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Journal article

The impact of executive function on response to cognitive behavioral therapy in late-life depression

Authors:
GOODKIND Madeleine S., et al
Journal article citation:
International Journal of Geriatric Psychiatry, 31(4), 2016, pp.334-339.
Publisher:
Wiley-Blackwell

Objective: Late-life depression (LLD) is a common and debilitating condition among older adults. Cognitive behavioural therapy (CBT) has strong empirical support for the treatment of depression in all ages, including in LLD. In teaching patients to identify, monitor, and challenge negative patterns in their thinking, CBT for LLD relies heavily on cognitive processes and, in particular, executive functioning, such as planning, sequencing, organising, and selectively inhibiting information. It may be that the effectiveness of CBT lies in its ability to train these cognitive areas. Methods: Participants with LLD completed a comprehensive neuropsychological battery before enrolling in CBT. The current study examined the relationship between neuropsychological function prior to treatment and response to CBT. Results: When using three baseline measures of executive functioning that quantify set shifting, cognitive flexibility, and response inhibition to predict treatment response, only baseline Wisconsin Card Sort Task performance was associated with a significant drop in depression symptoms after CBT. Specifically, worse performance on the Wisconsin Card Sort Task was associated with better treatment response. Conclusions: These results suggest that CBT, which teaches cognitive techniques for improving psychiatric symptoms, may be especially beneficial in LLD if relative weaknesses in specific areas of executive functioning are present. (Publisher abstract)

Journal article

Does participation in home-delivered meals programs improve outcomes for older adults? Results of a systematic review

Authors:
CAMPBELL Anthony D., et al
Journal article citation:
Journal of Nutrition in Gerontology and Geriatrics, 34(2), 2015, pp.124-167.
Publisher:
Taylor and Francis

Participation in home-delivered meals programs may contribute to the health and independence of older adults living in the community, especially those who are food insecure or those who are making transitions from acute, subacute, and chronic care settings to the home. A comprehensive and systematic review of all studies related to home-delivered meals was carried out in order to shed light on the state of the science. A complete review of articles appearing in PubMed using the keyword “Meal” was conducted; and titles, abstracts, and full-texts were screened for relevance. Included in this review are 80 articles. Most studies are descriptive and do not report on outcomes. Frequently reported outcomes included nutritional status based on self-reported dietary intake. Additionally, most studies included in this review are cross-sectional, have a small sample size, and/or are limited to a particular setting or participant population. More rigorous research is needed to (1) gain insight into why so few eligible older adults access home-delivered meals programs, (2) support expansion of home-delivered meals to all eligible older adults, (3) better identify what home-delivered meals models alone and in combination with other services works best and for whom, and (4) better target home-delivered meals programs where and when resources are scarce. (Edited publisher abstract)

Journal article

Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy

Authors:
CHAPLIN Robert, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 30(2), 2015, pp.178-184.
Publisher:
Wiley-Blackwell

Objective: This study aimed to evaluate the access, experiences and outcomes of older adults receiving psychological therapies in comparison with adults of working age Methods: Primary and secondary care providers of psychological therapy services participated in the National Audit of Psychological Therapies. The main standards of access, experience and outcomes were measured by retrospective case records audits of people who completed therapy and a service user questionnaire. Outcomes were measured pre-treatment and post-treatment on the PHQ-9 and GAD-7. Results: A total of 220 services across 97 organisations took part, 137 (62%) in primary care. Service user questionnaires were received from 14,425 (20%) respondents. A total of 122,740 records were audited, of whom 7794 (6.4%) were older adults. They were under represented as 13% of the sample would have been expected to be over 65 years according to age adjusted psychiatric morbidity figures. People over 75 years had the third expected referral rate. Significantly, more older adults than working age adults completed therapy (59.6% vs 48.6%) and were assessed as having 'recovered' post-treatment (58.5% vs 45.5%). Older adults were more satisfied with waiting times and numbers of sessions, but there were no differences in self-reported experience of therapy. Conclusion: Although older adults are less likely to gain access to psychological therapies, they appear to have better outcomes than working age adults. Further work is needed to improve access for older people. (Publisher abstract)

Journal article

Post-traumatic stress disorder in older adults: a systematic review of the psychotherapy treatment literature

Authors:
DINNEN Stephanie, SIMIOLA Vanessa, COOK Joan M.
Journal article citation:
Aging and Mental Health, 19(2), 2014, pp.144-150.
Publisher:
Taylor and Francis

Objectives: This systematic review examined reports of psychological treatment for trauma-related problems, primarily post-traumatic stress disorder (PTSD), in studies with samples of at least 50% adults aged 55 and older using standardised measures. Methods: The review of the literature was conducted on psychotherapy for PTSD with older adults using PubMed, Medline, PsychInfo, CINAHL, PILOTS, and Google Scholar.Results: A total of 42 studies were retrieved for full review; 22 were excluded because they did not provide at least one outcome measure or results were not reported by age in the case of mixed-age samples. Of the 20 studies that met review criteria, there were: 13 case studies or series, three uncontrolled pilot studies, two randomized clinical trials, one non-randomized concurrent control study and one post hoc effectiveness study. Significant methodological limitations in the current older adult PTSD treatment outcome literature were found reducing its internal validity and generalisability, including non-randomised research designs, lack of comparison conditions and small sample sizes.Conclusion: Select evidence-based interventions validated in younger and middle-aged populations appear acceptable and efficacious with older adults. There are few treatment studies on subsets of the older adult population including cultural and ethnic minorities, women, the oldest old (over 85), and those who are cognitively impaired. Implications for clinical practice and future research directions are discussed. (Edited publisher abstract)

Journal article

Motivators and barriers to exercise adherence

Author:
ROLLER Maureen
Journal article citation:
Nursing and Residential Care, 14(9), September 2012, pp.482-485.
Publisher:
MA Healthcare Ltd.
Place of publication:
London

Adults over the age of 65 are at increased risk if disabling injuries, diminished independence and vitality owing to a decline in strength, endurance and balance. Assisting this population in increased adherence to exercise programmes may promote a healthier life and improved function and quality of life. This article details findings from research which examined motivators and barriers to a 12-week exercise programme. The pre-study motivator scores were lower than the post-study scores, indicating that motivation factors increased after the programme. The more that people participated in the exercises, the lower the barriers became. The author concluded that access to exercise that is convenient may encourage older people to adhere to similar programmes and overcome any remaining barriers.

Journal article

Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial

Authors:
KING Anna I. I., et al
Journal article citation:
Health and Social Care in the Community, 20(4), July 2012, pp.365-374.
Publisher:
Wiley-Blackwell

Restorative care, which focuses on helping clients do things for themselves, is one approach to improving home care services. This study investigated the impact of a restorative home care service for 186 community-dwelling older people who received assistance from a home care agency in New Zealand. A randomised controlled trial was undertaken, where older people were interviewed face-to-face at baseline, four and seven months. Ninety three participants received restorative home care and 93 people received usual home care. Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life at 7 months for older people. There were no changes in other measurements for older people in either group over time. There was a significant difference in the number of older people in the intervention group identified for reduced hours (29%) compared with the control group (0%). The authors concluded that a restorative home care service may be of benefit to older people, and improve service efficacy.

Journal article

Chronic endurance exercise training prevents aging-related cognitive decline in healthy older adults: a randomized controlled trial

Authors:
MUSCARI Antonio, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.1055-1064.
Publisher:
Wiley-Blackwell

This study investigated the effects of endurance exercise training (EET) on the cognitive status of healthy community-dwelling older people in Pianoro, northern Italy. One hundred and twenty healthy subjects, aged 65 to 74 years, were randomised into treatment and control groups. The treatment consisted of 12 months of supervised EET in a community gym. All participants were assessed both at baseline and after 12 months. Cognitive status was assessed by the Mini Mental State Examination (MMSE). Anthropometric indexes, routine laboratory measurements and C-reactive protein (CRP) were also assessed. The control group showed a significant decrease in MMSE score, which differed significantly from the treatment group scores. The odds ratio for the treated older adults to have a stable cognitive status after 1 year, as compared to the control group, was 2.74 after adjustment for age, gender, educational level and several other possible confounders. Blood pressure, body mass index, waist circumference and serum cholesterol did not differ significantly between the two groups, while CRP decreased only in the treatment group. The authors concluded that a 12-month EET intervention may reduce the onset of age-related cognitive decline.

Journal article

Valuing the ICECAP capability index for older people

Authors:
COAST Joanna, et al
Journal article citation:
Social Science and Medicine, 67(5), September 2008, pp.874-882.
Publisher:
Elsevier

This paper reports the first application of the capabilities approach to the development and valuation of an instrument for use in the economic evaluation of health and social care interventions. The ICECAP index of capability for older people focuses on quality of life rather than health or other influences on quality of life, and is intended to be used in decision making across health and social care in the UK. The measure draws on previous qualitative work in which five conceptual attributes were developed: attachment, security, role, enjoyment and control. This paper details the innovative use within health economics of further iterative qualitative work in the UK among 19 informants to refine lay terminology for each of the attributes and levels of attributes used in the eventual index. For the first time within quality of life measurement for economic evaluation, a best-worst scaling exercise has been used to estimate general population values (albeit for the population of those aged 65+ years) for the levels of attributes, with values anchored at one for full capability and zero for no capability. Death was assumed to be a state in which there is no capability. The values obtained indicate that attachment is the attribute with greatest impact but all attributes contribute to the total estimation of capability. Values that were estimated are feasible for use in practical applications of the index to measure the impact of health and social care interventions.

Journal article

Costs and health outcomes of intermediate care: results from five UK case study sites

Authors:
KAAMBWA Billingsley, et al
Journal article citation:
Health and Social Care in the Community, 16(6), December 2008, pp.573-581.
Publisher:
Wiley-Blackwell

The objectives of this study were to explore the costs and outcomes associated with different types of intermediate care (IC) services, and also to examine the characteristics of patients receiving such services. Five UK case studies of 'whole systems' of IC were used, with data collected on a sample of consecutive IC episodes between January 2003 and January 2004. Statistical differences in costs and outcomes associated with different IC services and patient groups were explored. Factors associated with variation in IC episode outcomes were explored using an econometric framework. Data were available for 2253 episodes of IC. In terms of Department of Health criteria, a large proportion of patients (up to 47% of those for whom data were available) in this study were inappropriately admitted to IC services. As regards service function, compared to supported discharge, admission avoidance services were associated with both lower costs and greater health and functional gains. These gains appear to be driven, in part, by illness severity (more dependent patients tended to gain most benefit). In addition, these gains appear to be larger where the admission was appropriate. This study suggests a need for the development and application of robust and reliable clinical criteria for admission to IC, and close co-operation between hospital and community service providers over selection of patients and targeting of IC and acute care services to meet defined clinical need.

Journal article

Evidence-based interventions with older adults: concluding thoughts

Authors:
KROPF Nancy P., CUMMINGS Sherry M.
Journal article citation:
Journal of Gerontological Social Work, 50(S1), 2008, pp.345-355.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

This paper summarises the findings of the systematic reviews of psychosocial interventions reported in this issue of the journal, identifying effective intervention approaches for physical health problems, mental health problems and particular social roles (end of life care, family carers, grandparent carers, people with developmental disabilities and their carers). Problems with psychosocial intervention research are noted, including the small size and methodological weakness of many studies, a failure to report the details of an intervention and its implementation, and lack of consensus over which outcomes should be measured. Future research studies need to be larger, more robustly designed and with long term follow-up. They also need to cover more diverse populations (e.g. ethnic minority groups) and more diverse topics in addition to the problems of functional decline. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street,  Binghamton, NY 13904-1580).

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