did well in the past) group or the reminiscence therapy based on memories of enjoyment group. In both groups, the sessions lasted 30-50 min each, once a week, for 4 weeks. For assessment, we used the Positive and Negative Reminiscence Scale, the Geriatric Depression Scale 15, and the Life Satisfaction Index Z. Analysis of covariance using Bayesian statistics was conducted using the amount of change in each scale as the objective variable.

Results: There was a significant difference between groups in the change in Positive Reminiscence Scale scores (expected a posteriori = -1.87, β = -0.23, t = -2.28, 95% Bayesian confidence interval = [-3.45, -0.26], P (b > 0) (which was calculated as the probability that the coefficient (b) was greater than zero) = 0.01), suggesting a small-to-moderate effect in the reminiscence therapy based on memories of enjoyment group compared with the reminiscence therapy based on memories of hard work group.

Conclusions: The results suggested that reminiscence therapy based on memories of enjoyment may promote more positive reminiscence among community-dwelling older people than therapy based on memories of hard work.