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1.  Is loneliness in later life a self-fulfilling prophecy? 
Aging & Mental Health  2015;20(5):543-549.
Objectives: There are many stereotypes about ageing and later life. We looked at the association between expectations and stereotyping of loneliness in old age and actual self-reported loneliness status 8 years later in English Longitudinal Study of Ageing (ELSA).
Method: Data from 4465 ELSA core members aged over 50 who responded to Waves 2 (2004) did not report loneliness in Wave 2, and responded to loneliness questions at least once between Waves 3 and 6 (2006–2012) were used in multivariable repeated measures logit regression analysis to estimate relationship between perceived stereotypes and expectation of loneliness in older age and actual loneliness reported within 8 years of follow-up.
Results: Twenty-four per cent of respondents from the analytical sample agreed at Wave 2 that old age is time of loneliness and 33% expected to be lonely in old age. Loneliness was reported by 11.5% of respondents at Waves 3–6. Both stereotypes and expectation were significantly associated with later reported loneliness (OR 2.65 (95% CI 2.05–3.42) for stereotypes and 2.98 (95% CI 2.33–3.75) for expectations in age-sex adjusted analysis). Both variables significantly predicted future loneliness even when socio-demographic circumstances were taken into account and both variables were mutually adjusted although the effect was reduced (OR's 1.53 (95% CI 1.16–2.01) for stereotypes and 2.38 (95% CI 1.84–3.07) for expectations).
Conclusions: Stereotypes and expectations related to loneliness in the old age were significantly associated with reported loneliness 8 years later. Interventions aimed at changing age-related stereotypes in population may have more impact on reducing loneliness than individually based services.
doi:10.1080/13607863.2015.1023767
PMCID: PMC4806344  PMID: 25806794
ELSA; loneliness; age-stereotypes; expectation
2.  Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review 
Aging & Mental Health  2015;20(5):529-542.
Objectives: Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe.
Method: Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995–2013.
Results: A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances.
Conclusion: The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.
doi:10.1080/13607863.2015.1023766
PMCID: PMC4784497  PMID: 25806655
health inequalities; socio-economic position; subjective health and well-being; older age; systematic narrative review
3.  Drinking behavior among older adults at a continuing care retirement community: affective and motivational influences 
Aging & mental health  2014;19(3):279-289.
Objectives
The purpose of this pilot study was to describe patterns of alcohol consumption among continuing care retirement community(CCRC) residents and to explore the role of drinking motives and affective states on drinking context and consumption.
Method
We utilized a phone-based daily diary approach to survey older adults about their daily alcohol consumption, context of drinking (e.g. drinking alone), positive and negative affect, and their motives for drinking. Data were analyzed descriptively, and regression models were developed to examine associations between sociodemographic factors, affect, drinking context and motives, and alcohol consumption.
Results
CCRC residents drank most frequently at home and were alone almost half of drinking days on average, although the context of drinking varied considerably by participant. Problem alcohol use was rare, but hazardous use due to specific comorbidities, symptoms and medications, and the amount of alcohol consumption was common. Respondents endorsed higher social motives for drinking and lower coping motives. Social motives were associated with decreased likelihood of drinking alone, but negative affect was associated with decreased likelihood of drinking outside one’s home. Coping and social motives were associated with greater consumption, and higher positive affect was associated with lower consumption.
Conclusion
Among CCRC residents, alcohol use may be socially motivated rather than motivated by coping with negative affect. Future research should examine other motives for drinking in older adulthood. Evaluation of older adults living in CCRCs should include attention to health factors beyond problem use as other forms of hazardous use may be common in CCRCs.
doi:10.1080/13607863.2014.933307
PMCID: PMC4282826  PMID: 25010351
alcohol consumption; continuing care retirement community; drinking motives; positive affect; negative affect
4.  Reflections on living with HIV over time: Exploring the perspective of HIV-infected women over 50 
Aging & mental health  2014;19(2):121-128.
Objectives
Approximately 32.7% of people living with HIV/AIDS (PLWHA) in the U.S. are now over the age of 50. Women comprise a significant percentage of the U.S. HIV epidemic and the percentage of women diagnosed with HIV continues to grow; however, little is known about women’s experiences living and coping with HIV over time. The goal of this study was to explore experiences of U.S. women over 50 living with HIV to better understand how they make sense of their diagnosis and cope with their illness over time, and during the aging process.
Method
Nineteen women (mean age = 56.79, SD=4.63) referred from Boston-area organizations and hospitals completed one-time, in-depth individual interviews. 47% of participants identified as Black/African American, and 37% as White. Average time since diagnosis was 16.32 years (SD=5.70). Inclusion criteria included: female sex; aged 50 or older; HIV diagnosis; and English speaking. Transcribed interviews were analyzed using a grounded theory approach and NVivo 9 software.
Results
Findings are described across the following themes: 1) experiences at diagnosis, 2) uncertainty of disease course, 3) acceptance, 4) living “well” with HIV. Participants appeared to be well-adjusted to their HIV diagnosis and described a progression to acceptance and survivorship; they identified strategies to “live well” in the context of HIV. For some, health-related uncertainty about the future remained. These findings were organized into a model of coping with HIV.
Conclusions
Themes and issues identified by this study may help guide interventions across the lifespan for women with HIV.
doi:10.1080/13607863.2014.917608
PMCID: PMC4245325  PMID: 24903460
HIV/AIDS; women; aging; adjustment; coping
5.  A systematic review of physical illness, functional disability, and suicidal behaviour among older adults 
Aging & Mental Health  2015;20(2):166-194.
Objectives: To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older.
Method: Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review.
Results: Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed.
Conclusion: Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.
doi:10.1080/13607863.2015.1083945
PMCID: PMC4720055  PMID: 26381843
death wishes; suicidal ideation; nonfatal suicidal behaviour; suicide; physical illness; functional disability
6.  Erratum 
Aging & Mental Health  2014;19(7):666.
doi:10.1080/13607863.2014.980654
PMCID: PMC4710151  PMID: 25368902
7.  Differences in Life Satisfaction among Older Community-Dwelling Hispanics and non-Hispanic Whites 
Aging & mental health  2015;19(11):978-988.
Objectives
Hispanics are the fastest growing ethnic/racial group of the older adult population in the U.S., yet little is known about positive mental health in this group. We examined differences in life satisfaction between demographically-matched groups of older Hispanics and non- Hispanic Whites, and sought to identify specific factors associated with these differences.
Methods
Participants included 126 community-dwelling English-speaking Hispanics ages 50 and older, and 126 age-, gender-, and education-matched non-Hispanic Whites. Participants completed standardized measures of life satisfaction and postulated correlates, including physical, cognitive, emotional and social functioning, as well as positive psychological traits and religiosity/spirituality.
Results
Hispanics reported greater life satisfaction than non-Hispanic Whites (p<0.001). Ethnic groups were comparable on most postulated correlates of life satisfaction, except that Hispanics had lower levels of cognitive performance, and higher levels of daily spiritual experiences, private religious practices and compassion (ps<0.001). Among these factors, spiritual experiences, religious practices, and compassion were significantly associated with life satisfaction in the overall sample. Multivariable analyses testing the influence of these three factors on the association between ethnicity and life satisfaction showed that higher spirituality among Hispanics accounted for ethnic differences in life satisfaction.
Conclusion
English-speaking Hispanics ages 50 and older appeared to be more satisfied with their lives than their non-Hispanic White counterparts, and these differences were primarily driven by higher spirituality among Hispanics. Future studies should examine positive mental health among various Hispanic subgroups, including Spanish-speakers, as an important step toward development of culturally-sensitive prevention and intervention programs aimed at promoting positive mental health.
doi:10.1080/13607863.2014.971706
PMCID: PMC4433868  PMID: 25402813
Quality of Life/Well-being; Cultural aspects; Religion/Spirituality; Aging; Latino
8.  Santa Clara Strength of Religious Faith Questionnaire: Psychometric analysis in older adults 
Aging & mental health  2014;19(1):86-97.
Objectives
To assist researchers and clinicians considering using the Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ) with older-adult samples, the current study analyzed the psychometrics of SCSRFQ scores in two older-adult samples.
Method
Adults age 55 or older who had formerly participated in studies of cognitive-behavioral therapy for anxiety and/or depression were recruited to complete questionnaires. In Study 1 (N = 66), the authors assessed the relations between the SCSRFQ and other measures of religiousness/spirituality, mental health, and demographic variables, using bivariate correlations and nonparametric tests. In Study 2 (N = 223), the authors also conducted confirmatory and exploratory factor analyses of the SCSRFQ, as well as an Item Response Theory analysis.
Results
The SCSRFQ was moderately to highly positively correlated with all measures of religiousness/spirituality. Relations with mental health were weak and differed across samples. Ethnic minorities scored higher than White participants on the SCSRFQ, but only in Study 2. Factor analyses showed that a single-factor model fit the SCSRFQ best. According to Item Response Theory analysis, SCSRFQ items discriminated well between participants with low-to-moderate levels of the construct but provided little information at higher levels.
Conclusion
Although the SCSRFQ scores had adequate psychometric characteristics, the measure’s usefulness may be limited in samples of older adults.
doi:10.1080/13607863.2014.917606
PMCID: PMC4233001  PMID: 24892461
religion; spirituality; aging; mental health; measurement
9.  Development of a New Multidimensional Individual and Interpersonal Resilience Measure for Older Adults 
Aging & mental health  2014;19(1):32-45.
Objectives
Develop an empirically grounded measure that can be used to assess family and individual resilience in a population of older adults (aged 50-99).
Methods
Cross-sectional, self-report data from 1,006 older adults were analyzed in two steps. The total sample was split into two sub-samples and the first step identified the underlying latent structure through principal component Exploratory Factor Analysis (EFA). The second step utilized the second half of the sample to validate the derived latent structure through Confirmatory Factor Analysis (CFA).
Results
EFA produced an eight-factor structure that appeared clinically relevant for measuring the multidimensional nature of resilience. Factors included self-efficacy, access to social support network, optimism, perceived economic and social resources, spirituality and religiosity, relational accord, emotional expression and communication, and emotional regulation. CFA confirmed the eight-factor structure previously achieved with covariance between each of the factors. Based on these analyses we developed the Multidimensional Individual and Interpersonal Resilience Measure (MIIRM), a broad assessment of resilience for older adults.
Conclusion
This study highlights the multidimensional nature of resilience and introduces an individual and interpersonal resilience measure developed for older adults which is grounded in the individual and family resilience literature.
doi:10.1080/13607863.2014.909383
PMCID: PMC4414022  PMID: 24787701
Family resilience; individual resilience; successful aging; factor analysis; older adults
10.  Resilience, Stress, and Life Quality in Older Adults Living with HIV/AIDS 
Aging & mental health  2015;19(11):1015-1021.
Objectives
This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people living with HIV/AIDS (OPLWHA) 50 years of age and older.
Method
Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism and social support) and assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).
Results
SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.
Conclusion
Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.
doi:10.1080/13607863.2014.1003287
PMCID: PMC4520800  PMID: 25633086
Resilience; HIV/AIDS; older adults; quality of life; life stress
11.  Neurocognitive and Functional Correlates of Mobile Phone Use in Middle-Aged and Older Patients with Schizophrenia 
Aging & mental health  2015;20(1):29-35.
Objectives
Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning and functional outcome in 196 outpatients aged 40 and older who were diagnosed with schizophrenia.
Methods
Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity and informant-rated functional outcome.
Results
The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes.
Conclusions
Most older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.
doi:10.1080/13607863.2015.1008987
PMCID: PMC4568167  PMID: 25768842
Psychosis; cognitive functioning; disability; technology; aging
12.  Individual music therapy for agitation in dementia: an exploratory randomized controlled trial 
Aging & Mental Health  2013;17(6):667-678.
Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life.
Method: In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication.
Results: Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at −6.77 (95% CI (confidence interval): −12.71, −0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02).
Conclusion: This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample.
doi:10.1080/13607863.2013.790926
PMCID: PMC4685573  PMID: 23621805
agitation disruptiveness; psychotropic medication; quality of life; person-centered care; caregiver burnout
13.  The stability of coping strategies in older adults with osteoarthritis and the ability of these strategies to predict changes in depression, disability, and pain 
Aging & mental health  2015;19(12):1113-1122.
Objectives
Given the chronically painful, incurable nature of osteoarthritis, effective cognitive and behavioral coping strategies may be critical for older adults with the disease. Little is known about how and why coping changes over time, nor about stability of coping strategies in persons with osteoarthritis. The aims of this work were to examine the structure of coping in older adults with osteoarthritis, the association of coping strategies with well-being, the stability of coping over time, and its association with changes in well-being over the same period.
Method
In a longitudinal study, 199 older adults with osteoarthritis of the knee were assessed at baseline and two years' follow-up. Items from two coping scales were factor analyzed, and Pearson's correlations and paired-samples t-tests assessed relative and absolute stability of the resultant coping strategies. CFA assessed the stability of the factor structure itself. Ordinary least-squares regression analyses examined the impact of change in coping on well-being.
Results
A five-factor coping solution emerged: stoicism, refocusing, problem-solving, wishful-thinking, and emotion-focused coping. The factor structure showed stability over the two-year period. Absolute stability of strategies varied, indicating that change in coping styles was possible.
Conclusion
Changes in coping style predicts future well-being; however, coping remains malleable with age and maladaptive strategies can be effectively targeted. Greater knowledge of the utility or maladaptive nature of a given strategy may help guide decisions about interventions for patients with osteoarthritis and encourage more adaptive coping styles.
doi:10.1080/13607863.2014.1003286
PMCID: PMC4527956  PMID: 25658300
osteoarthritis; coping stability; chronic pain; depression; disability
15.  Inner strength – associated with reduced prevalence of depression among older women 
Aging & Mental Health  2014;19(12):1078-1083.
Objectives: The aim of this study was to explore if inner strength is independently associated with a reduced prevalence of depression after controlling for other known risk factors associated with depression.
Methods: A population-based cross-sectional study was performed, where all women living in Åland, a Finnish self-govern island community in the Baltic Sea, aged 65 years or older were sent a questionnaire including the Geriatric Depression Scale and the Inner Strength Scale along with several other questions related to depression. Factors associated with depression were analyzed by means of multivariate logistic regression.
Results: The results showed that 11.2% of the studied women (n = 1452) were depressed and that the prevalence increased with age and was as high as 20% in the oldest age group. Non-depressed women were more likely to never or seldom feel lonely, have a strong inner strength, take fewer prescription drugs, feeling needed, being able to engage in meaningful leisure activities, as well as cohabit.
Conclusion: Our results showed an association between stronger inner strength and being non-depressed. This can be interpreted to mean that inner strength might have a protective effect against depression. These findings are interesting from a health-promotion perspective, yet to verify these results, further longitudinal studies are required.
doi:10.1080/13607863.2014.977775
PMCID: PMC4566880  PMID: 25402943
depression; GDS-15; inner strength; old age; women
16.  Diagnostic communication in the memory clinic: a conversation analytic perspective 
Aging & Mental Health  2015;19(12):1123-1130.
Objectives: Whether and how patients should be told their dementia diagnosis, has been an area of much debate. While there is now recognition that early diagnosis is important for dementia care little research has looked at how dementia-related diagnostic information is actually verbally communicated. The limited previous research suggests that the absence of explicit terminology (e.g., use of the term Alzheimer's) is problematic. This paper interrogates this assumption through a conversation analysis of British naturalistic memory clinic interaction.
Method: This paper is based on video-recordings of communication within a UK memory clinic. Appointments with 29 patients and accompanying persons were recorded, and the corpus was repeatedly listened to, in conjunction with the transcripts in order to identify the segments of talk where there was an action hearable as diagnostic delivery, that is where the clinician is evaluating the patient's condition.
Results: Using a conversation analytic approach this analysis suggests that diagnostic communication, which is sensitive and responsive to the patient and their carers, is not predicated on the presence or absence of particular lexical choices. There is inherent complexity regarding dementia diagnosis, especially in the ‘early stages’, which is produced through and reflected in diagnostic talk in clinical encounters.
Conclusion: In the context of continuity of dementia care, diagnostic information is communicated in a way that conforms to intersubjective norms of minimizing catastrophic reactions in medical communication, and is sensitive to problems associated with ‘insight’ in terms of delivery and receipt or non-receipt of diagnosis.
doi:10.1080/13607863.2014.1003289
PMCID: PMC4566896  PMID: 25647148
Alzheimer's disease; conversation analysis; dementia; diagnosis; health communication; qualitative methods
17.  Race Differences in the Association of Spiritual Experiences and Life Satisfaction in Older Age 
Aging & mental health  2013;17(7):888-895.
Objectives
The primary objective of this study was to examine an African American ‘faith advantage’ in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites.
Method
The data came from 6,864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale.
Results
In a regression model adjusting for age, sex, marital status, education, income, and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race × spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans.
Conclusion
The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource - distinct from worship attendance- that enable older African Americans to overcome decrements in life satisfaction and in fact, that lower spiritual experiences may be especially harmful for older African American’s life satisfaction.
doi:10.1080/13607863.2013.793285
PMCID: PMC4545598  PMID: 23627686
spirituality; well-being; race/ethnicity
18.  Event-Based Prospective Memory Is Independently Associated with Self-Report of Medication Management in Older Adults 
Aging & mental health  2014;18(6):745-753.
Background
Identifying potentially modifiable risk factors for medication non-adherence in older adults is important in order to enhance screening and intervention efforts designed to improve medication-taking behavior and health outcomes. The current study sought to determine the unique contribution of prospective memory (i.e., “remembering to remember”) to successful self-reported medication management in older adults.
Methods
Sixty-five older adults with current medication prescriptions completed a comprehensive research evaluation of sociodemographic, psychiatric, and neurocognitive functioning, which included the Memory for Adherence to Medication Scale (MAMS), Prospective and Retrospective Memory Questionnaire (PRMQ), and a performance-based measure of prospective memory that measured both semantically-related and semantically-unrelated cue-intention (i.e., when-what) pairings.
Results
A series of hierarchical regressions controlling for biopsychosocial, other neurocognitive, and medication-related factors showed that elevated complaints on the PM scale of the PRMQ and worse performance on an objective semantically-unrelated event-based prospective memory task were independent predictors of poorer medication adherence as measured by the MAMS.
Conclusions
Prospective memory plays an important role in self-report of successful medication management among older adults. Findings may have implications for screening for older individuals “at risk” of non-adherence, as well as the development of prospective memory-based interventions to improve medication adherence and, ultimately, long-term health outcomes in older adults.
doi:10.1080/13607863.2013.875126
PMCID: PMC4040152  PMID: 24410357
Episodic memory; Adherence; Neuropsychological assessment; Geropsychology
19.  Hearing Loss and Dementia – Who’s Listening? 
Aging & mental health  2014;18(6):671-673.
doi:10.1080/13607863.2014.915924
PMCID: PMC4075051  PMID: 24875093
20.  Mental health service utilization among Korean elders in Korean churches: preliminary findings from the Memory and Aging Study of Koreans in Maryland (MASK-MD) 
Aging & mental health  2013;18(1):102-109.
Background
Korean Americans (KA) comprise the fourth largest Asian-American subgroup, with a population estimated at nearly 1.7 million, and the vast majority (up to 85%) of KA elders attends ethnic churches. Despite the rapid increase of the KA elderly population, data on mental health service utilization among KA elders are scarce.
Method
Based on a cluster sampling method, the Memory and Aging Study among Koreans in Maryland (MASK-MD) recruited and assessed 630 KA elders (mean age: 70.9 ± 6.1 years; 68.9% female) in KA churches for depression, dementia, and level of mental health service utilization. The Korean versions of the Patient Health Questionnaire (PHQ-9K) and Mini-mental Status Examination (MMSE-KC) were administered by trained community health workers.
Results
Of the 630 participants, 23.2% and 7.3% had PHQ-9 scores of 5 (‘mild depression’) or above and 10 or above (‘clinical depression’), respectively. In addition, 7.0% scored below the age- and education-specific cutoff values for probable dementia based on the MMSE-KC. Of the 92 participants with ‘clinical depression’ or having thoughts of death or self-injury, only 16 (17%) reported utilizing mental health services. Likewise, of 56 participants with probable dementia, only 3 (7.3%) sought treatment from a health care provider.
Conclusion
The prevalence of depression and cognitive impairment are high in community-dwelling KA elders attending KA churches, but the rate of mental health service utilization among depressed or cognitively impaired Korean elders is low. Further research is warranted to identify barriers to and strategies for adequate mental health care for Korean immigrant elders.
doi:10.1080/13607863.2013.814099
PMCID: PMC4519089  PMID: 23889338
cultural aspects; health service use; epidemiology (mental health); epidemiology (dementia)
21.  Greater Age-Related Decline in Markers of Physical, Mental and Cognitive Health among Israeli Older Adults Exposed to Lifetime Cumulative Adversity 
Aging & mental health  2013;18(5):610-618.
Objectives
This longitudinal investigation addressed whether and how lifetime cumulative adversity and depressive symptoms moderated age-related decline in markers of physical, mental and cognitive health.
Method
1,248 older adults (mean age = 62 at Wave 1) who completed the first two waves of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) reported on exposure to potentially traumatic life events, depressive symptoms, and three outcomes – disability, quality of life and cognitive markers.
Results
Age was related to greater functional decline in outcome measures across the two waves (i.e., increase in disability and decrease in quality of life and cognitive functioning). This age-related decline became stronger as lifetime adversity increased. A three-way interaction showed that the greatest age-related functional decline in outcome measures was especially salient among those with high level of lifetime adversity and high level of depressive symptoms.
Conclusion
Lifetime cumulative adversity is associated with a more noticeable process of age-related dysfunction across various markers of health. Although the majority of older adults are resilient to lifetime adversity, prevention and intervention programs should be aimed at mitigating the pronounced senescence observed when adversity accumulated to a large degree, and especially when it is accompanied with high level of distress.
doi:10.1080/13607863.2013.860951
PMCID: PMC4021036  PMID: 24328416
potentially traumatic life events; depressive symptoms; SHARE-Israel
22.  An empirical typology of lifetime and current gambling behaviors: Association with health status of older adults 
Aging & mental health  2009;13(2):265-273.
Purpose
Despite the low prevalence of gambling problems, older adults experience poorer health status given certain vulnerabilities associated with aging. Thus, we aimed to classify lifetime (LPG) and current (CPG) problem gambling patterns, identify determinants of gambling patterns, and examine their association with current health status
Methods
Using older adult gamblers (n = 489) in the Gambling Impact and Behavior Study, Latent Class Analysis classified LPG and CPG subgroups based on 10 DSM-IV criteria: preoccupation, tolerance, withdrawal, loss of control, escape, chasing losses, lying, illegal acts, relationship impairment and financial bailout.
Results
A two-class solution was the best fitting for LPG and CPG groups. Except for illegal acts, the remaining criteria endorsed the distinguishing patterns. We observed 10.8% LPGs, 8.4% CPGs and 2.2% with both. Participation in religious services was protective of both groups. Gambling for excitement and to win money were related to CPG. Further, CPG was significantly related to worse self-rated health.
Implications
Although problem gambling is strongly characterized by number and type of diagnostic criteria, findings support a focus to include targeted assessment of additional clinically meaningful gambling correlates. Research on the moderator of participation in faith-based communities on problem gambling is also warranted.
doi:10.1080/13607860802459849
PMCID: PMC4459587  PMID: 19347693
23.  Delineating the third age: joint models of older people's quality of life and attrition in Britain 2002–2010 
Aging & Mental Health  2015;19(7):576-583.
Objectives: In the public mind, later life is being transformed by the emerging possibility of a flourishing third age with sustained quality of life. We draw trajectories of life quality measured using CASP-19 over eight years. We refine these trajectories by jointly modelling attrition, since older people tend to leave longitudinal studies (attrite) not at random.
Methods: Growth curve models are applied to the English Longitudinal Study of Ageing waves 1 to 5. Then joint model is estimated where attrition is considered. Extensive predictors are entered including demographic attributes, social and economic status, health conditions, and behaviours.
Results: Strong non-linear age trajectory of life quality is revealed by the growth curve models where the peak is achieved in the late 60s. Then the joint model uncovers the peak somewhat later in time, and also reveals secular improvement in life quality experienced by recent cohorts. Sharp estimates for many predictors of higher levels of life quality are also found.
Conclusion: For the first time, the trajectories of life quality in the third age are drawn and improvement across cohorts is demonstrated. The contributions are estimated for predictors amenable to intervention such as social capital. This can help in policy discussion on improving the lives of older people in the third age.
doi:10.1080/13607863.2014.1003279
PMCID: PMC4445379  PMID: 25642833
quality of life/well-being; mental health measures; epidemiology
24.  Food activities and identity maintenance in old age: a systematic review and meta-synthesis 
Aging & Mental Health  2014;19(8):667-678.
Objectives: Services provided to older people should be developed based on active ageing policies. Nutrition is one aspect of active ageing, but little is known about how food activities contribute to psychological well-being in later life. This is a systematic review of qualitative and quantitative research that answers the question ‘What is known about the relationship between food activities and the maintenance of identities in old age?’.
Methods: We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and used quality assessment parameters to complete a systematic review and narrative synthesis. Academic Search Premier, MEDLINE, CINAHL Plus, and PsycINFO databases were searched.
Results: We initially identified 8016 articles, of which 167 full-text articles were screened for inclusion. Twenty-two articles were included in the review. There was moderate evidence from nine qualitative and two quantitative studies, of variable quality, that food activities contribute to the maintenance of women's gendered identities, the ethnic identities of men and women, and community identities. There was moderate evidence from 10 qualitative studies, of variable quality, that a change in food choice and deteriorating health changed food activity participation. These changes threatened identities. Most studies included both younger adults and older adults.
Conclusion: In later life, there are many life experiences leading to change. Further research is needed to develop understanding of how identity and mental well-being are maintained, despite changes in everyday activities like cooking and eating. This may enable health care professionals to meet psychological needs alongside biological needs during nutritional interventions.
doi:10.1080/13607863.2014.971707
PMCID: PMC4440631  PMID: 25373998
identity; maintenance; food; nutrition; active ageing
25.  Physical and mental decline and yet rather happy? A study of Danes aged 45 and older 
Aging & mental health  2014;19(5):400-408.
Objectives
Little is known about whether the feeling of happiness follows the age-related decline in physical and mental functioning. The objective of this study was to analyze differences with age in physical and mental functions and in the feeling of happiness among Danes aged 45 years and older.
Method
Three Danish population-based surveys including 11,307 participants aged 45+ years, of whom 2411 were in the age group of 90+, were conducted in the period 1995–2001. The participation rate in the three surveys was between 63% and 82% and the same design and the same instrument were used. Self-reported mobility, a cognitive composite score, and a depression symptomatology score including a question about happiness were assessed. T-score metric was used to compare across domains and age groups.
Results
Overall, successively older age groups performed worse than the youngest age group (45–49 years), and the estimated linear decline was greater after age 70 than before age 70. For example, when comparing the oldest age group (90+ years) with the youngest, the T-score differences were found to be the largest for the mobility score (men: 40.2, women: 41.4), followed by the cognitive function (men: 22.0, women: 24.9), and the total depression symptomatology score (men: 15.5, women: 17.4). Conversely, the T-score difference in happiness was small (men: 5.6, women: 6.0).
Conclusion
Despite markedly poorer physical and mental functions with increasing age, in this Danish sample age did not seem to affect happiness to a similarly notable extent, although, in this study, cohort and age effects cannot be disentangled.
doi:10.1080/13607863.2014.944089
PMCID: PMC4356733  PMID: 25117759
happiness; cognitive composite score; depression symptomatology; mobility; aging

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