A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults.

Older adults (3 men, 4 women, aged 55 to 68 years) with chronic sleep-maintenance insomnia were treated sequentially with relaxation therapy (RT) and then with a cognitive-behavioral therapy (CBT) specifically designed for alleviating sleep maintenance problems. Sleep diaries and an objective measure of sleep, the sleep assessment device, showed only modest improvements in measures of wake time after sleep onset, sleep efficiency, and night-to-night sleep variability following RT. However, significant improvements in these measures were observed following CBT and at a 3-month follow-up. These findings, considered in conjunction with previous reports, suggest that CBT specifically addresses factors that sustain sleep maintenance complaints. Additional trials of CBT with larger samples are warranted.     

Primary versus secondary insomnia in older adults: subjective sleep and daytime functioning

Most psychological research on insomnia has centered on primary insomnia (PI). Secondary insomnia (SI), though more common than PI, has received little attention because of its presumed unresponsiveness to treatment. The present study recruited older adults with PI, SI, and a comparison group of older adults with no insomnia (NI). Self-report assessments of sleep revealed no significant difference between the 2 insomnia groups. Daytime functioning measures found significant differences in impairment between the 3 groups with SI having the worst daytime functioning, followed by PI, which was worse than NI. Further analyses found substantial independence between sleep and daytime functioning. Implications of these findings for the clinical management of SI are discussed.     

Depression and sleep quality in older adults: a meta-analysis

The literature emphasizes depression and poor sleep quality as problems that affect many elderly individuals. However, these problems have been related in few studies and there is no meta-analysis performed so far on this relationship. The present research reviewed the studies performed on the subjective sleep quality in order to understand how it relates to depression in older adults. The review was conducted in January 2016 and comprised publications between 2005 and 2015. Based on the electronic databases Web of Science and EBSCO, we used the keywords ‘sleep quality’, ‘depression’, and ‘older’ to identify the empirical studies performed. After assessing the collected studies, we selected those that presented the elderly as participants, resulting in nine papers (N = 3069). A random-effects method was used to evaluate the relationship between depression and sleep. We found that an older person’s lack of good sleep quality is significantly related with depression. The main limitation of this study was the difficulty in collecting a greater number of studies. Future research should consider the importance of additional variables (e.g. moderators) in order to understand and investigate viable interventions for prevention and health promotion in the elderly.     

Subjective age and sleep in middle-aged and older adults

Objective: Chronological age is commonly used to explain change in sleep. The present study examines whether subjective age is associated with change in sleep difficulties across middle adulthood and old age.

Design: Participants were drawn from the second (2004–2005) and third (2013–2014) waves of the Midlife in the United States Survey (MIDUS, N = 2350; Mean Age: 55.54 years), the 2008 and 2014 waves of the Health and Retirement Study (HRS, N = 4066; Mean Age: 67.59 years) and the first (2011) and fourth (2014) waves of the National Health and Aging Trends Survey (NHATS, N = 3541; Mean Age: 76.46). In each sample, subjective age, sleep difficulties, depressive symptoms, anxiety and chronic conditions were assessed at baseline. Sleep difficulties was assessed again at follow-up.

Main outcome measures: Sleep difficulties.

Results: An older subjective age at baseline was related to an increase in sleep difficulties over time in the three samples, and was mediated, in part, through more depressive symptoms, anxiety and chronic conditions. Feeling older was associated with an increased likelihood of major sleeping difficulties at follow-up in the three samples.

Conclusion: Subjective age is a salient marker of individuals’ at risk for poor sleep quality, beyond chronological age.     

Sleep patterns and aging: comparison of older adults with and without insomnia complaints

The nature of geriatric insomnia was studied by comparing older adults with (n = 42) and without (n = 30) insomnia complaints on measures of sleep, mood, life-style, health, and sleep-requirement expectations. Elderly persons with insomnia complaints reported longer sleep latency and more frequent and longer awakenings and used sleeping aids more often than those without insomnia complaints. Nocturnal sleep time was not a reliable discriminator. Poor sleepers showed greater discrepancies between their current sleep patterns and sleep-requirement expectations than did good sleepers. Elderly insomniacs acknowledged greater symptomatology of depression and anxiety than did good sleepers. Daytime napping and physical exercise were equivalent in both groups. Medical disorders, pain conditions, and drug usage (other than sleep aids) did not distinguish the two groups. Clinical implications for the treatment of geriatric insomnia are discussed.     

Hemispheric asymmetry reduction in older adults: the HAROLD model

A model of the effects of aging on brain activity during cognitive performance is introduced. The model is called HAROLD (hemispheric asymmetry reduction in older adults), and it states that, under similar circumstances, prefrontal activity during cognitive performances tends to be less lateralized in older adults than in younger adults. The model is supported by functional neuroimaging and other evidence in the domains of episodic memory, semantic memory, working memory, perception, and inhibitory control. Age-related hemispheric asymmetry reductions may have a compensatory function or they may reflect a dedifferentiation process. They may have a cognitive or neural origin, and they may reflect regional or network mechanisms. The HAROLD model is a cognitive neuroscience model that integrates ideas and findings from psychology and neuroscience of aging.     

Development of and change in cognitive control: A comparison of children, young adults, and older adults

Cognitive control involves adjustments in behavior to conflicting information, develops throughout childhood, and declines in aging. Accordingly, developmental and age-related changes in cognitive control and response-conflict detection were assessed in a response-compatibility task. We recorded performance measures, pre-response time (pre-RT) activity and medial frontal negativity (MFN)—sequentially occurring, putative event-related potential (ERP) indexes, respectively, of cognitive control and response-conflict detection. When response conflict reached the highest levels by requiring incompatible responses on posterror trials, children and older adults showed the greatest performance decrements. ERPs indicated that young adults implemented control (pre-RT) and detected the increased conflict (MFN) only when that conflict was at the highest levels, whereas children and older adults did so at lower levels (e.g., posterror, compatible responses). Consequently, the developmental and age-related performance decrements observed here may be due to the undifferentiated and inefficient manner in which children and older adults recruited the processes associated with both cognitive control and response-conflict detection.     

Chronic strain, locus of control, and distress in older adults

In this study, I examined whether locus of control beliefs buffer or mediate the impact of chronic financial strain on psychological well-being. Data are from a longitudinal survey of a random community sample of older adults. Findings suggest that elderly people with internal locus of control beliefs are less likely to suffer from the deleterious effects of chronic financial strain than are older adults with external locus of control orientations.     

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.     

Self-efficacy and compliance with benzodiazepine taper in older adults with chronic insomnia.

Better understanding of compliance with BZD taper is warranted. Compliance with a taper program and perceived self-efficacy (SE) in being able to comply with hypnotic reduction goals was monitored weekly in 52 older adults (mean age: 63.0 years) with chronic insomnia (average duration: 21.9 years) who underwent a 10-week physician-supervised medication tapering. One group received cognitive- behavior therapy for insomnia during discontinuation, whereas the other did not. Compliant patients showed higher SE ratings at Weeks 6, 8, 9, and 10. Medication-free patients at the end of the treatment also reported higher mean SE ratings at those 4 weeks. Differences remained significant when withdrawal symptoms and sleep efficiency were controlled for. These results have important clinical implications because SE may indicate key time points when patients are experiencing more difficulty during discontinuation.     

Treatment of depression in low-income older adults

The purpose of this study was to compare cognitive-behavioral group therapy (CBGT), clinical case management (CCM), and their combination (CBGT + CCM) to treat depression in low-income older adults (60+). Sixty-seven participants with major depressive disorder or dysthymia were randomly assigned and entered into 1 of the 3 treatment conditions for 6 months. They were followed for 18 months after treatment initiation on depression and functional outcomes. CCM and CBGT + CCM led to greater improvements in depressive symptoms than CBGT, but CBGT led to greater improvements in physical functioning. All 3 conditions resulted in similar reduction of needs. Findings suggest that disadvantaged older adults with depression benefit from increased access to social services either alone or combined with psychotherapy.     

Judgments of blame and forgiveness: A comparison of young adults,older adults,and older adults with dementia

IntroductionAlzheimer's disease may modify moral judgment.ObjectiveIn two studies, we assessed the impact of dementia on blame and forgiveness. Study 1 compared the ways in which young adults, older adults, and older adults with dementia cognitively integrated two factors. Study 2 assessed the number of different factors that older adults with dementia were able to integrate during these moral judgments.MethodThe participants recorded their moral judgements in a blame task and in a forgiveness task. In study 1, the two questionnaires contained scenarios built from the combination of two factors. In study 2, the participants were confronted with the same tasks under three different conditions with scenarios that combined three, four or five factors.ResultsThe data from study 1 showed that the older adults with dementia did not combine the two factors in the same way as young adults did: the combination depended on the type of moral judgment. Study 2 revealed differences in moral judgment between older adults with dementia and adults without dementia in all tasks (i.e. with three, four or five factors combined).ConclusionDementia has an impact on moral judgments. Moral judgment among people with dementia is both task- and condition-dependant.     

The effects of sleep on episodic memory in older and younger adults

Evidence on sleep-dependent benefits for episodic memory remains elusive. Furthermore we know little about age-related changes on the effects of sleep on episodic memory. The study we report is the first to compare the effects of sleep on episodic memories in younger and older adults. Memories of stories and personal events were assessed following a retention interval that included sleep and following an equal duration of wakefulness. Both older and younger adults have superior memory following sleep compared to following wakefulness for both types of material. Amount of forgetting of personal events was less during wakefulness in older adults than in younger adults, possibly due to spontaneous rehearsal. Amount of time spent sleeping correlated highly with sleep benefit in older adults, suggesting that quantity of total sleep, and/or time spent in some stages of sleep, are important contributors to age-related differences in memory consolidation or protection from interference during sleep.     

Aging, subjective experience, and cognitive control: dramatic false remembering by older adults

Recent research suggests that older adults are more susceptible to interference effects than are young adults; however, that research has failed to equate differences in original learning. In 4 experiments, the authors show that older adults are more susceptible to interference effects produced by a misleading prime. Even when original learning was equated, older adults were 10 times as likely to falsely remember misleading information and were much less likely to increase their accuracy by opting not to answer under conditions of free responding. The results are well described by a multinomial model that postulates multiple modes of cognitive control. According to that model, older adults are likely to be captured by misleading information, a form of goal neglect or deficit in inhibitory functions.     

Dispositional mindfulness,insomnia, sleep quality and dysfunctional sleep beliefs in post-treatment cancer patients

Dispositional mindfulness, or the tendency to be more mindful in daily life, has been associated with better psychological functioning and reduced overall distress. This study investigated the degree to which dispositional mindfulness was associated with sleep disturbances in cancer patients with insomnia. Further, we examined whether levels of mindfulness moderated the relationship between stress levels, mood disturbance, insomnia severity, sleep quality and dysfunctional sleep beliefs. Participants (N = 111) were adults who had been previously treated for cancer and currently met diagnostic criteria for insomnia. Higher levels of acting with awareness, non-judging and non-reacting were associated with better sleep and psychological outcomes. Despite these significant associations, mindfulness facets did not significantly moderate the relationship between stress, mood and sleep outcomes. This negative finding raises the possibility that increased mindfulness may not act directly to improve psychological outcomes, but rather through a series of other cognitive and affective changes. Our results emphasize the importance of addressing mood symptoms and stress appraisals as predictors of sleep disturbance in cancer patients.     

Perseverative behavior and adaptive control in older adults: performance monitoring,rule induction,and set shifting

Older adults, like patients with dorsolateral frontal lobe lesions, have been shown to be progressively susceptible to errors of perseveration in the Wisconsin Card Sorting Test (WCST). This deficit may result from several types of endogenous adaptive control abilities. First, to enable behavioral modifications in response to sudden changes in task demands, one has to consider and evaluate the possible alternative categorization rules and select one for further testing (rule induction). Second, to perform the required shift appropriately, one should suppress the no-longer relevant task set and replace it by an appropriate new one (set shifting). Third, however, proper application of rule-induction and set-shifting abilities requires the ability to monitor and interpret task cues and feedback signals appropriately to guide behavior and to recognize the need to apply rule-shift operations (performance monitoring). To explore the extent to which these different endogenous adaptive control abilities are differentially sensitive to the effect of aging, young and older adults were tested in two experiments using WCST-like tasks. From the finding that older adults were not able to capitalize on explicit shift cues (either nonspecific or specific) the inference can be drawn that basic set-shifting abilities, rather than rule-induction or performance-monitoring abilities, were the primary factor responsible for the increased tendency to perseverate as adults grow into senescence.     

Automatic and voluntary control of attention in young and older adults

Young and older adults searched for a target character in a 3-item display. On each trial, both a symbolic cue (arrow at fixation) and a spatial cue (abrupt onset of one item) could indicate the target's position. Participants were told to use the central arrow cue on all trials because it had 75% validity. The onset cue also had 75% validity for half the participants and 25% validity for the other half. Both age groups showed about the same cost and benefit effects for the central arrow cues, but the abrupt onsets had much larger cuing effects for older adults. Young adults were able to suppress at least partially an automatic attentional response to an abrupt onset item when the arrow cue preceded the onset and had a higher validity than the onset cue. Older adults appeared to be less able to inhibit their responses to abrupt onsets and to disengage their attention from invalid onset cues than were the young adults.