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Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research
- Authors:
- BERK Lotte, BOXTEL Martin van, OS Jim van
- Journal article citation:
- Aging and Mental Health, 21(11), 2017, pp.1113-1120.
- Publisher:
- Taylor and Francis
Objectives: An increased need exists to examine factors that protect against age-related cognitive decline. There is preliminary evidence that meditation can improve cognitive function. However, most studies are cross-sectional and examine a wide variety of meditation techniques. This review focuses on the standard eight-week mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Method: The authors searched the PsychINFO, CINAHL, Web of Science, COCHRANE, and PubMed databases to identify original studies investigating the effects of MBI on cognition in older adults. Results: Six reports were included in the review of which three were randomised controlled trials. Studies reported preliminary positive effects on memory, executive function and processing speed. However, most reports had a high risk of bias and sample sizes were small. The only study with low risk of bias, large sample size and active control group reported no significant findings. Conclusion: The authors conclude that eight-week MBI for older adults are feasible, but results on cognitive improvement are inconclusive due a limited number of studies, small sample sizes, and a high risk of bias. Rather than a narrow focus on cognitive training per se, future research may productively shift to investigate MBI as a tool to alleviate suffering in older adults, and to prevent cognitive problems in later life already in younger target populations. (Edited publisher abstract)
Cognitive impairment in elderly patients with schizophrenia: age related changes
- Author:
- HARVEY Philip D.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(S1), December 2001, pp.78-85.
- Publisher:
- Wiley
Cognitive impairment in schizophrenia is a major feature of the illness, however it has not been studied extensively in older patients. This article provides an overview of the research in this area looking specifically at: comparisons of good and poor outcome; age effects of on cognition in poor outcome patients; the course of cognitive and functional deficits in late life; and evidence regarding progressive decline in individual patients with schizophrenia.
Potential of mobile technologies and applications in the detection of mild cognitive impairment among older generation groups
- Authors:
- KLIMOVA Blanka, VALIS Martin, KUCA Kamil
- Journal article citation:
- Social Work in Health Care, 56(7), 2017, pp.588-599.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
At present, demographic changes result in the growing number of older people. This trend inevitably brings about serious social and economic issues, as well as occurrence of ageing diseases. The purpose of this study is to discuss the potential of using mobile technologies and applications in the detection of ageing disorders such as mild cognitive impairment. The methods used for this review study include a literature search in the world’s acknowledged databases. The findings of this study indicate that mobile applications can serve as appropriate diagnostic tools for ageing disorders such as mild cognitive impairment because they seem to provide better, faster, and less costly care for older people. (Publisher abstract)
Self-awareness of memory impairment in Parkinson’s disease: a review of the literature
- Authors:
- BLOOMFIELD Jacqueline, WOODS Damith Thushara, LUDINGTON Jason
- Journal article citation:
- Working with Older People, 20(1), 2016, pp.57-64.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to review and provide information on the small but growing body of literature that demonstrates that some people with Parkinson’s disease (PD) are unaware of the memory impairment, and this has clinical implications for how family members care for their loved one, and how clinical staff and others may interact with them on a day-to-day perspective. Design/methodology/approach: The approach takes the form of a general review. Findings: People with PD experience a variety of cognitive impairment including deficits in memory and higher level executive processes. Impairment in these areas can occur early in the disease course and result in adverse consequences including distractibility, trouble recalling information, and problems remembering to execute planned actions like adhering to medication regimes. The literature also suggests heterogeneity in both the memory performance of people with PD and in the definition of awareness used to investigate this phenomenon. Practical implications: Strategies for remembering may be of practical importance for people with PD, and/or caregivers should be introduced and educated to the nature of memory impairment in PD, as well as its likely course and natural progression in a non-threatening way before they are later instructed on “tips” for maximising daily functioning as more severe cognitive deficits begin to appear. Originality/value: This paper adds to the small body of literature that investigates patients’ awareness of memory impairment in PD and advocates for ongoing research within the area. (Publisher abstract)
Drug cessation in complex older adults: time for action
- Authors:
- van der CAMMEN Tischa J.M., et al
- Journal article citation:
- Age and Ageing, 43(1), 2014, pp.20-25.
- Publisher:
- Oxford University Press
Background: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available. Objectives: To identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use. Methods: Electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations. Results: The authors selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life. Conclusion: Little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status. (Publisher abstract)
Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature
- Authors:
- DEWEY Michael E., SAZ Pedro
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(8), August 2001, pp.751-761.
- Publisher:
- Wiley
Reports on research to estimate the influence on mortality of cognitive impairment and dementia. Data sources were Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. The search located 68 community studies. Concludes that levels of cognitive impairment commonly found in community studies gives rise to an increased risk of mortality, and this appears to be true even for quite mild levels of impairment. The analysis confirms the increased risk of mortality for dementia, but reveals a dearth of information on the causes of the excess mortality and on possible effect modification by age, dementia subtype or other variables.
Older persons' and their caregivers' perspectives and experiences of research participation with impaired decision-making capacity: a scoping review
- Authors:
- HOSIE Annmarie, et al
- Journal article citation:
- Gerontologist, 62(2), 2022, pp.e112-e122.
- Publisher:
- Oxford University Press
Background and Objectives: Human research ethics statements support the equitable inclusion of diverse groups. Yet older people are underrepresented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify the perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. Research Design and Methods: Scoping review of the literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. Results: From 4,171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods, and foci, with hypothetical scenarios, quantitative analyses, and examination of proxy consent predominating. Participants (N = 7,331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%), and older persons with dementia/cognitive impairment (6%). Synthesis identified 2 themes: willingness to participate and decision-making approaches. Discussion and Implications: Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons' and caregivers' perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media. (Edited publisher abstract)
Enabling older people with mental health needs to engage with community social care: a scoping review to inform a theory of change
- Authors:
- NEWBOULD Louise, TUCKER Susan, WILBERFORCE Mark
- Journal article citation:
- Health and Social Care in the Community, 30(4), 2022, pp.1286-1306.
- Publisher:
- Wiley
Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, the researchers undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals’ mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design. (Edited publisher abstract)
The effect of music therapy on cognitive functions in patients with dementia: a systematic review and meta-analysis
- Authors:
- FUSAR-POLI Laura, et al
- Journal article citation:
- Aging and Mental Health, 22(9), 2018, pp.1097-1106.
- Publisher:
- Taylor and Francis
Objectives: The aim of the present study was to meta-analyze the effect of music therapy (MT) on cognitive functions in patients with dementia. Method: A systematic literature search was performed in Medline, PsycINFO, Embase, CINAHL and RILM up to 8 September 2016. The authors included all randomized controlled trials that compared MT with standard care, or other non-musical types of intervention, evaluating cognitive outcomes in patients with dementia. Outcomes included global cognition, complex attention, executive function, learning and memory, language, and perceptual-motor skills. Results: From 1089 potentially relevant records, 110 studies were assessed for eligibility, and 7 met the inclusion criteria, of which 6 contained appropriate data for meta-analysis (330 participants, mean age range 78.8–86.3). Overall, random-effects meta-analyses suggested no significant effects of MT on all outcomes. Subgroup analysis found evidence of a beneficial effect of active MT on global cognition (SMD = 0.29, 95% CI 0.02 to 0.57, p = 0.04). Conclusion: Despite the limited evidence of the present review, it is important to continue supporting MT as a complementary treatment for older adults with dementia. RCTs with larger sample sizes are needed to better elucidate the impact of MT on cognitive functions. (Edited publisher abstract)
Hospital outcomes of older people with cognitive impairment: an integrative review
- Authors:
- FOGG Carole, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(9), 2018, pp.1177-1197.
- Publisher:
- Wiley
Objectives: To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. Methods: Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. Results: One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all‐cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. Conclusions: Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes. (Edited publisher abstract)