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Hoarding severity predicts functional disability in late-life hoarding disorder patients
- Authors:
- AYERS Catherine R., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(7), 2014, pp.741-746.
- Publisher:
- Wiley
Objective: Late-life hoarding is a serious psychiatric condition with significant implications in health and functioning. Geriatric hoarding patients show greater impairment in activities of daily living and have a greater number of medical conditions compared with same-aged nonhoarders. This study examined the relationship between geriatric hoarding severity and functional disability severity. Methods: Sixty-five subjects age 60 or older with hoarding disorder (HD) participated in the current study. Participants were assessed with measures of hoarding severity, psychiatric symptoms, and general disability. Hierarchical regression was used to test the unique association of hoarding symptoms with functional disability beyond the effects of demographic factors, anxiety, and depression. Results: When controlling for demographics (age and gender) and psychiatric symptoms (anxiety and depression), hoarding severity predicts functional disability severity. Analyses also show that clinician-administered measures of hoarding are stronger predictors of disability than patient self-report measures. Conclusions: When treating older adults with HD, clinicians must consider symptom impact on daily life. A multidisciplinary team must be utilized to address the wide-ranging consequences of hoarding symptoms. Future work should examine how psychiatric treatment of HD affects functional disability (Publisher abstract)
Multiple influences on participating in physical activity in older age: developing a social ecological approach
- Authors:
- BOULTON Elisabeth R., HORNE Maria, TODD Chris
- Journal article citation:
- Health Expectations, 21(1), 2018, pp.239-248. Online only
- Publisher:
- Wiley
Background: Evidence of the benefits of engaging in physical activity (PA) is strong, yet the number of older adults meeting the recommended 150 min/wk is low. Policy to increase uptake and adherence has focussed on the health benefits of PA, but may not be the most successful approach. Objective: This qualitative study sought to ask older adults what the components of a successful intervention to promote PA would be, by asking active older adults what motivated them to be active and asking inactive older adults what might encourage them to change. Design, setting and participants: Focus groups and semi-structured interviews were held with 60 community-dwelling older adults, aged 50-87 years. Framework analysis was used to analyse the data, and themes congruent with a social ecological model of behaviour change were developed. Findings: Five themes emerged that influenced PA engagement at multiple levels: individual; interpersonal; perceived environment; community or organizational; and policy. PA engagement was determined by attitude or health status for some participants, but for the majority, PA being enjoyable, sociable, affordable, accessible, flexible and seasonal were more important than the health benefits. Discussion and conclusions: A social ecological model is presented, highlighting the fact that both motivated and unmotivated older adults need to have a range of appropriately labelled, appealing and accessible activities to choose from when thinking about engaging in PA. Policymakers and practitioners need to ensure that their offers of activity sessions are easy to access and easy to remain involved in. (Publisher abstract)
Age of onset and progression of hoarding symptoms in older adults with hoarding disorder
- Authors:
- DOZIER Mary E., PORTER Ben, AYERS Catherine R.
- Journal article citation:
- Aging and Mental Health, 20(7), 2016, pp.736-742.
- Publisher:
- Taylor and Francis
Objectives:The authors investigated (1) age of onset of hoarding disorder (HD) symptoms and diagnosis, (2) late-onset HD, (3) progression of HD symptoms, and (4) association between demographics and hoarding progression. Method: Eighty-two older adults with HD provided retrospective ratings of their hoarding symptoms for each decade of life. Age of onset of symptoms (saving, difficulty discarding, and clutter) was operationalised as the first decade in which the participant reported at least minor symptom severity, and age of onset for possible HD diagnosis was operationalised as the first decade in which the participant reported all three symptoms. The authors used mixed effects modeling to examine the progression of HD symptoms. Results: The median age of onset for symptoms was between 10 and 20 years, and the median age of onset for possible HD diagnosis was between 20 and 30 years. Twenty-three percent of participants reported onset of possible HD diagnosis after the age of 40. All HD symptoms increased in severity over time. Men reported higher initial clutter and a slower increase in hoarding severity for all symptoms. Increased education was associated with slower increase in saving. Having at least one parent with hoarding tendencies was associated with higher initial hoarding symptoms. Conclusion: Generally, symptoms of HD begin relatively early and worsen across the lifespan. However, approximately one fourth of older adults with HD reported a possible onset after the age of 40. (Edited publisher abstract)
The hidden impact of home adaptations: using a wearable camera to explore lived experiences and taken‐for‐granted behaviours
- Authors:
- WILSON Gemma, et al
- Journal article citation:
- Health and Social Care in the Community, 27(6), 2019, pp.1469-1480.
- Publisher:
- Wiley
Most adults over 65 years old live in mainstream housing in the United Kingdom, yet these can often be unsuitable for an individual's needs. With increased understanding of the relationship between housing, and health and well‐being, the importance of modifying the home to suit individuals is recognised as being paramount. However, it is often difficult to monitor the ways in which home adaptations and equipment are used in the home. This study used innovative wearable technology to explore everyday, lived experiences of using home adaptations and equipment. Six older adults who had received a major home adaptation in the last 24 months took part in this study. Each participant used a wearable camera for one day and participated in a semi‐structured interview while watching the images back as a ‘slideshow’. Using this novel approach, three themes were generated from the data: acquiring adaptations and equipment, adapting routine and changing behaviour, and inconsistent and unintended uses. The findings of this study open up the complexity of the lived experience of using home adaptations and equipment. Experiences from access to long‐term outcomes are personal, and individuals modify and use the adaptations in various ways to suit their own needs. The wearable camera allowed additional insight into lived experience that would otherwise not have been captured without its use, as the photographs acted as a way of stimulating conversation and highlighting taken‐for‐granted behaviours not often consciously considered by the individuals. (Edited publisher abstract)
What do older people do when sitting and why? Implications for decreasing sedentary behavior
- Authors:
- PALMER Victoria J., et al
- Journal article citation:
- Gerontologist, 59(4), 2019, pp.686-697.
- Publisher:
- Oxford University Press
Background and Objectives: Sitting less can reduce older adults’ risk of ill health and disability. Effective sedentary behaviour interventions require greater understanding of what older adults do when sitting (and not sitting), and why. This study compares the types, context, and role of sitting activities in the daily lives of older men and women who sit more or less than average. Research Design and Methods: Semistructured interviews with 44 older men and women of different ages, socioeconomic status, and objectively measured sedentary behaviour were analyzed using social practice theory to explore the multifactorial, inter-relational influences on their sedentary behaviour. Thematic frameworks facilitated between-group comparisons. Results: Older adults described many different leisure time, household, transport, and occupational sitting and non-sitting activities. Leisure-time sitting in the home (e.g., watching TV) was most common, but many non-sitting activities, including “pottering” doing household chores, also took place at home. Other people and access to leisure facilities were associated with lower sedentary behaviour. The distinction between being busy/not busy was more important to most participants than sitting/not sitting, and informed their judgments about high-value “purposeful” (social, cognitively active, restorative) sitting and low-value “passive” sitting. Declining physical function contributed to temporal sitting patterns that did not vary much from day-to-day. Discussion and Implications: Sitting is associated with cognitive, social, and/or restorative benefits, embedded within older adults’ daily routines, and therefore difficult to change. Useful strategies include supporting older adults to engage with other people and local facilities outside the home, and break up periods of passive sitting at home. (Edited publisher abstract)
The relation between mood, activity, and interaction in long-term dementia care
- Authors:
- BEERENS Hanneke C., et al
- Journal article citation:
- Aging and Mental Health, 22(1), 2018, pp.26-32.
- Publisher:
- Taylor and Francis
Objective: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities. Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool. Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response. Conclusion: Fulfilling PwD's need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care. (Publisher abstract)
Dealing with daily challenges in dementia (deal-id study): an experience sampling study to assess caregiver functioning in the flow of daily life
- Authors:
- KNIPPENBERG R.J.M. van, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.949-958.
- Publisher:
- Wiley
Objective: Accurate assessment of caregiver functioning is of great importance to gain better insight into daily caregiver functioning and to prevent high levels of burden. The experience sampling methodology (ESM) is an innovative approach to assess subjective experiences and behaviour within daily life. In this study, the feasibility of the ESM in spousal caregivers of people with dementia was examined, and the usability of ESM data for clinical and scientific practice was demonstrated. Methods: Thirty-one caregivers collected ESM data for six consecutive days using an electronic ESM device that generated ten random alerts per day. After each alert, short reports of the caregiver's current mood state and context were collected. Feasibility was assessed by examining compliance and subjective experiences with the ESM. Usability was described using group and individual ESM data. Results: Participants on average completed 78.8% of the reports. One participant completed less than 33% of the reports and was excluded from data analyses. Participants considered the ESM device to be a user-friendly device in which they could accurately describe their feelings and experiences. The ESM was not experienced as too burdensome. Zooming in on the ESM data, personalised patterns of mood and contextual factors were revealed. Conclusions: The ESM is a feasible method to assess caregiver functioning. In addition to standard retrospective measurements, it offers new opportunities to gain more insight into the daily lives of people with dementia and their caregivers. It also provides new possibilities to tailor caregiver support interventions to the specific needs of the caregiver. (Edited publisher abstract)
Age at onset and clinical features of late life compulsive hoarding
- Authors:
- AYERS Catherine R., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(2), February 2010, pp.142-149.
- Publisher:
- Wiley
Compulsive hoarding is a debilitating disorder, yet little is known about its onset or clinical features. Hoarding symptoms often come to clinical attention with older patients. However, no prior study has examined whether elderly compulsive hoarders have early or late onset of hoarding symptoms, whether their hoarding symptoms are idiopathic or secondary to other conditions, or whether their symptoms are similar to compulsive hoarding symptoms seen in younger and middle-aged populations. This study determines the onset and clinical features of late life compulsive hoarding, including psychiatric and medical relationships. A group of 18 participants over 60 with clinically significant compulsive hoarding were assessed using structured interviews, including the Mini International Neuropsychiatric Interview, Structured Clinical Interview for DSM-IV, Yale-Brown Obsessive Compulsive Scale, and UCLA Hoarding Severity Scale. Self-report Measures Included the Beck Anxiety Inventory, Beck Depression Inventory, Sheehan Disability Scale, and Savings Inventory-Revised. Psychosocial and medical histories were also obtained. Participants were asked to rate their hoarding symptoms and describe major life events that occurred during each decade of their lives. Results show that onset of compulsive hoarding symptoms was initially reported as being in mid-life but actually found to be in childhood or adolescence - no subjects reported late onset compulsive hoarding. Compulsive hoarding severity seemed to increase with each decade of life. Comorbid mood and anxiety disorders were common, but only 16% of patients met criteria for OCD. The vast majority of patients had never received treatment for hoarding behaviour. Older adults with compulsive hoarding were usually socially impaired and lived alone. In conclusion compulsive hoarding appears to be a progressive and chronic condition that begins early in life. Left untreated, its severity increases with age. Compulsive hoarding should be considered a distinct clinical syndrome, separate from OCD.
The effect of depression on social engagement in newly admitted Dutch nursing home residents
- Authors:
- ACHTERBERG Wilco, et al
- Journal article citation:
- Gerontologist, 43(2), April 2003, pp.213-218.
- Publisher:
- Oxford University Press
The purpose of this article was to study the effect of depression (high levels of depressive symptoms) on social engagement. In 65 nursing homes in the Netherlands, 562 newly admitted residents were assessed at admission. Social engagement was measured with the MDS Index of Social Engagement. A multivariate logistic regression model was used to study the effect of depression, measured according to the MDS-depression rating scale and controlled for confounders, on social engagement. Fifty-one percent of the newly admitted residents had a low level of social engagement; twenty seven percent were depressed (high levels of depressive symptoms). Residents with a depression were significantly more often found to have low social engagement (OR 3.3), and confounders did not influence the strength of this relationship. Low social engagement on admission is predicted by depression and low cognitive performance, and to a lesser extent by impairments in vision and ADL. Low social engagement is very common in newly admitted nursing home residents, and depression is an important independent risk factor.
Theoretical models of cognitive aging and implications for translational research in medicine
- Authors:
- BROWN Scott C., PARK Denise C.
- Journal article citation:
- Gerontologist, 43(Special Issue), March 2003, pp.57-67.
- Publisher:
- Oxford University Press
This article provides an overview of theoretical models of cognitive aging and present empirical research that uses these models to explain older patients' medical behaviours and to develop interventions for improving the delivery of health information and services to older adults. Theoretical accounts of age and cognition are summarized and are related to key research findings, including age differences in comprehension of medical information, adherence, and use of medical technologies. The implications of cognitive aging theories for designing optimal medical environments and enhancing adherence are discussed. Age declines in basic cognitive abilities such as working memory capacity limit older adults' ability to comprehend and recall several types of novel medical information. In contrast, automatic processes and environmental cues can benefit older adults, as shown by age increases in compliance for practiced or mentally imaged health behaviors, but can also be dangerous, as shown by older adults' greater belief in false but familiar health statements. Last, cognitive aging is shown to be a useful model for investigating cognitive disorders.