We investigated patients’ difficulties in managing their diet (i.e., diet setbacks) and associations with change in disease-specific and general emotional distress (diabetes distress and depressive symptoms) among patients with type 2 diabetes and their spouses.
Data for this study were collected in couples’ homes (N = 115 couples) using structured interviews and self-administered questionnaires at three time points: baseline (T1), six months after baseline (T2), and twelve months after baseline (T3).
Patients’ diet setbacks were associated with an increase in their diabetes distress in the shorter-term (over six months). Patients’ diet setbacks were not associated with longer-term change in diabetes distress or with change in depressive symptoms at either time point (six months or one year). In contrast, spouses’ perceptions of patients’ diet setbacks were associated with increases in their own diabetes distress at both time points (over six months and one year), and also with an increase in their depressive symptoms in the longer-term (over one year).
Findings reveal detrimental consequences of patients’ diet nonadherence for emotional well-being that extend to the well-being of their spouses.
chronic illness management; diabetes distress; depressive symptoms
We evaluated the use of the Cornell Scale for Depression in Dementia (CSDD) as a proxy measure. Study questions were: How do residents’ self-reports on the CSDD compare with the nurse proxy CSDD ratings of the resident? How do characteristics of depression as rated by the resident CSDD and the nurse CSDD compare? To what extent are demographic and clinical variables associated with resident CSDD, nurse CSDD, and the discrepancy between resident and nurse CSDD scores?
Residents and nurse proxy pairs (n=395 pairs) from 28 nursing homes (NHs) participated. We calculated discrepancy scores for total and subscale CSDD scores, examined correlations between resident and nurse CSDD scores, and described rates of clinical depression using each of the scores. We conducted multivariate analyses to examine factors associated with resident and nurse CSDD and discrepancy scores.
On average, participants had mild cognitive impairment, were White, and female. Associations between resident and nurse CSDD were low (r=.16). The mean discrepancy score was −2.03 (SD=5.28, p<0.001), indicating that nurses evaluated residents as less depressed than residents evaluated themselves. Discrepancy scores were not associated with residents’ cognitive status, but were associated with a measure of self-report reliability. Regression analyses indicated that depression diagnosis accounted for a small but significant association with resident CSDD, but was not significantly associated with nurse CSDD.
These findings underscore the importance of obtaining resident input when assessing depression in NH residents with dementia, and educating NH nurses in the most effective ways to assess depression.
depression; proxy measure; nursing homes; dementia
Identification of risk factors for loss of meaning in life among older adults is needed. In the current paper, we test hypotheses derived from the Interpersonal Theory of Suicide concerning the role of perceptions that one is a burden on others as a risk factor for lower meaning in life.
A prospective design was used to examine the temporal associations between perceptions of burdensomeness on others and perceived meaning in life among older adults (n = 65) seeking mental health treatment (primarily for depression and/or anxiety) at an outpatient geriatric mental health clinic. Participants completed self-report questionnaires within a month following intake. Follow-up questionnaires were completed over the phone two months later.
Perceived burdensomeness predicted lack of meaning in life two months later, while accounting for depression severity. In contrast, baseline levels of meaning in life did not significantly predict levels of burdensomeness at two months.
The findings suggest that burdensomeness may contribute to suicide morbidity and mortality in late-life by eroding meaning in life. Empirically supported treatments for late-life depression could be adapted to focus on perceptions of burdensomeness and its connections with meaning in life.
meaning in life; elderly; older adults; interpersonal theory of suicide
Using data from a national sample of informal caregivers to older adults, we identify predictors of lack of choice and the consequences of lack of choice in taking on the caregiving role.
A national telephone survey with 1397 caregivers was carried out to assess whether respondents had a choice in taking on the caregiving role, their demographic characteristics, the nature and duration of their caregiving experience, and its impact on their physical and psychological well-being. We compare caregivers who felt they had no choice in taking on the caregiving role to those who did.
Forty-four percent of caregivers reported a lack of choice in taking on the caregiving role. Highly educated, older caregivers caring for a younger care recipient with emotional or behavioral problems were most likely to report that they had no choice in taking on the caregiving role. Lack of choice is associated with higher levels of emotional stress, physical strain, and negative health impacts, after controlling for multiple confounds including level of care provided, relationship type, primary health condition of the care recipient, and demographic characteristics.
Lack of choice is an independent risk factor for the negative effects of caregiving, and clinicians should be vigilant to lack of choice as a marker of caregiver distress.
informal caregiving; consumer choice; caregiver health
To examine the association of cognitive function with use of non-prescribed therapies for managing acute and chronic conditions, and to determine whether use of non-prescribed therapies changes over time in relation to baseline cognitive function.
200 community-dwelling adults aged 65 and older were recruited from three counties in south central North Carolina. Repeated measures of daily symptoms and treatment were collected on three consecutive days at intervals of at least one month. The Mini-Mental State Examination (MMSE), the primary cognitive measure, was collected as part of the baseline survey. Data were collected on the daily use of common non-prescribed therapies (use of prayer, ignore symptoms, over-the-counter remedies, food and beverage therapies, home remedies, and vitamin, herb, or supplements) on each of the three days of the follow-up interviews for up to six consecutive months.
Older adults with poorer cognitive function were more likely to pray and ignore symptoms on days that they experienced acute symptoms. Poorer cognitive function was associated with increased use of home remedies for treating symptoms related to existing chronic conditions.
Cognitive function may play a role in why older patients use some non-prescribed therapies in response to acute and chronic conditions.
cognitive function; self health management; health services
The Rating Anxiety in Dementia (RAID; Shankar et al, 1999)is a clinical rating scale developed to evaluate anxiety in persons with dementia. This report explores the psychometric properties and clinical utility of a new structured interview format of the RAID (RAID-SI), developed to standardize administration and scoring based on information obtained from the patient, an identified collateral, and rater observation.
The RAID-SI was administered by trained master’s level raters. Participants were 32 persons with dementia who qualified for an anxiety treatment outcome study. Self-report anxiety, depression, and quality of life measures were administered to both the person with dementia and a collateral.
The RAID-SI exhibited adequate internal consistency reliability and inter-rater reliability. There was also some evidence of construct validity as indicated by significant correlations with other measures of patient-reported and collateral-reported anxiety, and non-significant correlations with collateral reports of patient depression and quality of life. Further, RAID-SI scores were significantly higher in persons with an anxiety diagnosis compared to those without an anxiety diagnosis.
There is evidence that the RAID-SI exhibits good reliability and validity in older adults with dementia. The advantage of the structured interview format is increased standardization in administration and scoring, which may be particularly important when RAID raters are not experienced clinicians.
dementia; anxiety; clinical interview; assessment; Rating for Anxiety in Dementia
The objective of the study was to determine whether spousal caregiving and bereavement increases caregiver depressive symptoms. We followed 1,967 community-dwelling elderly couples from the 1993 Health and Retirement Study (HRS) until 2002 (five bi-annual surveys) or death. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. Adjusted depressive symptoms were higher for females for three of the four caregiving arrangements tested (as were unadjusted baseline levels). Depressive symptoms were lowest when neither spouse received caregiving (adjusted CESD of 2.97 for males; 3.44 for females, p<0.001). They were highest when females provided care to their husband with assistance from another caregiver, (4.01) compared to (3.37; p<0.001) when males so cared for their wife. A gender by caregiving arrangements interaction was not significant (p 0.13), showing no differential effect of caregiving on CESD by gender. Depressive symptoms peaked for bereaved spouses within three months of spousal death (4.67; p<0.001) but declined steadily to 2.75 (p<0.001) more than 15 months after death. Depressive symptoms initially increased for the community spouse after institutionalization of the care recipient, but later declined. We conclude that caregiving increases depressive symptoms in the caregiver, but does not have a differential effect by gender. Increases in depressive symptoms following bereavement are short-term.
The current study examined individual differences in exposure to daily stressors and self-reported changes in memory among older adults. A sample of 87 older adults completed measures of daily stressful experiences, negative affect, cognitive interference, and rated their memory compared to six months ago. Results indicated that more frequent exposure to daily stressors was associated with rating one’s memory to be worse compared to six months prior. Furthermore, cognitive interference, but not negative affect partially mediated this association. The findings highlight cognitive interference as a psychological pathway for understanding the links between daily stress and perceptions of memory and cognition in old age.
Stress; Self-Rated Memory; Daily Stress; Negative Affect; Cognitive Interference
We sought to examine whether there are patterns of evolving depression symptoms among older primary care patients that are related to prognostic factors and long-term clinical outcomes.
Primary care practices were randomly assigned to Usual Care or to an intervention consisting of a depression care manager offering algorithm-based depression care. In all, 599 adults 60 years and older meeting criteria for major depression or clinically-significant minor depression were randomly selected. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients according to the patterns of depression symptoms across 12 months. Depression diagnosis determined after a structured interview at 24 months was the long-term clinical outcome.
Three patterns of change in depression symptoms over 12 months were identified: high persistent course (19.1% of the sample), high declining course (14.4% of the sample), low declining course (66.5% of the sample). Being in the intervention condition was more likely to be associated with a course of high and declining depression symptoms than high and persistent depression symptoms (OR = 2.53, 95% CI [1.01, 6.37]). Patients with a course of high and persistent depression symptoms were much more likely to have a diagnosis of major depression at 24 months compared with patients with a course of low and declining depression symptoms (adjusted OR = 16.46, 95% CI [7.75, 34.95]).
Identification of patients at particularly high risk of persistent depression symptoms and poor long-term clinical outcomes is important for the development and delivery of interventions.
clinicaltrials.gov registration number: NCT00000367.
Aged; Primary health care; Geriatric depression
To explore the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults.
Design and methods
We analyzed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorized as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorized as nondepressed (score < 10) or depressed (≥ 10). Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated.
The prevalence of a major depressive state was higher in women, and increased with advancing age. The probability of becoming depressed increased with advancing age among the healthy but not the sick. Women showed a greater probability than men of becoming depressed, regardless of health status. Major depressive symptoms persisted over one-year intervals in about 60% of the healthy and 75% of the sick, with little difference between men and women.
Clinically significant depressive symptoms occur commonly in older adults, especially women, increase with advancing age, are associated with poor self-rated health, and are largely intransigent. In order to limit the deleterious consequences of depression among older adults, increased attention to prevention, screening, and treatment is warranted. A self-rated health item could be used in clinical settings to refine the prognosis of late-life depression.
self-rated health; mental health; epidemiology
Previous studies have reported conflicting findings on relationship between race and cognitive decline in elders with dementia. Few studies have examined the role of race in cognitive decline in mild cognitive impairment (MCI). We investigate the relationship between race and cognitive decline in participants with mild cognitive impairment (MCI) in a community-based, longitudinal study of cognitively impaired elders.
Based on a validated method utilizing a neuropsychiatric battery, 133 subjects [mean age: 78.7 years (SD =6.5); female: 112 (76.7%); black: 59 (44.4%)] out of 512 participants in the Memory and Medical Care Study (MMCS) were diagnosed with MCI. The main outcome measure was the Telephone Interview for Cognitive Status (TICS) score over three years. Other baseline subject characteristics (demographics, health-related variables, behavioral and psychiatric symptoms) were included in the analysis.
Overall, the three-year decline in mean TICS score was significantly higher among African Americans than non-African Americans [3.31 (SD: 7.5) versus 0.96 (SD: 3.0), t-value = 1.96, p-value = 0.05]. General estimating equation analyses revealed that African American race was associated with a faster rate of cognitive decline in all models.
The rate of cognitive decline in MCI appears to be faster in African Americans than non-African Americans in the community. Diagnosis of MCI among African-American elders could lead to early interventions to prevent or delay cognitive decline in the future.
Race; Mild Cognitive Impairment; Dementia; Cognitive Decline; African-American
Objectives and Method
Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults’ (n=719; baseline M=61 years) 20-year, intra-individual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories.
Over the 20-year study interval participants declined in use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms; and fewer financial resources, were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant.
Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults’ stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle age.
Coping; Stress; Older adults; Longitudinal trajectories
To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50-64 years of age with those 65+ years of age (N=10,891).
Data were from the 2008–2009 U.S. National Surveys on Drug Use and Health.
Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50–64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8 % vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group.
Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.
Cigarette smoking; cigar smoking; older adults; smokeless tobacco use; epidemiology; binge drinking, substance use, depression, anxiety
Based on data from the National Social Life, Health, and Aging Project, Wave 1, the purpose of this study was to examine possible gender difference in the relationship between the level of spouse/partner support and depressive symptoms in late life. Depressive symptoms were measured by the 11-item, four-point Center for Epidemiologic Scale for Depression (CES-D), and spouse/partner support was measured by a four-item scale, an abbreviated version of the original spouse support/strain scale developed by Schuster, Kessler, and Aseltine (1990). The results from regression analyses show that low perceived spouse/partner support, as opposed to unavailability of the support, was associated with higher CES-D scores among women only, while high spouse/partner support was associated with lower CES-D scores for both genders. These relationship patterns were found in both younger and older groups of men and women.
depression; social support; mental health assessments
In order to better understand if measurement problems underlie the inconsistent findings that exist regarding differences in depression levels between Black and White caregivers, this study examined the factor structure and invariance of the Center for Epidemiologic Studies-Depression scale (CES-D).
A confirmatory factor analysis of the 20-item CES-D was performed on a sample of 167 Black and 214 White family caregivers of older adults with dementia from Los Angeles County.
The relationships between the 20 items and the four factors, as well as the relationships among each of the factors, were equivalent across both caregiver groups, indicating that the four-factor model fit the data for both racial groups.
These findings offer further evidence that the standard four-factor model is the best fitting model for the CES-D and is invariant across racial groups.
depressive symptoms; dementia caregivers; structural equation model; factorial invariance
Recent investigations have reported an association between depression and geriatric syndromes associated with low body mass, including frailty and osteoporosis. The objective of this study was to explore the relationship between depression and body composition among older adults.
Data were from a case-cohort study (n = 98) of adults aged 60 and older nested within the Baltimore Epidemiologic Catchment Area Study. Lifetime depression syndrome was assessed using the Diagnostic Interview Schedule. Body composition (total and central lean and fat mass) was assessed by dual-energy x-ray absorptiometry (DEXA). The association between depression and body composition was evaluated using linear regression with bootstrap standard errors.
Overall, there was no association between depression and total fat or total lean body mass. Among women, a depression was associated with reduced central fat (B = −3.6kg, p<0.06) and lean (B = −3.3kg, p<0.04) mass adjusting for age, race, smoking status, and physical activity. Depression was unrelated to total or central fat or lean mass among men.
Depression is associated with significantly lower central fat and lean mass among older women. These findings are consistent with the hypothesis that depression and frailty are interrelated in later life, particularly among women.
frailty; body composition; metabolic risk; depression
This study examined the effects of religiosity on the trajectories of depressive symptoms in a sample of community-dwelling older adults over a four-year period in a Southern state in the U.S.
Data from the University of Alabama at Birmingham Study (UAB) of Aging were analyzed using a hierarchical linear modeling (HLM) method. This study involved 1,000 participants aged 65 and older (M age = 75 at baseline, SD = 5.97) and data were collected annually from 1999 through 2003. The Geriatric Depression Scale measured depressive symptoms; the Duke University Religion Index measured religious service attendance, prayer, and intrinsic religiosity; and control variables included sociodemographics, health, and social and economic factors.
The HLM analysis indicated a curvilinear trajectory of depressive symptoms over time. At baseline, participants who attended religious services more frequently tended to report fewer depressive symptoms. Participants with the highest levels of intrinsic religiosity at baseline experienced a steady decline in the number of depressive symptoms over the four-year period, while those with lower levels of intrinsic religiosity experienced a short-term decline followed by an increase in the number of depressive symptoms.
In addition to facilitating access to health, social support and financial resources for older adults, service professionals might consider culturally-appropriate, patient-centered interventions that boost the salutary effects of intrinsic religiosity on depressive symptoms.
depressive symptoms; HLM; religiosity; trajectories
Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers’ reports of patients’ medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients’ mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers’ reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients’ relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients’ beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence.
The purpose of the study was to examine the association between financial transfers from older parents to their adult children and mental health among the parents. The analysis examined the act of transfer-giving, the extent of transfers given and the purpose of the transfer in relation to depressive symptoms.
The study was a secondary analysis of data gathered in the first wave of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analysis focused upon persons from the majority Jewish elderly cohort, aged 50 years and older, who had living children (n=1795). Respondents' scores on the Euro-D Depression Scale were regressed on the three financial transfer measures, controlling for age, gender, marital status, household income, health and functional status.
The findings demonstrate a significant inverse relationship between the giving of financial transfers and the number of depressive symptoms of the giver, above and beyond the effects of gender, marital status, income, health status and functional status. The extent of giving was positively related.
The findings support a positive association between acceptable levels of financial giving in late life and mental health. This association is explained as the result of altruistic motivations for giving. Maintenance of viable levels of income security for the older population and promotion of acceptable intergenerational transfers from them to their adult children will benefit both sides of the generational divide.
Depression; exchange; older Jewish parents; adult children; Israel
Older and midlife adults tend to report greater emotional complexity and greater emotional wellbeing than younger adults but there is variability in these factors across the lifespan. The current study determined how the personality trait of Neuroticism at baseline predicts emotional complexity and emotional well-being 10 years later; a goal was to determine if Neuroticism is a stronger predictor of these emotion outcomes with increasing age in adulthood. Data were from two waves of the MIDUS projects (N = 1,503; aged 34 to 84). Greater Neuroticism predicted less emotional complexity as indicated by associations between Positive (PA) and Negative Affect (NA), particularly for older participants. Neuroticism predicted lower emotional well-being and this association was stronger for older and midlife than for younger adults. Overall, high Neuroticism may be greater liability for poor emotion outcomes for older and perhaps for midlife adults than for younger persons. Clinical and theoretical implications of this conclusion are discussed.
Age; Positive Affect; Negative Affect; Neuroticism; Older Adults; MIDUS; Emotional complexity; Emotional well-being
This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimer’s disease. It was hypothesized that more depressive symptoms would be significantly correlated with both “primary” caregiver stressors (i.e., care recipient problem behaviors) and “secondary” stress (i.e., role overload), but that this relationship would be significantly mediated by 4 variables: a) personal mastery, b) coping self-efficacy, c) activity restriction, and d) avoidance coping.
We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway.
Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms.
These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.
Alzheimer’s Disease; Depression; Coping; Behavioral Activation; Self Efficacy; Stress-Process
Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimer’s disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD.
Baseline measures were collected from 162 AD patients and their partners enrolled in a multisite study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors.
While over 70% of all patients initiated physically intimate activities (i.e. kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p < .01). Satisfaction with intimacy was significantly associated with fewer stress and depressive symptoms in female caregivers (r = −.29, p < .01). Caregiver gender, satisfaction with intimacy, and caring for a patient with Mild AD were significant predictors of caregiver depressive symptoms (ps < .05).
The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patient’s level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.
dementia; Alzheimer’s disease (AD); sexuality; intimacy; gender differences
To assess: 1) changes in use of psychotropic medications across two cohorts, ten years apart, of community-dwelling elderly and the socio-demographic, physical and mental health correlates of their use; and 2) changes in psychotropic medication use over 3.5 years follow-up.
Data were taken from two national surveys of the Israeli Jewish population aged 75–94, which respectively sampled two cohorts in 1989 (n=1200) and again in 1999 (n=421). Psychotropic medications were assessed from the list of all medications recorded during a face-to-face interview. The current analysis focused on two medication groups: anxiolytics & sedatives/hypnotics and antidepressants.
Sedatives/hypnotics & anxiolytics use increased from 22.2% in 1989 to 25.4% in 1999 and antidepressants from 3.8% to 4.8% (both nonsignificantly) corresponding to a decline in the health profile of community-dwelling older adults. Similar patterns of associations were observed for socio-demographics, physical and mental health status indicators with use of psychotropic medications across the two cohorts. The pooled multivariate analysis showed significantly higher use of sedative/hypnotics & anxiolytics among women and lower use among religious elderly. Additional risk factors were sleeping problems, number of other medications, depressive symptoms and traumatic life events. Antidepressants use was related to a higher education, ADL disability and depressive symptoms. Longitudinally, use of psychotropic medications was not significantly different among participants who were followed again after 3.5 years.
Sedative/hypnotics & anxiolytics use was relatively high while antidepressants use was low even among depressed elderly suggesting that some depressed elderly were treated inappropriately with benzodiazepines.
A systematic review and meta-analysis of memory training research was conducted to characterize the effect of memory strategies on memory performance among cognitively intact, community-dwelling older adults, and to identify characteristics of individuals and of programs associated with improved memory. The review identified 402 publications, of which 35 studies met criteria for inclusion. The overall effect size estimate, representing the mean standardized difference in pre-post change between memory-trained and control groups, was 0.31 standard deviations (SD; 95% confidence interval (CI): 0.22, 0.39). The pre-post training effect for memory-trained interventions was 0.43 SD (95% CI: 0.29, 0.57) and the practice effect for control groups was 0.06 SD (95% CI: -0.05, 0.16). Among 10 distinct memory strategies identified in studies, meta-analytic methods revealed that training multiple strategies was associated with larger training gains (p=0.04), although this association did not reach statistical significance after adjusting for multiple comparisons. Treatment gains among memory-trained individuals were not better after training in any particular strategy, or by the average age of participants, session length, or type of control condition. These findings can inform the design of future memory training programs for older adults.
memory training; memory; strategy use; meta-analysis; mnemonics
Closer relationships between caregivers and care recipients with dementia are associated with positive outcomes for care recipients, but it is unclear if closeness is a risk or protective factor for the health and psychological well-being of caregivers. We examined 234 care dyads from the population-based Cache County Dementia Progression Study. Caregivers included spouses (49%) and adult offspring (51%). Care recipients mostly had dementia of the Alzheimer’s type (62%). Linear mixed models tested associations between relationship closeness at baseline, or changes in closeness prior to versus after dementia onset, with baseline levels and changes over time in caregiver affect (Affect Balance Scale; ABS), depression (Beck Depression Inventory; BDI), and mental and physical health (components of the Short-Form Health Survey; SF-12). After controlling for demographic characteristics of the caregiver, number of caregiver health conditions, and characteristics of the care recipient (type of dementia, functional ability, and behavioral disturbances), we found that higher baseline closeness predicted higher baseline SF-12 mental health scores (better mental health), and lower depression. Higher baseline closeness also predicted greater worsening over time in ABS and SF-12 mental health. In addition, caregivers who reported a loss of closeness in their relationship with the care recipient from pre- to post-dementia displayed improved scores on ABS and SF-12 mental health, but worse SF-12 physical health over the course of the study. These results suggest that closeness and loss of closeness in the care dyad may be associated with both positive and adverse outcomes for caregivers, both cross-sectionally and over time.