Journal of Clinical Geropsychology

To examine the factors associated with social participation and to determine whether social participation is predictive of mortality, a cohort of 1405 randomly selected older people aged 65 years and over, living in Settsu, Osaka Prefecture, was followed up for 66 months. By multivariate analysis using logistic regression, female sex, older age, disability, medical treatment, no use of health checks, no daily preventive health practices, and no life worth living (no Ikigai) were independent risk factors for no participation in social activities. From the analysis using the Kaplan–Meier method, the cumulative survival rates were higher among those who took part in social activities than among those who did not in both age groups, 65–74 years and 75 years and older, for men and women. Application of the Cox proportional hazards model resulted in adjusted hazard ratio of no participation in social activities for mortality of 1.53 (95% confidence interval: 1.11–2.11), controlling for other potential factors. These results suggest that participation in social activities is closely associated with health and psychosocial conditions and may be an independent risk factor for mortality among community-residing older people.

This investigation examined whether characteristics of elders and their caregivers and facets of the nursing home decision-making context were associated with recalled levels of stress during nursing home decision-making. Employing a conceptual framework based upon the literature on caregiver stress and nursing home decision-making, we considered a number of factors that might influence sponsors' stress as decisions were being made about nursing home placements. We examined data from telephone interviews with a sample of 142 sponsors (responsible parties) of first-time, recently admitted nursing home residents. Higher levels of reported stress were directly associated with more factors triggering the decision to admit, higher levels of competing demands, and limited time. Employment was indirectly related to higher stress through its impact on demands. Hospitalization and being the spouse or an adult child of the resident were indirectly related to stress because they were associated with limited available time. The results offer some insights into the types of individuals who may be vulnerable to higher levels of stress and the kinds of interventions that might avert high stress in the nursing home decision process.

Trong phần giới thiệu này, tôi cung cấp một cái nhìn tổng quan ngắn gọn về năm bài báo có trong số đặc biệt này của Tạp chí Tâm lý học Lão khoa Lâm sàng. Mục tiêu của số báo này là cung cấp thông tin và cái nhìn mới về các phương pháp điều trị khác nhau cũng như các vấn đề liên quan đến việc đánh giá và điều trị các vấn đề hành vi ở người lớn tuổi. Những bài báo này đề cập đến cả các vấn đề cơ bản và ứng dụng liên quan đến chủ đề rộng lớn về quản lý hành vi trong giai đoạn cuối đời, cung cấp những cái nhìn mới và định hướng cho nghiên cứu trong tương lai.

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.

We model the effects of disability, functional limitation, and receipt of help on perceived health. This analysis specifies a model with two dimensions of disability and three dimensions of functional limitation, including upper body disability, lower body disability, basic activities of daily living (ADLs), household ADLs, and advanced ADLs. The latent variables of receiving help are modeled for each of the ADLs as intervening between limitations and perceived health. The results show that instrumental social support in the form of receiving help for ADLs has no substantive independent effect on perceived health. In addition, receiving instrumental social support shows a pattern of task-specific responses to individual measures of need. Implications for both caregiver and care recipient are discussed.

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.

In this preliminary, intrasubject study (N = 8), we examined the effects of communication skills training and the use of memory books by Nursing Assistants (NAs) on the social ecology of a nursing home. Through inservice and on-the-job training, NAs were taught to use communication skills and memory books during their interactions with residents with mild to moderate cognitive impairment (Mini Mental Status Examination, M = 16.25), but relatively intact communication abilities. An abbreviated staff motivational system called Behavioral Supervision (Burgio and Burgio, 1990. Int. J. Aging Hum. Deve. 30: 287–302.) was attempted to encourage performance of these skills on the nursing units. Results showed that, regardless of sporadic implementation of the intervention by nursing staff, the intervention improved communication between staff and residents during care routines, increased the amount of time other residents and visitors spent talking with target residents, and increased the rate of positive statements made by the target residents and others in their immediate environment. Results are discussed in terms of limitations of the staff motivational system and modifications made to the system in a larger ongoing intervention trial.

A single-case analysis was carried out to study the nonpharmacological treatment of post-stroke anxiety in an older adult male. The intervention consisted of a biofeedback-assisted program of autogenic training; efficacy was demonstrated using multiple discontinuations and reinstatements of treatment. Physiological indices and self-report measures of anxiety and depression documented treatment success, although a moderate increase in fear was evident on the Fear Survey Schedule II at the final follow-up assessment.

Although anxiety is a serious problem among the elderly, very little research has been conducted with anxious older adults. One reason is that although anxiety disorders overall are more common than depression in older community samples, many specific anxiety disorders are relatively rare. Furthermore, anxious older adults often do not seek treatment or otherwise come to the attention of mental health researchers. This paper describes the first year of recruitment efforts for a treatment outcome study of psychotherapy for generalized anxiety disorder in adults at least 55 years old. Successful methods included collaborations with hospital-based health education programs and senior centers, as well as notices in local and senior newspapers. Less successful methods included radio public service announcements and mailings to residential facilities, churches and synagogues, and physicians. Recommendations for recruitment of anxious older adults into research projects are discussed.

Chúng tôi đã khảo sát 553 người từ 85 tuổi trở lên, chiếm 92% trong tổng số 601 công dân của thành phố Vantaa, Phần Lan. Các bài kiểm tra như Kiểm Tra Trạng Thái Tinh Thần Mini (MMSE), Chỉ Số Các Hoạt Động Hằng Ngày (ADL), và Thang Điểm Các Hoạt Động Hằng Ngày Khác (IADL) đã được hoàn thành. Chẩn đoán về chứng mất trí nhớ và trầm cảm được thực hiện theo tiêu chí DSM-III-R. Điểm số trung bình MMSE của nam giới là 20,1, trong khi của nữ giới là 16,8 (chênh lệch = 3,3 điểm). Khi loại trừ các đối tượng mắc chứng mất trí (N = 210), chênh lệch giảm còn 2,2 điểm. Khi cũng loại trừ các đối tượng bị trầm cảm, chênh lệch giảm thêm còn 1,9 điểm. Sự giáo dục và sự sống trong cơ sở điều dưỡng đã giải thích một phần chênh lệch này, nhưng giới tính cũng có ảnh hưởng độc lập đến điểm số MMSE. Các phụ nữ sống tại nhà có khả năng chức năng thấp hơn so với nam giới tương ứng, được đo lường qua thang điểm ADL. Không có sự khác biệt nào được ghi nhận trong thang điểm IADL. Có vẻ như nam giới trên 85 tuổi đại diện cho một quần thể rất được chọn lọc. Nam giới có lẽ chết “sớm hơn” trong quá trình bất kỳ bệnh tật nào suy giảm. Cũng có khả năng rằng các phép đo khả năng nhận thức của chúng tôi có lợi cho nam giới trong số rất người cao tuổi.