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The double burden of age and disease on cognition and quality of life in bipolar disorder
- Authors:
- WEISENBACK Sara L., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(9), 2014, pp.952-961.
- Publisher:
- Wiley
Objective: Bipolar disorder (BPD) and normal aging are known to impact cognitive skills and health-related quality of life (HRQOL). This study investigated how ageing and disease interact in predicting cognitive and psychosocial outcomes. Methods: Eight cognitive and ten subjective HRQOL domain ratings were measured. Subjects included 80 young (18–29 years) and late middle-aged (50–65 years) BPD patients in the euthymic phase and 70 age-equivalent healthy comparison participants. Results: An age X disease interaction was detected in three domains of cognitive functioning that reflect emotion processing, processing speed, and executive functioning skills, with BPD patients in the older group performing most poorly. There was a double burden of ageing and disease on reported ability to perform physical tasks. However, regardless of age, disease status was associated with lower ratings of HRQOL in the psychosocial/affective sphere and the majority of cognitive domains. Post hoc analyses revealed that number of years ill was positively associated with select HRQOL ratings in older, but not younger BPD adults. Conclusions: These findings may stimulate future longitudinal study of cognition and quality of life in BPD patients across the life span, focusing on additive and interactive effects of aging and disease burden, which could culminate in developing more effective treatment and rehabilitation strategies for this traditionally challenging to treat population. (Publisher abstract)
Measuring psychological well-being in cognitively impaired persons
- Authors:
- BURGENER Sandy C., TWIGG Prudence, POPOVICH Ann
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 4(4), November 2005, pp.463-485.
- Publisher:
- Sage
An objective measure of psychological well-being (a previously understudied outcome for persons with dementia) was developed and tested as part of a longitudinal study (n= 96 participant pairs; n= 73 pairs remaining at 18 months). The reliability and validity of the Psychological Well-being in Cognitively Impaired Persons (PWB-CIP) scale was examined as a measure of one dimension of quality of life (QoL) as persons progress in the disease. The original 16-item PWB-CIP Likert-type scale required only five to 10 minutes to complete and was reduced to 11 items following factor analysis. Cronbach's alpha for the total scale was .79 at baseline and .82 at 18 months. Two subscales were identified: positive affect/interaction and negative affect/interaction. One item ('involved in a single activity for > five minutes') loaded on a different subscale at baseline (early disease stages) compared to 18 months (reflecting disease progression). The internal consistency of the two subscales remained acceptable across the two measurement intervals. Controlling for mental status, the PWB-CIP's construct validity was supported through significant relationships with depression, personal characteristics (personality), and the behavioral competence QoL dimensions at baseline and at 18 months. Because both rural (55%) and urban populations were sampled and the PWB-CIP was used across care settings, the findings support the PWB-CIP as a psychometrically sound measure of psychological well-being for diverse populations of persons with dementia.
Moments of homecoming among people with advanced dementia disease in a residential care facility
- Authors:
- NORBERG Astrid, TERNESTEDT Britt-Marie, LUNDMAN Berit
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 16(5), 2017, pp.629-641.
- Publisher:
- Sage
This study concerns moments of homecoming among people with advanced dementia disease living in a residential care facility. The authors' main finding from participant observations with nine residents was that the residents showed moments of homecoming, i.e. they alternated between verbal and/or nonverbal expressions of feeling at home and of not feeling at home. If care providers understand that they can help people with advanced dementia disease experience moments of homecoming, they can focus on aspects of care that can promote these experiences (Edited publisher abstract)
'I hate having nobody here. I'd like to know where they all are': can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?
- Authors:
- CAHILL Suzanne, DIAZ-PONCE Ana
- Journal article citation:
- Aging and Mental Health, 15(5), July 2011, pp.562-572.
- Publisher:
- Taylor and Francis
This paper examined whether similarities or differences existed in perceptions of quality of life (QOL) amongst nursing home (NH) residents with different levels of cognitive impairment (CI). Face-to-face interviews were held with 61 older people with a CI (13 mild, 20 moderate and 28 severe) living in Dublin based NHs. Four key themes of QOL were identified: social contact; attachment; pleasurable activities; and affect. Whilst some similarities existed between the three groups, findings revealed emerging differences, particularly between those with a mild and severe CI. Those with a severe CI reflected an absence of social contact, a quest for human contact and a lack of awareness of enjoyable activities. The majority also reported feelings of loneliness and isolation. Findings support the evidence that people with a CI and those advanced dementia can often still communicate their views and preferences about what is important to them. Whilst depression and anxiety are common in advanced dementia, the social inclusion of these people in day-to-day NH life needs a more careful consideration.
Measuring the values and preferences for everyday care of persons with cognitive impairment and their family caregivers
- Author:
- WHITLATCH Carol J.
- Journal article citation:
- Gerontologist, 45(3), June 2005, pp.370-380.
- Publisher:
- Oxford University Press
This study describes the development and psychometric properties of a 24-item scale to be used in both research and practice settings that assesses the everyday care values and preferences of individuals with cognitive impairment and the perceptions of family caregivers about their relative's values and preferences for care. The Values and Preferences Scale was developed on the basis of previous measures used with cognitively intact samples with additional items generated by the authors in consultation with an advisory committee of practitioners, researchers, family caregivers, and persons with cognitive impairment. A total of one hundred and eleven individuals with mild to moderate cognitive impairment and their family caregivers were interviewed for the study taken from population samples in San Francisco in the USA. Results of a factor analysis determined that the Values and Preferences Scale can be divided into two domains or subscales for persons with cognitive impairment and their family caregivers (i.e., Environment–Social Network and Personal Autonomy). These domains were found to have good internal consistency for both the individuals and their caregivers. Evidence of their psychometric properties compared with measures of depression, quality of life, and involvement in decision making was also found. These findings suggest that persons with cognitive impairment are able to express values and preferences about care they currently receive or will need in the future. Further application and testing of the Values and Preferences Scale should prove useful to practitioners who assist those with cognitive impairment and their caregivers with daily care decisions and the development of care plans.
Social participation perspectives of people with cognitive problems and their care-givers: a descriptive qualitative study
- Authors:
- DONKERS Hanneke, et al
- Journal article citation:
- Ageing and Society, 39(7), 2019, pp.1485-1511.
- Publisher:
- Cambridge University Press
The aim of this study is to explore how community-dwelling older people with cognitive problems and their care-givers (dyads) perceive their own social participation, how care-givers evaluate the social participation of the people they care for and what factors they perceive as influential. This qualitative study performed 13 semi-structured, in-depth interviews with dyads who participated in the Social Fitness Programme. This study used content analysis to analyse the interviews thematically. Social participation perceptions include changes over time and a discrepancy in perspectives. All the people with cognitive problems and most care-givers perceived a decreased social participation. Most people with cognitive problems answered that they were satisfied, in contrast to most care-givers who were dissatisfied with the decreased social participation of the people they cared for. Analysing the influencing factors resulted in five themes: behavioural, physical, social environmental, physical environmental and activity-related. People with cognitive problems and their care-givers displayed a discrepancy in social participation perspectives. This becomes a major dilemma, especially for younger care-givers. A key element is a sometimes deliberate choice of people with cognitive problems to refrain from social participation to protect themselves from the consequences of cognitive problems and from encounters with others. This highlights the dynamics of social participation as an interaction between personal factors and the social and physical environment in which social participation occurs. (Edited publisher abstract)
Psychoeducation group on improving quality of life of mild cognitive impaired elderly
- Authors:
- YOUNG Daniel Kim-Wan, NG Petrus Yat-nam, CHENG Daphne
- Journal article citation:
- Research on Social Work Practice, 29(3), 2019, pp.303-310.
- Publisher:
- Sage
Purpose: This research study aims to evaluate the effectiveness of a psychoeducation group, which is founded on an Eastern approach to health care, in improving the quality of life of Chinese people with mild cognitive impairment (PwMCI). Method: In a randomized controlled trial (RCT), 40 Chinese PwMCI were randomly assigned to either a 10-session psychoeducation group or the control group. Results: A paired sample t test indicated that the treatment group (n = 18) showed significant improvement in their World Health Organization Quality of Life Measure (WHOQOL) score, while the control group (n = 22) did not. Moreover, an independent t test showed that the treatment group was more effective than the control group to improve their WHOQOL score. A reduction in the depressive symptoms was related to the improvement in WHOQOL score. Conclusions: This RCT provides evidence to support the feasibility and effectiveness of psychoeducation groups for improving the overall quality of life of PwMCI. (Edited publisher abstract)
Emotional distress mediates the relationship between cognitive failures, dysfunctional coping, and life satisfaction in older people living in sheltered housing: a structural equation modelling approach
- Authors:
- LEUNG Phuong, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(1), 2019, pp.179-185.
- Publisher:
- Wiley
Objectives: Little is known about the relationship between cognitive failures, emotional distress, and life satisfaction in late life. Experiencing cognitive failures is a known risk for declining life satisfaction in older people, although the mechanisms that may explain cognitive failures remain unclear. This study investigated the associations between psychosocial factors, cognitive failures, and coping strategies and their influence on life satisfaction in older people living in sheltered housing. Methods: A total of 204 older people living in sheltered housing in London were recruited (mean age = 75.08 years). We used structural equation modelling path analysis to test several hypotheses based on theories of emotional distress (anxiety and depression) and cognitive failures and their influence on life satisfaction. Results: Self‐reported depressive symptoms (29.5%), anxiety symptoms (33%), and cognitive failures (41%) were common. The final model had a good fit (X2 = 2.67; DF = 2; P = 0.26; NFI = 0.99, CFI = 0.99; RMSEA = 0.04); analyses showed that both cognitive failures and dysfunctional coping were significantly associated and exerted a moderate effect on emotional distress. Cognitive failures and dysfunctional coping had an indirect effect on life satisfaction through emotional distress which directly decreased levels of life satisfaction (β = −0.70, P ≤ 0.001). Conclusions: This study found that experiencing emotional distress helped to explain the association and negative effects of cognitive failures and dysfunctional coping on life satisfaction in older people living in sheltered housing. These findings contribute to our understanding of the key mechanisms of experiencing cognitive failures in late life and can help guide future interventions of well‐being in later life. (Edited publisher abstract)
Cognitive functioning and quality of life: Diverging views of older adults with Alzheimer and professional care staff
- Authors:
- DEWITTE Laura, VANDENBULCKE Mathieu, DEZUTTER Jessie
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(8), 2018, pp.1074-1081.
- Publisher:
- Wiley
Objective: Staff ratings of quality of life (QOL) in dementia are often lower and more strongly related to the cognitive functioning of the person with dementia than self‐ratings. However, cognition‐related items in QOL measures and limited cognitive screening measures hamper a clear understanding of the relationship, two issues addressed in the current study. Methods: The authors collected data of 88 pairs of older adults with Alzheimer disease and their professional caregivers in 9 residential care settings. Both self‐report and staff report of the QOL of residents were assessed with the Quality of Life in Alzheimer's Disease. Cognitive functioning was assessed with the Mini‐Mental State Examination and a battery of specific cognitive measures. Results: Intraclass correlations and a paired sample t test confirmed a discrepancy between self‐rating and staff rating, with staff significantly underestimating QOL as experienced by the resident. After removing the possibly confounding memory item of the Quality of Life in Alzheimer's Disease, Mini‐Mental State Examination score remained a significant predictor of staff ratings but not self‐ratings in regression analyses. Exploratory analyses of specific cognitive measures showed a significant contribution of a memory test of intentional visual association learning in the prediction of staff‐rated QOL. Conclusions: Staff reports cannot simply substitute reports of the subjective experience of residents with Alzheimer, so both judgments should be taken into account to form an adequate picture of QOL. Staff might be guided more strongly by a cognitive point of view when evaluating QOL of residents with Alzheimer disease, while the latter might have shifted their evaluation standards to cope adequately with the challenges posed by their disease. (Edited publisher abstract)
Cognitive impairment in Parkinson's disease: impact on quality of life of carers
- Authors:
- LAWSON R.A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1362-1370.
- Publisher:
- Wiley
Background: The quality of life (QoL) of informal caregivers of people with Parkinson's disease (PD) (PwP) can be affected by the caring role. Because of cognitive symptoms and diminished activities of daily living, in addition to the management of motor symptoms, carers of PwP and cognitive impairment may experience increased levels of burden and poorer QoL compared with carers of PwP without cognitive impairment. This study aimed to investigate the impact of cognitive impairment in PD upon QoL of carers. Methods: Approximately 36 months after diagnosis, 66 dyadic couples of PwP and carers completed assessments. PwP completed a schedule of neuropsychological assessments and QoL measures; carers of PwP completed demographic questionnaires and assessments of QoL. Factor scores of attention, memory/executive function and global cognition, as derived by principal component analysis, were used to evaluate cognitive domains. Results: Hierarchical regression analysis found lower Montreal Cognitive Assessment was a significant independent predictor of poorer carer QoL, in addition to number of hours spent caregiving, carer depression and PD motor severity. Attentional deficits accounted for the largest proportion of variance of carer QoL. Carers of PwP and dementia (n = 9) had significantly poorer QoL scores compared with PwP and mild cognitive impairment (n = 18) or normal cognition (n = 39) carers (p < 0.01). Conclusions: Attentional deficits were the strongest predictor of carer QoL compared with other cognitive predictors. Carers for those with PD dementia reported the poorest QoL. Interventions such as respite or cognitive behavioural therapy to improve mood and self-efficacy in carers may improve carer QoL. (Publisher abstract)