Improving quality of life in diverse rural older adults: a randomized trial of a psychological treatment

The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care.     

The functions and value of reminiscence for older adults in long-term residential care facilities

For the many older adults living in long-term care facilities, the ability to connect with others, as well as with one’s own personal past, may be of particular value. Reflecting on the past and sharing reminiscences with others serves different psychosocial functions in various settings. This study examined the functions of reminiscence for long-term care residents in the United States (M_age?=?86.5) by addressing the self-reported frequency of reminiscence, the counterparties involved, the overall purpose and value of reminiscence, and the relation to residents’ mental health and well-being. Results demonstrated that although some functions of reminiscence were comparable to those found in community-dwelling older adults, others were unique to the long-term care setting. Residents were most likely to reminisce alone and they found the experience enjoyable. They reported engaging in and enjoying reminiscence with family more than with fellow residents, and a subset desired increased opportunities to share memories with healthcare providers. Residents with lower morale and more depressive symptoms were more likely to engage in unhealthy styles of reminiscence. These findings suggest that interventions shaping reminiscence encounters may have positive outcomes for long-term care residents.     

老年人自尊、希望和抑郁关系的纵向研究

为考察老年人自尊、希望与抑郁间的关系,本研究对281名老年人进行为期一年的追踪调查。相关分析及纵向中介分析结果表明:(1)自尊和希望与老年人的抑郁显著负相关,老年人自尊和希望显著正相关。(2)自尊正向预测老年人的希望,老年人的希望负向预测抑郁。(3)希望在自尊对老年人抑郁的影响中起中介作用。本研究结果揭示了希望是自尊对老年人抑郁产生效应的重要机制变量。这些结果对于减缓老年人抑郁,促进老年心理健康具有一定的实践价值。     

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were self-referred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.     

老年夫妻的老化刻板印象对死亡焦虑的行动者效应和对象效应

目的：考察老年人的老化刻板印象对自身及配偶的死亡焦虑的影响。方法：145对老年夫妻完成老化印象量表和死亡焦虑量表,并运用行动者-对象互依模型进行数据分析。结果：（1）老化刻板印象和死亡焦虑在夫妻内部分别具有一致性;（2）老化刻板印象对自身死亡焦虑的行动者效应显著;（3）丈夫的积极老化刻板印象对妻子死亡焦虑的对象效应显著,妻子的消极老化刻板印象对丈夫死亡焦虑的对象效应显著。结论：老年人的老化刻板印象不仅影响自身而且影响配偶的死亡焦虑,但夫妻之间的影响存在性别差异。     

The treatment of depression in older adults in the primary care setting: an evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults.     

Predictors and impact of psychotherapy side effects in young adults

What should we tell our younger clients—who may or may not have chosen to come to therapy—about possible risks of engaging in psychotherapy? To explore this question, we examined psychotherapy side effects in 366 young adults with a history of psychotherapy or counselling. Psychotherapy side effects were common, with 41% of participants reporting at least one. Perceived lack of control over the decision of when and how to engage in therapy was the strongest predictor of experiencing therapy side effects. Of the different kinds of side effects, feeling that therapy had gone on too long and experiencing worsening of existing symptoms were the most strongly predictive of poor therapy outcomes such as dissatisfaction with care and lower perceived improvements. Finally, there was a significant association between reporting side effects of psychiatric medications and side effects of psychotherapy, suggesting common factors that contribute to side effect experience across treatment modalities. These findings highlight the need to monitor possible side effects during psychotherapy and counselling, and to have an open dialogue with our youngest clients and their families about the likelihood for negative outcomes when they are compelled to engage in therapy.     

Psychological Distress and Help Seeking in Rural America

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.     

Aging, emotion, and health-related decision strategies: motivational manipulations can reduce age differences

According to socioemotional selectivity theory, age-related constraints on time horizons are associated with motivational changes that increasingly favor goals related to emotional well-being. Such changes have implications for emotionally taxing tasks such as making decisions, especially when decisions require consideration of unpleasant information. This study examined age differences in information acquisition and recall in the health care realm. Using computer-based decision scenarios, 60 older and 60 young adults reviewed choice criteria that contained positive, negative, and neutral information about different physicians and health care plans. As predicted, older adults reviewed and recalled a greater proportion of positive than of negative information compared with young adults. Age differences were eliminated when motivational manipulations elicited information-gathering goals or when time perspective was controlled statistically. Implications for improving decision strategies in older adults are discussed.     

Do the Emotional Benefits of Optimism Vary Across Older Adulthood? A Life Span Perspective

This study examined whether the emotional benefits of dispositional optimism for managing stressful encounters decrease across older adulthood. Such an effect might emerge because age‐related declines in opportunities for overcoming stressors could reduce the effectiveness of optimism. This hypothesis was tested in a 6‐year longitudinal study of 171 community‐dwelling older adults (age range = 64–90 years). Hierarchical linear models showed that dispositional optimism protected relatively young participants from exhibiting elevations in depressive symptoms over time, but that these benefits became increasingly reduced among their older counterparts. Moreover, the findings showed that an age‐related association between optimism and depressive symptoms was observed particularly during periods of enhanced, as compared to reduced, stress. These results suggest that dispositional optimism protects emotional well‐being during the early phases of older adulthood, but that its effects are reduced in advanced old age.     

Recognition and Treatment of Late-Life Addictions in Medical Settings

Addictive disorders among the elderly have emerged as a growing public health concern. As the proportion of the elderly population increases, more and more older adults will either develop addictions as a dysfunctional means of coping with the psychosocial consequences of aging, or will carry their long-standing addictive behaviors with them into later life. Among the most common of these addictions are smoking, excess consumption of alcohol, and gambling. This article briefly reviews these three addictive disorders and examines assessment and treatment options. The current cohort of older adults tends not to seek help for addiction problems in specialty mental health or substance abuse treatment. To improve rates of cessation and abstinence, assessment and intervention should be delivered in general medical settings such as primary care. With the addition of a behavioral health specialist, primary care has the potential to offer improved interventions in a cost-effective and time-efficient manner.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

Caregiver Attributions for Late‐Life Depression and Their Associations with Caregiver Burden

Late‐life depression (LLD) has detrimental effects on family caregivers that may be compounded when caregivers believe that depressive behaviors are volitional or within the patient's capacity to control. In this study we examined three person‐centered caregiver attributions that place responsibility for LLD on the patient (i.e., character, controllability, and intention), and the impact of such attributions on levels of general caregiver burden and burden specific to patient depressive symptoms. Participants were 212 spouses and adult children of older adults enrolled in a depression treatment study. Over one third of caregivers endorsed character attributions, which significantly predicted greater levels of both general and depression‐specific burden. Intention attributions were significantly associated with general burden, but not depression‐specific burden. Contrary to our expectation, controllability attributions did not predict either type of burden. Our findings suggest that the assessment of family caregiver attributions for LLD may be useful in identifying caregivers at risk for burden and subsequent health effects, as well as those who may need education and support to provide effective care to a vulnerable population of older adults.     

Social support,social integration,and health-related quality of life over time: Results from the Fitness and Arthritis in Seniors Trial (FAST)

The present study tested whether baseline perceived social support and social integration predicted baseline and follow-up measures of health-related quality of life for 364 older adults with osteoarthritis. The findings are secondary analyses of a randomized controlled trial of an exercise intervention. Multiple regression analyses indicate that perceived social support was related to baseline measures of functioning in psychological (depressive symptoms, social functioning, and life satisfaction) and physical domains (self-rated disability, observed physical function, and perceived health), after accounting for demographic and clinical status factors. At 18-month follow-up (additionally controlling for exercise intervention and baseline outcomes), social support significantly predicted changes in psychosocial functioning, but was unrelated to changes in self-reported and observed physical health. The findings indicate that social support is an important predictor of long-term psychosocial outcomes, but is less important than baseline clinical status for physical health endpoints in this cohort of older adults. In contrast, social integration was not a consistent predictor of outcomes.     

The role of religious resources for older adults coping with illness

The present study investigated the role of religious/spiritual appraisal and coping among a community sample of older adults with illness. In particular this study explored the relationship between these religious resources and nonreligious cognitive appraisals (e.g., threat) and coping behavior in response to illness. These religious resources were related to more adaptive forms of general appraisal and coping. For example, meaning-making related to God (e.g., God's will) was linked to more positive appraisals of the illness and its potential to lead to growth. As well, various forms of religious coping behavior were associated with older adults' use of positive reframing and active forms of general coping. Such findings have implications for counselors and health care providers in their work with older adults adjusting to illness.     

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

Health incongruence in later life: implications for subsequent well-being and health care.

OBJECTIVE: The premise that pessimistic health appraisals compromise well-being whereas optimistic appraisals are compensatory was examined in a longitudinal study of 232 community-dwelling older adults (ages 79-98 years). DESIGN: Subjective health (SH) appraisals were contrasted with objective health (OH) to identify realists, whose ratings were congruent (SH = OH), distinguishing them from health pessimists (SH < OH) and health optimists (SH > OH), whose ratings were incongruent. Analyses of covariance were used to examine group differences 2 years later on well-being and health care. MAIN OUTCOME MEASURES: Outcome measures were psychological well-being (life satisfaction, positive and negative emotions), functional well-being (objective and perceived physical activity, activity restriction), and health care (health care management, hospital admissions, length of hospital stays). RESULTS: Compared with realists, pessimists had significantly poorer outcomes and optimists had better outcomes. Because perceived control (PC) was weaker among pessimists and stronger among optimists, supplemental analysis determined whether PC differences explained these findings. When accounting for PC, many pessimism and optimism effects became nonsignificant, yet effects on functional well-being remained unchanged. CONCLUSION: Findings have implications for older adults at risk of functional decline.