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Course of cognitive impairment following attempted suicide in older adults
- Authors:
- GUJRAL Swathi, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(6), 2016, pp.592-600.
- Publisher:
- Wiley
Objective: Cognitive impairment has been associated with late-life suicidal behaviour. Without longitudinal data it is unclear whether these are transient features of a depressive state or stable impairments. We examined longitudinally the course of cognitive impairment in older adults with depression and a history of suicide attempt. Methods: The authors investigated the persistence of cognitive impairment over time in 198 depressed older adults (age >60); 91 suicide attempters, 39 depressed individuals with suicidal ideation (ideators), and 68 non-suicidal depressed adults assessed over a 2-year period at four time points. The authors used linear mixed effects modelling to examine group differences in trajectories of cognitive decline over 2 years, using the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (DRS), and Executive Interview (EXIT). Results: Over the 2-year period, suicide attempters performed significantly worse than both suicide ideators and non-suicidal depressed older adults on the MMSE (mean difference: from ideators: −0.88, p = 0.02; from non-suicidal depressed: −1.52, p < 0.01), while on the EXIT and DRS, suicide attempters performed significantly worse than non-suicidal depressed older adults (mean difference: in EXIT: −1.75, p = 0.01; in DRS: 3.04, p < 0.01; in MMSE: 1.15, p < 0.01). Cognitive impairment in suicide attempters partly resolved, as indicated by a group × time interaction on the DRS (p = 0.039), but not the EXIT (p = 0.58) or the MMSE (p = 0.08). Conclusions: Cognitive impairment in late-life suicidal behavior appears to involve both a stable and a state-related component. (Edited publisher abstract)
Daytime somnolence as an early sign of cognitive decline in a community-based study of older people
- Authors:
- TSAPANOU Angeliki, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(3), 2016, p.247–255.
- Publisher:
- Wiley
Objective: This study aimed to examine the association between self-reported sleep problems and cognitive decline in community-dwelling older people. The authors hypothesised that daytime somnolence predicts subsequent cognitive decline. Methods: This is a longitudinal study in a 3.2-year follow-up, with 18-month intervals. The setting is the Washington Heights-Inwood Community Aging Project. There were 1098 participants, who were over 65 years old and recruited from the community. Sleep problems were estimated using five sleep categories derived from the RAND Medical Outcome Study Sleep Scale: sleep disturbance, snoring, awaken short of breath/with a headache, sleep adequacy, and daytime somnolence. Four distinct cognitive composite scores were calculated: memory, language, speed of processing, and executive functioning. The authors used generalised estimating equations analyses with cognitive scores as the outcome, and time, sleep categories and their interactions as the main predictors. Models were initially unadjusted and then adjusted for age, gender, education, ethnicity, depression, and apolipoprotein E-ε4 genotype. Results: Increased daytime somnolence (including feeling drowsy/sleepy, having trouble staying awake, and taking naps during the day) was linked to slower speed of processing both cross-sectionally (B = −0.143, p = 0.047) and longitudinally (B = −0.003, p = 0.027). After excluding the demented participants at baseline, the results remained significant (B = −0.003, p = 0.021). Conclusions: Findings suggest that daytime somnolence may be an early sign of cognitive decline in the older population (Edited publisher abstract)
Processes of identity development and behaviour change in later life: exploring self-talk during physical activity uptake
- Authors:
- OLIVER E.J., HUDSON J., THOMAS L.
- Journal article citation:
- Ageing and Society, 36(7), 2016, pp.1388-1406.
- Publisher:
- Cambridge University Press
The benefits of exercise are well documented, nevertheless, physical activity decreases progressively with age, a trend exacerbated in those who have fallen. An important predictor of exercise behaviour is the extent to which motivation for exercise has been internalised into one's identity, however, we know little about changing health behaviours in older people, with calls for longitudinal studies to aid understanding. Grounded in self-determination theory, the present study explored the role of self-talk in the process of identity change during the initial ten weeks of an exercise referral falls prevention programme. Six participants identified at risk of falling completed weekly measures of their physical activity-related cognition and identity; in-depth interviews were completed at course commencement and ten weeks later. During this initial phase of the behaviour change programme, participants developed stronger physical activity identities, with themes reflecting a transition from a physically impaired and negative self to a more future-orientated, capable and integrated self-identity. Concurrently, autonomy-supportive and competence-reinforcing self-talk significantly increased, with non-significant increases and decreases in controlling and amotivational self-talk, respectively. The data suggest that self-talk may be usefully conceptualised as a process through which social messages are interpreted and internalised to integrate a new behaviour into one's existing self-concept. (Publisher abstract)
‘Thinking you're old and frail’: a qualitative study of frailty in older adults
- Authors:
- WARMOTH Krystal, et al
- Journal article citation:
- Ageing and Society, 36(7), 2016, pp.1483-1500.
- Publisher:
- Cambridge University Press
Many older adults experience what is clinically recognised as frailty but little is known about the perceptions of, and attitudes regarding, being frail. This qualitative study explored adults' perceptions of frailty and their beliefs concerning its progression and consequences. Twenty-nine participants aged 66–98 with varying degrees of frailty, residing either in their homes or institutional settings, participated in semi-structured interviews. Verbatim transcripts were analysed using a Grounded Theory approach. Self-identifying as ‘frail’ was perceived by participants to be strongly related to their own levels of health and engagement in social and physical activity. Being labelled by others as ‘old and frail’ contributed to the development of a frailty identity by encouraging attitudinal and behavioural confirmation of it, including a loss of interest in participating in social and physical activities, poor physical health and increased stigmatisation. Using both individual and social context, different strategies were used to resist self-identification. The study provides insights into older adults' perceptions and attitudes regarding frailty, including the development of a frailty identity and its relationship with activity levels and health. The implications of these findings for future research and practice are discussed. (Publisher abstract)
How dementia differs from normal ageing
- Author:
- GINESI Laura
- Journal article citation:
- Nursing Times, 112(24), 2016, pp.12-15.
- Publisher:
- Nursing Times
Dementia is the collective name for as set of mood changes, confusion and increasing difficulty with everyday tasks.. This four part series provides an overview of dementia and it's treatment, from its causes a pathophysiology to diagnosis and the nurse's role in its management. This, first article reviews the main forms of dementia and how research is shedding new light on the differences between dementia and normal ageing. (Publisher abstract)
Public health and prevention: acting to make longer lives healthier
- Authors:
- ALESSI Charles, RASHBROOK Elaine
- Journal article citation:
- Working with Older People, 20(2), 2016, pp.110-120.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to outline the action that can be taken to ensure longer and healthier lives. Design/methodology/approach: The paper draws on the relevant recommendations set out by the National Institute for Clinical Excellence to delay or prevent the onset of ill health in later years, followed by a number of recommended approaches to promote healthy behaviours in older adults as well as those in midlife. Findings: There is a clear need for public health and the prevention agenda to help ensure that later years are not just longer, but healthier. Practical implications: The paper identifies how, when and where the health risks associated with the majority of years lost to ill health can be addressed, and advocates the importance of taking an asset-based approach to promoting good health in older people. Originality/value: The paper is a comprehensive review of the key public health actions that can be taken to ensure longer and healthier lives. (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)
Health behaviors and demographic factors of chronic health conditions among elderly veteran men
- Authors:
- TRAN Thanh V., CANFIELD Julie, WANG Kaipeng
- Journal article citation:
- Social Work in Health Care, 55(4), 2016, pp.328-345.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
As male veterans age, there are unique opportunities for health-related prevention efforts to be introduced throughout the life cycle to ameliorate the effects of chronic health conditions such as cardiovascular disease, asthma, arthritis, and diabetes. This study analysed data from the Behavioral Risk Factor Surveillance System (2012) with a sample of 27,187 male veterans aged 65–84 years and 4,079 male veterans over 85 years of age. The study examined associations between behaviours, demographics, and five chronic health conditions with variables that included marital status, health insurance coverage, alcohol consumption, smoking history, and income levels. These associations varied between the two age groups, suggesting the need for intervention with veterans across their lifespans. Public health social workers could help veterans modify their health behaviours to prevent the occurrence or worsening of chronic health conditions over time and across the ageing process. (Edited publisher abstract)
The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour
- Authors:
- ZWIJSEN S.A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(6), 2016, pp.567-574.
- Publisher:
- Wiley
Objective The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care. Methods: A stepped wedge design was used. Challenging behaviour and quality of life were measured using the Cohen Mansfield Agitation Inventory (CMAI) and the QUALIDEM. Quality-adjusted life years (QALYs) were calculated using the EuroQol-5D. Psychoactive medication use (range 0–5 per measurement) and sick leave were registered. Costs included medication, time spent on challenging behaviour and education. Costs and effects were analysed using linear multilevel regression. Incremental cost-effectiveness ratios were calculated. Statistical uncertainty was estimated using bootstrapping. Results: Seventeen dementia special care units participated. GRIP led to improvement on the QUALIDEM subscale social relations (1.6; 95% CI 0.18 to 3.4) and on the use of psychoactive medication (−0.73; 95% CI −1.1 to −0.46) and to a decrease in QALYs (−0.02; 95% CI −0.06 to −0.003). No significant effects on CMAI, sick leave and other QUALIDEM subscales were found. The intervention was not cost-effective in comparison with usual care with regard to CMAI score, QALYs and sick leave. The willingness to pay should be 320€/point improvement on the QUALIDEM subscale social relations and 370€/psychoactive medication less to reach a 0.95 probability of cost-effectiveness. Conclusion: It depends on how much society is willing to pay whether GRIP can be considered cost-effective. Because the appropriateness of the current methods for analysing cost-effectiveness in this specific population is uncertain, the positive effects on behaviour, medication and job satisfactions should also be taken in account in the decision making (Publisher abstract)
Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial
- Authors:
- D' AMICO Francesco, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(6), 2016, p.656–665.
- Publisher:
- Wiley
Objective: Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. The authors aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia. Methods: Cost-effectiveness analysis within a two-arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored, for 20–30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses. Results: Mean intervention cost was £284 per dyad. For the subsample of 52 dyads, the intervention group had significantly higher mean cost from a societal perspective (mean difference £2728.60, p = 0.05), but costs were not significantly different from a health and social care perspective. The exercise intervention was more cost-effective than treatment as usual from both societal and health and social care perspectives for the measure of behavioural and psychological symptoms (Neuropsychiatric Inventory). It does not appear cost-effective in terms of cost per quality-adjusted life year gain. Conclusions: The exercise intervention has the potential to be seen as cost-effective when considering behavioural and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains. (Edited publisher abstract)