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.
To clarify whether physical activity among older Americans is associated with depressive symptoms, beyond the effects of social network type, physical health and sociodemographic characteristics.
The analysis used data from a sub-sample, aged 65–85, from the National Social Life, Health and Aging Project (N = 1,349). Hierarchical regressions examined the respective effects of selected network types and extent of engagement in physical activity on depressive symptoms, controlling for physical health and sociodemographic background.
The findings showed that physical activity was correlated inversely with late life depressive symptoms. However, when interaction terms for the selected social network types and the extent of physical activity were also considered, the main effect of social network on depressive symptoms increased, while that of physical activity was eliminated.
The results show that older American adults embedded in family network types are at risk of limited physical activity. However, interventions aimed to increase their engagement in physical activity might help to reduce depressive symptoms within this group.
exercise; mobility; older adults; network type; American; NSHAP
The aim of this study was to develop and test a model of depression, hippocampal changes, and cognitive decline.
Participants were 248 community-dwelling, depressed patients and 147 healthy, non-depressed individuals 60 years and older. Participants received a structured interview assessing current depressive symptoms and past depressive episodes, completed cognitive testing with the MMSE, and underwent structural MRI of the brain. For up to ten years, assessment of depressive symptoms and MMSE administration was repeated at least annually, and MRI was repeated every two years.
Regression analyses demonstrated that depression diagnosis at baseline predicted decrease in right (but not left) hippocampal volume over a four-year period. Analyses using structural equation modeling demonstrated that a decrease in left and right hippocampal volume predicted decrease in MMSE score over four years.
Results provide some evidence for relationships between depression and decrease in right hippocampal volume, and between hippocampal volume and MMSE score. This would be consistent with depression as a causal factor in subsequent cognitive decline. Plausible biological mechanisms include a glucocorticoid cascade or a facilitating effect of depression on amyloid-beta plaque formation. Future studies should examine the relationship between hippocampal volume and specialized memory measures, as well as between depression diagnosis and volume of other brain structures.
major depressive disorder; glucocorticoid cascade hypothesis; neuroimaging; structural equation modeling
Using data from a 30-day diary study with 239 adults (81 young, 81 middle-aged, and 77 older adults) this study examined whether a specific ratio between positive and negative affect distinguished individuals with different mental health status and especially flourishing from non-flourishing individuals. In addition, the study addressed whether there were age differences in the positivity ratio when daily affect data were used, and whether the proposed critical positivity ratio of 2.9 discriminated equally well between individuals with different mental health status across the adult lifespan. Findings showed that the ratio of positive to negative affect differed across adulthood such that age was associated with an increasing preponderance of positive to negative affect. The positivity ratio was also associated with mental health status in the hypothesized direction; higher positivity ratios were associated with better mental health. Finally, although the data supported the notion of a positivity ratio of 2.9 as a “critical value” in young adulthood, this value did not equally well discriminate the mental health status of middle-aged and older adults.
adulthood; positive and negative affect; positivity ratio; mental health
While psychosocial interventions for late-life anxiety show positive outcomes, treatment effects are not as robust as in younger adults. To date, the reach of research has been limited to academic and primary care settings, with homogeneous samples. The current review examines recently funded and ongoing late-life anxiety research that uses innovative approaches to reach unique patient populations and tailor treatment content and delivery options to meet the unique needs of older adults.
A systematic search was conducted using electronic databases of funded clinical trials to identify ongoing psychosocial intervention studies targeting older adults with anxiety. The principal investigators of the studies were contacted for study details and preliminary data, if available. In some cases, the principal investigators of identified studies acted as referral sources in identifying additional studies.
Eleven studies met inclusion criteria and represented three areas of innovation: new patient groups, novel treatment procedures, and new treatment delivery options. Studies and their associated theoretical bases are discussed, along with preliminary results reported in published papers or conference presentations.
Psychosocial intervention trials currently in progress represent promising new strategies to facilitate engagement and improve outcomes among unique subsets of older adults with anxiety. Continued investigation of evidence-based treatments for geriatric anxiety will allow greater understanding of how best to tailor the interventions to fit the needs of older adults.
psychosocial treatment; late life anxiety; generalized anxiety disorder; older adults; review
This measurement study operationalized family caregiver skill in managing behavioral symptoms associated with Alzheimer’s disease (AD) by testing a Caregiver Assessment of Behavioral Skill-Self Report measure (CAB-SR).
A cross-sectional design was used. Caregivers had a family member with possible/probable AD, resided at home with the care recipient and provided the majority of care (N=82). The mail-administered assessment included the CAB-SR and other care recipient and caregiver measures.
Preliminary CAB-SR reliability and validity were determined, using reliability, factor analytic and correlational procedures.
This measure provides a preliminary assessment of caregiver skill in managing behavioral symptoms of AD and shows promise for use in research and clinical intervention settings.
caregiver assessment; caregiver effectiveness; measurement development
Peaceful Mind, a cognitive-behavioral therapy for treating anxiety in persons with dementia, is a promising new treatment currently under investigation. This article reports results of our examination of a modification of the treatment protocol in two cases that included multiple caregivers in treating two persons with dementia.
Two case presentations of the benefits and challenges of including multiple caregivers in treatment are discussed. Treatment outcome data for these cases were collected as part of a larger investigation of Peaceful Mind.
The involvement of multiple collaterals resulted in several benefits, including increased family communication, as well as increased opportunities for the practice of new skills. These cases have also presented unique challenges requiring alterations in therapy structure and attention to issues of family conflict.
Including multiple collaterals in cognitive-behavioral therapy for treating anxiety in persons with dementia is feasible and may be beneficial in maximizing treatment gains and increasing the family’s investment in therapy.
cognitive-behavioral therapy; anxiety; dementia
This study examines: (1) the effect of widowed persons' frequency of contact with friends and relatives on their depressive and grief symptoms six months following spousal loss and (2) the extent to which the effects of social contact are contingent upon the degree of emotional support received from these relationships and the congruence between widowed persons' preferred and actual levels of social contact.
Analyses are based on the Changing Lives of Older Couples (CLOC) study, a prospective study of a two-stage area probability sample of 1,532 married men and women aged 65 or older. Depressive and grief symptoms 6 months after spousal loss were regressed on social contact, support, and congruence between preferred and actual social contact.
Frequency of contact did not have a significant influence on psychological distress when contextual factors are controlled. Social support and the incongruence between preferred and actual social contact were significantly associated with decreased psychological distress for several outcomes. As for the moderating effects of social support and incongruence on the link between social contact and distress, those who had high social contact and high social support experienced less anger and fewer intrusive thoughts than their counterparts; and those who had low social contact but preferred high social contact experienced greater anger.
The findings highlight the importance of understanding the quality of widowed persons' relationships as well as the congruence between their preferred and actual social contact.
widowhood; social support; social isolation; grief
The present study examined the relationship between self-reported physical health, depressive symptoms, and the occurrence of depression diagnosis in Hispanic female dementia caregivers.
Participants were 89 Hispanic female dementia caregivers.
This study used a cross-sectional design. Baseline depression and physical health data were collected from participants enrolled in the ‘Reducing Stress in Hispanic Anglo Dementia Caregivers’ study sponsored by the National Institute on Aging.
Physical health was assessed using the Medical Outcome Study Short Form-36 (SF-36), a one-item self-report health rating, body mass index, and the presence or history of self-reported physical illness. Depressive symptoms were assessed using the Center for Epidemiologic Studies – Depression Scale (CES-D). The occurrence of depression diagnosis was assessed using the Clinical Interview for DSM-IV Axis I Disorders (SCID).
Multiple linear and logistic regression analysis was used to examine the extent to which indices of physical health and depressive symptoms accounted for variance in participants’ depressive symptoms and depressive diagnoses.
Self-reported indices of health (e.g., SF-36) accounted for a significant portion of variance in both CES-D scores and SCID diagnoses. Caregivers who reported worsened health tended to report increased symptoms of depression on the CES-D and increased likelihood of an SCID diagnosis of a depressive disorder.
Self-reported health indices are helpful in identifying Hispanic dementia caregivers at risk for clinical levels of depression.
depression; physical health; Hispanics dementia caregivers
The role of spirituality in the context of mental health and successful aging is not well understood. In a sample of community-dwelling older women enrolled at the San Diego site of the Women's Health Initiative study, we examined the association between spirituality and a range of variables associated with successful cognitive and emotional aging, including optimism, resilience, depression, and health-related quality of life (HRQoL).
A detailed cross-sectional survey questionnaire on successful aging was completed by 1,973 older women. It included multiple self-reported measures of positive psychological functioning (e.g., resilience, optimism,), as well as depression and HRQoL. Spirituality was measured using a 5-item self report scale constructed using two items from the Brief Multidimensional Measure of Religiosity/Spirituality and three items from Hoge's Intrinsic Religious Motivation Scale
Overall, 40% women reported regular attendance in organized religious practice, and 53% reported engaging in private spiritual practices. Several variables were significantly related to spirituality in bivariate associations; however, using model testing, spirituality was significantly associated only with higher resilience, lower income, lower education, and lower likelihood of being in a marital or committed relationship.
Our findings point to a role for spirituality in promoting resilience to stressors, possibly to a greater degree in persons with lower income and education level. Future longitudinal studies are needed to confirm these associations.
Spirituality; religiosity; elderly; successful aging; resilience
The purpose of this paper is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression.
Capitalizing on the substantial interest in the US on the patient-centered medical home concept, the Aging Brain Care Medical Home targets older adults with dementia and/or late life depression in the primary care setting. We describe a structured set of activities that laid the foundation for a new partnership with the primary care practice and the lessons learned in implementing this new care model. We also provide a description of the core components of this innovative memory care program.
Findings from three recent randomized clinical trials provided the rationale and basic components for implementing the new memory care program. We used the reflective adaptive process as a relationship building framework that recognizes primary care practices as complex adaptive systems. This framework allows for local adaptation of the protocols and procedures developed in the clinical trials. Tailored care for individual patients is facilitated through a care manager working in collaboration with a primary care physician and supported by specialists in a memory care clinic as well as by information technology resources.
We have successfully overcome many system-level barriers in implementing a collaborative care program for dementia and depression in primary care. Spontaneous adoption of new models of care is unlikely without specific attention to the complexities and resource constraints of health care systems.
Dementia; primary care; late life depression; implementation science
Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both patients suffering from dementia and their informal caregivers.
To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis.
We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC).
Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (SD 9.5), 40% were African Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day re-hospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs.
The tools of “implementation science” can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program.
dementia care; memory care practice; implementation science; complex adaptive system; informal caregiver
The current study explored the relationship between three dimensions of religiosity: (a) organizational religiosity (e.g. attendance at religious events), (b) non-organizational religiosity (e.g. prayer), and (c) subjective religiosity (e.g. importance of religion) and caregiver health behavior patterns in a sample of Latina and Caucasian female caregivers of older adult relatives with dementia. It was hypothesized that religiosity would have a significant association with reduced cumulative health risk as determined by an index of health behaviors. It was also hypothesized that, when examining the individual health behaviors subsumed in the overarching index, religiosity would be positively associated with adaptive health behaviors like exercise and negatively associated with health risk behaviors like smoking. Amongst Caucasians, increased subjective religiosity was related to increased cumulative health risk. Conversely, in Latinas, non-organizational religiosity was positively correlated with improved dietary practices (reduced dietary restriction). Increased levels of subjective religiosity were significantly associated with decreased maintenance of a routine exercise regimen across ethnic groups. Recommendations for clinicians and religious leaders, and avenues of future research are discussed.
caregiver; health behaviors; religiosity; Alzheimer’s disease; stress/burden; physical health measures
Psychosocial stressors faced by patients with fragile X-associated tremor/ataxia syndrome (FXTAS) and their caregivers have not been systematically explored. FXTAS is a neurodegenerative disease occurring in approximately 45% of elderly male carriers and 8–16% of female carriers of the FMR1 premutation. This study investigated subjective needs of patients with FXTAS and their family caregivers, by utilizing Q-sort methodology.
Patients with FXTAS and their caregivers seen during January 2005 to June 2007 participated. The Q-sort was composed of 17 (8 formal, 9 informal) items, designed to explore emotional, informational, and instrumental needs of patients with FXTAS and their caregivers. Item scores were generated, from 1= least important, to 7 = most important. Analysis included descriptive statistics for all the demographic and outcome variables. Generalized estimating equations were used to identify which of the need domains were perceived as most important by the participants.
24 patients (79% men, mean age 65.6 ± 6.4 years) with FXTAS and 18 caregivers (11% men, mean age 63.6 ± 6.2 years) completed the Q-sort. Both patients and caregivers rated informational needs as most important, followed by emotional and, lastly, by instrumental needs. Participants lacked many important resources, in particular those addressing instrumental needs.
Providers should be educated and able to provide timely information and referrals to formal services, as well as to informal resources, including the National Fragile X Foundation online support network (www.fragilex.org).
family caregivers; FXTAS dementia; psychosocial stressors; fragile X
Examine the relationship between early age at first birth and mental health among women in their fifties.
Analysis of data on women from a British 1946 birth cohort study and the US Health and Retirement Study birth cohort of 1931-41.
In both samples a first birth before 21 years, compared to a later first birth, is associated with poorer mental health. The association between early first birth and poorer mental health persists in the British study even after controlling for early socioeconomic status, midlife socioeconomic status, and midlife health. In the US sample, the association becomes non-significant after controlling for educational attainment.
Early age at first birth is associated with poorer mental health among women in their fifties in both studies, though the pattern of associations differs.
birth timing; mental health; aging
Several Studies claim that psychophysical stress and depression contribute significantly to cardiovascular disease (CVD) development. The aim of our research is to discover and analyse a possible relationship between two psychosocial disorders (Depression and Perceived Mental Stress) and traditional cardiovascular risk markers.
We selected 106 subjects (M:58, F:48), mean age 79,5 ± 3,8 years old, from The Massa Lombarda Project, an epidemiological study including 7000 north Italian adult subjects. We carried out anamnesis, clinical and blood tests. Then we administered the Perceived Stress Questionnaire (PSQ range-score 0-1) and the Self Rating Depression Scale (SRDS range score 50-70 Z), as validated instruments for depression and stress evaluation, which focus on the individual's subjective perception and emotional response. Statistical descriptive and inferential analysis of data collected were performed.
The Multiple linear regression analysis showed a negative correlation between PSQ Index score and Uric Acid, LDL-C, BMI, Systolic and Diastolic Blood Pressure values, a positive and statistically significant correlation between PSQ Index score and Triglycerides(P<0.05). We found an inverse relationship between Zung SRDS score and LDL-C, Uric Acid, Glucose, Waist Circumference values, this correlation was significant only for Uric Acid (P<0.01); besides a positive and significant correlation between Zung SRDS and Triglycerides (P<0.05) was observed.
We suppose that psycho-emotional stress and depression disorder, often diagnosed in elderly people, may influence different metabolic parameters (triglycerides, Uric Acid, BMI) that are involved in the complex process of Metabolic Syndrome.
depression; mental stress; metabolic syndrome; uric acid; triglycerides