Advancing cognitive behaviour therapy for older adults with comorbid insomnia and depression

Insomnia and depression are two of the most common mental health problems that negatively impact older adults. The burden associated with these highly comorbid conditions requires an innovative approach to treatment. There have been significant advancements in the field of cognitive behaviour therapy for insomnia (CBT-I) over recent years. CBT-I has evolved from targeting homogenous insomnia samples to now showing promising results for comorbid insomnia. CBT-I is not only effective at treating comorbid insomnia, but can also have a positive impact on depression severity. Despite these important clinical developments, limited research has explored whether modifying CBT-I programmes to specifically target comorbid depression could improve outcomes for older populations. This paper reviews recent literature and provides therapeutic recommendations to advance CBT-I for older adults with comorbid insomnia and depression.     

Evangelical group membership,depression, and well-being among older Mexican Americans: a comparison with older non-Hispanic Whites

This study assesses denominational differences in well-being among older Mexican Americans and examines differences between this group and older non-Hispanic Whites. Data came from two representative surveys of the US older adult population, focusing on each of these ethnic groups (N?=?996 and N?=?612, respectively). Evangelical Mexican Americans reported fewer symptoms of depression and greater life satisfaction than their Catholic counterparts, but there were no such differences among non-Hispanic Whites. Potential explanatory mechanisms examined included differences in frequency of attendance at religious services, use of positive and negative religious coping, and social support or conflict in the congregation. Among these, only the relationship of attendance and denomination varied by ethnicity, but this factor did not appear to explain differences in well-being. We propose that aspects of conflict between Catholic and Mexican-American identities contribute to making Evangelical affiliation more strongly related to well-being in this group.     

The association of anxiety,depression, and worry symptoms on cognitive performance in older adults

Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS). Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.     

Spiritual,Religious, Nonspiritual,and Nonreligious Narratives in Marginalized Older Adults: A Typology of Coping Styles

SUMMARY

Narrative therapy is an important tool in the phenomenological framing of life events with older clients. Seventy-nine older adults who lived independently in four subsidized high-rise housing facilities in Chicago were interviewed in a research project about managing life challenges. Cases represent four types in a spiritual-religious typology: religious and spiritual, religious only, spiritual only, and neither religious nor spiritual (Zinnbauer, 1997). This article explores how older adults managed adversity and maintained a sense of self-efficacy. Findings indicate that older adults use many references to religion and spirituality in their narratives, either embracing these domains or defining themselves in contrast to them. Narrative therapy suggests that the implications of religious and spiritual resources addressed in client stories may reinforce coping capacity and promote aging well.     

Reporting spiritual needs of older adults living in Bavarian residential and nursing homes

We intended to study unaddressed psychosocial and spiritual needs among older people (of at least 65 years of age) living in nine residential/nursing homes in Bavaria in Southern Germany. We conducted an anonymous cross-sectional study with standardised questionnaires (i.e., Spiritual Needs Questionnaire, Brief Multidimensional Life Satisfaction Scale, Schedule for Meaning in Life Evaluation, etc.). Religious needs were predicted best by residents’ religious trust. Existential needs and inner peace needs correlated moderately with grief, and were predicted best by family/social support needs. All members of an interdisciplinary team should be trained in the specific competence of recognising older people's unmet spiritual needs. When these needs are recognised, caregivers and relatives have the chance to react.     

Trajectories of change in dimensions of forgiveness among older adults and their association with religious commitment

Forgiveness is a complex construct with an important role in religious traditions worldwide, and is associated with mental and physical health outcomes. This seven-year longitudinal study examined changes within individuals during, and differences based on birth cohort, in forgiveness during late life. Growth curve analysis was used to analyse the general pattern of change across the course of older adulthood in eight dimensions related to forgiveness. Increases over time were observed in forgiveness of others, conditionality of forgiveness of others, forgiveness of self, feelings of being forgiven by God, and feelings of being forgiven by others. Decreases over time were observed in difficulty forgiving oneself, and perceptions of conditionality in God's forgiveness. Religious commitment was related to reporting more a more forgiving attitude on seven of these dimensions, but also to more perceived conditionality in God's forgiveness. Finally, differences in mean levels of forgiveness emerged between birth cohorts.     

The relation between risk perceptions and physical activity among older adults: A prospective study

Past studies have found that risk perceptions of suffering from diseases play an important role in the development of intentions to perform physical activity (PA). According to the behaviour motivation hypothesis, perceived risk could be positively and directly related to PA, but this possibility has been ignored and/or underestimated. Accounting for recent methodological developments on the importance of study design and risk perception assessment, the purpose of the present study was to examine the risk-perceptions–PA relationship among older adults. Participants (N?=?143) aged from 61 to 70 years initially underwent measurement of risk perceptions, baseline PA, socio-demographic and health factors. Six months later, they were asked about their PA participation. Multiple regression analyses revealed that perceived risk of suffering from diseases and conditions without regular PA participation was an independent positive predictor of later PA, over and beyond baseline behaviour, socio-demographic and health variables. This study fills a gap in the existing literature on the PAs of older adults and reveals that risk perceptions are directly linked to their participation. In addition, it extends existing knowledge in health psychology on the behaviour motivation hypothesis, and emphasises the necessity of methodological adjustments when assessing the risk-perception–behaviour relationship.     

Multiple Religious Belonging among visitors of Dominican spiritual centers in the Netherlands

ABSTRACT

In the religiously pluralized Western world, a trend called ‘Multiple Religious Belonging’ (MRB) has been identified. Although it is a much theologically debated concept, empirical research on the practice of MRB is limited. The present research project therefore explores the phenomenon of MRB among visitors of Dominican spiritual centers in the Netherlands (n=472). It investigates to what extent and in which ways such visitors combine elements from more than one religious tradition in their lives and what they perceive to be the benefits of combining elements. It links this information to their views on religion, the resources they draw from, their (religiously diverse) networks, and their motivations for attending spiritual activities. The results indicate that respondents who combine elements from more than one religious tradition (‘combiners’) are more likely than ‘non-combiners’ to: a) see religion as something that is constantly changing during the life course; b) have networks which are religiously diverse; c) place importance on nature, in-depth conversations, personal rituals or practices, and theological, philosophical, and spiritual texts as resources; d) be motivated to attend spiritual centers because of a focus on self-exploration.     

The influence of the visual surrounding environment in older adults and young adults’ cognitive performance: an alternative paradigm

ABSTRACT

This study investigated how the characteristics of the visual surrounding environment influence older- and young-adults’ cognitive performance. Sixty-four older adults and 64 young adults performed four visual cognitive tasks (attention and memory tasks) in two independent sessions while being exposed to a high-load and a low-load visual surrounding environment. We expected that the high-load environment would hurt the older-adults performance due to typical difficulties in ignoring irrelevant stimuli, whereas no such effect would likely occur for the young-adults whose cognitive abilities are at their best. Overall, our results were consistent with our prediction in three tasks (go/no-go, choice reaction time, and Corsi block-tapping). Additionally, the older adults performed worse than the young adults in all tasks, thus confirming expected age-related differences. Our results are consistent with those obtained when distractors and targets are presented in the same display, now using a paradigm which locates the distractors in the surrounding environment.     

Age stereotypes,flexible goal adjustment,and well-being among Chinese older adults

Previous studies have examined the independent roles of positive age stereotypes (PAS) and negative age stereotypes (NAS) in successful aging. This study aimed to examine the joint effect of PAS and NAS on the well-being of Chinese older adults, and to further examine whether this effect was moderated by flexible goal adjustment (FGA). Using a cross-sectional design, 279 Chinese older adults (age range 60?97 years) completed measures related to age stereotypes, FGA, and well-being. The results showed that PAS interacted with NAS to predict well-being. In addition, the joint effect of PAS and NAS was moderated by FGA. Specially, for older adults with low FGA, NAS weakened the positive association between PAS and well-being; whereas, for older adults with high FGA, NAS could not influence the association between PAS and well-being. Tailored interventions to modify aging perceptions and to enhance coping flexibility competence might be helpful for promoting the well-being of older adults.     

Aggression among older adults: The relationship of interaction networks and gender role to direct and indirect responses

This study examined interpersonally aggressive strategies among older adults and the social and personal context in which these strategies are likely to be employed. Specifically we assessed the relationship of social interaction networks and gender roles to the use of direct and indirect aggression. We predicted that older adults would be more likely to employ indirect than direct strategies and that the use of such strategies would be associated with network structure (i.e., size, density, and knowingness) and gender roles. One hundred ten older adults (mean age, 71 years; range, 55–89 years) completed questionnaires and interviews designed to measure aggressive strategies; gender roles; and network size, density, and knowingness. Respondents reported using more indirect than direct strategies. Those who reported using indirect aggression also reported being relatively masculine and having larger but less connected interaction networks. Use of direct aggression was associated with lower femininity scores but was not related to network structure. Aggr. Behav. 26:145–154, 2000. © 2000 Wiley‐Liss, Inc.     

Spirituality,quality of life,and depression in older people with dementia

ABSTRACT

This study aimed to observe dementia’s role in the relationship between spirituality, quality of life, and depression in aging. The sample included 61 participants between 65 and 98 years old, separated into two groups: participants diagnosed with dementia (N = 31) and control participants (N = 30). There was no significant difference in spirituality between demented and control participants; however, different patterns of correlation were observed between spirituality, depression, and quality of life in these groups. Although the level of spirituality did not differ despite dementia, this pathology would appear to play a role in the relationship between spirituality, quality of life, and depression.     

Psychometric properties of the Wolpe-Lazarus assertiveness scale with community-dwelling older adults

The psychometric properties of the Wolpe-Lazarus Assertiveness Scale (WLAS) were examined with an older community-dwelling, nonclinical, adult population. Three hundred twenty-seven older adults (ages, 57–96; mean, 75.68) who were not psychiatrically impaired completed a demographic questionnaire and the WLAS. Fifty-seven of the 327 subjects also filled out the WLAS on a repeated basis after 3 or 4 weeks in order to determine the test-retest reliability. Results indicate that the WLAS has an adequate internal consistency (Cronbach's=.75) and test-retest reliability (r=.81). WLAS cutoff scores of 14 and under identify unassertiveness. Older adults who are (1) African-American or (2) of lower SES tend to be significantly less assertive. Also, five factors emerged from a principal-components analysis accounting for 34.7% of the total variance.This research is based on the senior author's doctoral dissertation in partial fulfillment of the Ph.D. under the direction of the second, third, and fourth authors.     

Social anxiety in older adults: phenomenology, prevalence, and measurement

Although phobias represent the most common anxiety disorders among the elderly, little is known about their social nature. The present study provides information about the prevalence, measurement, and phenomenology of social anxiety in older adults (n = 283) and compares results to those of younger adults (n = 318). Analyses revealed that social anxiety is less prevalent in old age than it is within younger cohorts and is associated with different symptomatology. The psychopathological profile of those who reach clinical levels of social anxiety is however similar, irrespective of age. Results regarding the psychometric properties of the SPAI when used for the elderly were promising, but the questionnaire appears to be difficult for some older adults to complete. Results are discussed in terms of explanations for age differences in social anxiety, initial psychometrics of the SPAI in an older adult sample, and suggestions for future research.     

Thinking about the past,present, and future: Time perspective and self-esteem in adolescents,young adults,middle-aged adults,and older adults

We examined time perspective and self-esteem in adolescents, young adults, middle-aged adults, and older adults. Time perspective was measured with scales that assess relative orientations and relationships among the past, present, and future. Age effects were examined with standard analytic strategies to determine categorical differences between age groups and with new statistical techniques designed to show continuous age patterns. Findings indicated that (1) thinking about the future was greatest for adolescents and young adults and lowest for middle-aged and older adults, and thinking about the present increased across ages; (2) fewer adolescents and middle-aged participants perceived that the time periods were interrelated compared to younger and older adults; and (3) across ages, a greater emphasis towards the past compared to other time periods was associated with lower self-esteem, whereas emphasizing the present and the future jointly was associated with higher self-esteem.     

Relational spirituality and depression among married couples in Antigua

The World Health Organization indicates depression is the leading cause of disability worldwide. At the same time researchers have found religion/spirituality is inversely associated with depression. However, the mechanisms by which spirituality/religion impacts mental health have not been clearly identified particularly in non-western populations. Relational spirituality is a concept that focuses attention on the ways people relate to the sacred. This study examines whether different ways of relating to the sacred are implicated in levels of depression and whether marital partners affect each other’s level of relational spirituality and depression. Ninety-one (n?=?91) married heterosexual couples in the Caribbean Island of Antigua completed measures of relational spirituality and depression. Data were analysed using path analysis and through Actor Partner Interdependence Model methods. Results of the analysis showed wives’ and husbands’ depression scores covaried (COV?=?6.59, Pearson r?=?.28, p?β?=??.24, unstandardised B?=??3.23, se?=?1.30), and higher instability scores (β?=?.49, unstandardised B?=?5.46, se?=?.96). The husbands’ disappointment (β?=?.21, unstandardised B?=?2.17, se?=?.95) and instability (β?=?.54, unstandardised B?=?4.65, se?=?.72) were positively related to their depression scores. The results demonstrate relational spirituality is a useful framework for addressing depression in individuals as well as married couples.     

Associations of ethnic discrimination with symptoms of anxiety and depression among Hispanic emerging adults: a moderated mediation model

Background and Objectives: Emerging adulthood is often marked with elevated symptoms of anxiety and depression. Hispanic emerging adults may face cultural stressors such as ethnic discrimination that further increase levels of anxiety and depression symptoms. The study aims were to examine if (a) self-esteem mediated effects of ethnic discrimination on symptoms of anxiety and depression, and (b) if gender moderated the indirect effects of discrimination. Design: The study design was cross-sectional self-report. Method: Two moderated mediation models were tested, with 1084 Hispanic emerging adults (ages 18–25) enrolled in institutions of post-secondary in the United States. Results: Results indicated that (a) higher ethnic discrimination was associated with higher anxiety symptoms (β?=?.05, p?=?.04), higher depression symptoms (β?=?.06, p?=?.02), and lower self-esteem (β?=??.30, p?Conclusions: Findings suggest that the mediating effects of self-esteem linking ethnic discrimination with symptoms of anxiety and depression vary between genders.     

"Involving the Elderly in Mission" -A Service Project

As one church grew from a small immigrant church to a conglomerate of 1,200 members, the natural social networks were no longer adequate to support the population of older persons. Networks had to be made intentional through programming. A needs assessment of the senior population identified specific subgroups and their needs. Recognizing the diversity of the senior population, a broad spectrum of programs was established. An effort was made to maintain a balance between traditional and innovative. The senior program has strengthened the networking among seniors, increased their integration with the other age groups in the church, and provided an entry level for those new to the church. The program has also become known in the community, which has resulted in cooperation with other senior service organizations who provide education and training. The Area Agency on Aging, realizing the importance of the church to the senior population, has selected a member of the church community to serve on its Advisory Board.