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.     

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.     

Evidence-based psychological treatments for insomnia in older adults

The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future.     

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.     

Adoption and maintenance of physical activity: Planning interventions in young, middle-aged, and older adults

Young, middle-aged, and older adults in orthopaedic outpatient rehabilitation (N?=?373) were randomly assigned to either an interviewer-assisted or a standard-care self-administered planning intervention. Physical activity planning consisted of specifying action plans to facilitate action initiation, and coping plans to overcome barriers. The interviewer-assisted condition led to more complete action plans and a longer duration of physical activities up to six months after discharge. Regarding coping planning, older and middle-aged adults benefited more from interviewer-assisted planning while younger adults benefited more from self-administered planning. Planning as such was found to be an effective tool for enactment irrespective of chronological age. The delayed effect of coping planning on enactment suggests that coping planning is important for long-term maintenance.     

Psychological interventions for arthritis pain management in adults: a meta-analysis.

CONTEXT: The psychosocial impact of arthritis can be profound. There is growing interest in psychosocial interventions for managing pain and disability in arthritis patients. OBJECTIVE: This meta-analysis reports on the efficacy of psychosocial interventions for arthritis pain and disability. DATA SOURCES: Articles evaluating psychosocial interventions for arthritis were identified through Cochrane Controlled Trials, EMBASE, Ovid MEDLINE, and Ovid PsycINFO data sources. STUDY SELECTION: Randomized controlled trials testing the efficacy of psychosocial interventions in arthritis pain management were reviewed. DATA EXTRACTION: Twenty-seven randomized controlled trials were analyzed. Pain intensity was the primary outcome. Secondary outcomes included psychological, physical, and biological functioning. DATA SYNTHESIS: An overall effect size of 0.177 (95% CI=0.256-0.094) indicated that patients receiving psychosocial interventions reported significantly lower pain than patients in control conditions (combined p=.01). Meta-analyses also supported the efficacy of psychosocial interventions for the secondary outcomes. CONCLUSIONS: These findings indicate that psychosocial interventions may have significant effects on pain and other outcomes in arthritis patients. Ample evidence for the additional benefit of such interventions over and above that of standard medical care was found.     

Human behavioral momentum in a sample of older adults.

Behavioral momentum, the persistence of behavior under altered environmental contingencies, is derived from Newtonian physics and operant psychology. It has relevance to behavior analysis in terms of shaping strong behaviors and ensuring effective relapse prevention strategies in behavior modification and therapy. The authors investigated whether changing the operant schedule contingencies affects the responses of older humans to different stimuli when reinforcement density is systematically manipulated. Fifteen older adults participated in a computer study in which each of 2 keys in a baseline condition was associated with the same schedule of reinforcement and multiple variable intervals; the only difference was that 1 reinforcer was 10 times larger than the other. After 6 sessions, the authors changed the contingency schedule to either an extinction condition, a variable-time schedule, or a different variable-interval schedule, to assess how participants' responses persisted when reinforcement contingencies were systematically changed. The results were consistent with the predictions of behavioral momentum. The participants not only biased their responses in favor of the more densely reinforcing key, but when contingencies changed, they showed significantly biased responses. Results supported the conclusion that healthy older adults allocate their behaviors in a manner very sensitive to training stimuli conditions; consistent with the basic principles of behavioral momentum, they show a degree of resistance to change in their behaviors when the behavioral contingencies are altered.     

Telephone versus mail interventions for maintenance of physical activity in older adults.

Although telephone and mail are often used to promote physical activity adoption, their ability to produce long-term maintenance is unclear. In this study, 140 men and women aged 50-65 years received 1 year of telephone counseling to adopt higher (i.e., more vigorous) versus lower intensity (i.e., moderate) exercise. After 1 year, participants were rerandomized to a 2nd year of contact via (a) telephone and mail or (b) predominantly mail. Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail. Both strategies were similarly effective in promoting maintenance in the lower intensity condition. Results suggest that after successful adoption of physical activity with the help of telephone counseling, less intensive interventions are successful for physical activity maintenance in older adults.     

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.     

How young and older adults differ in their responses to perceived age discrimination

The authors examined the consequences of perceived age discrimination for well-being and group identification. The rejection-identification model suggests that perceived discrimination harms psychological well-being in low status groups but that group identification partially alleviates this effect. The authors hypothesized that this process model would be confirmed among older adults because their low status group membership is permanent but not confirmed among young adults whose low status is temporary. Using structural equation modeling, the authors found support for the hypothesized direct negative link between perceived age discrimination and well-being among older adults, with increased age group identification partially attenuating this effect. For young adults, these relationships were absent. Differences in responses to discrimination appear to be based on opportunities for leaving a low status group.     

Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.

OBJECTIVE: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.     

Changes in childhood caregiving impressions among middle-aged and older adults

Childhood experiences and impressions are important for individuals' health and well-being—they often set the stage for how people approach relationships across the lifespan and how they make sense of their relational worlds. However, impressions of these experiences are likely not static and can change over time, even years after these experiences happened. The current study examined how impressions of parental relationships in childhood changed over time, and predictors of these changes, among middle-aged and older adults followed over a 4-year period (N = 2692; M_age = 66.67, SD = 9.15; 64.1% women). Childhood impressions of parental care were mostly stable over time, with 53.5%–65.0% of participants reporting consistent impressions. Becoming divorced/separated as an adult was associated with more negative impressions about relationships with fathers in the past. Having a mother pass away was associated with more positive impressions of mothers' caregiving when participants were children. Higher depressive symptoms at follow-up were associated with darker perceptions of the past—more negative impressions of mothers and fathers as caregivers. The current study is one of the most comprehensive studies of late-life changes in childhood impressions to date, suggesting future directions for studying the organization of relational experiences and recollection over time.     

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.     

Personality and risk for Alzheimer's disease in adults 72 years of age and older: a 6-year follow-up

[Correction Notice: An erratum for this article was reported in Vol 26(2) of Psychology and Aging (see record 2011-05802-001). This article contains an error in the Discussion, under the Implications, Caveats, Future Directions heading. The third paragraph includes the sentences that should have been removed. The corrected paragraph appears in the correction.] We conducted secondary analyses to determine the relationship between longstanding personality traits and risk for Alzheimer's disease (AD) among 767 participants 72 years of age or older who were followed for more than 6 years. Personality was assessed with the NEO-FFI. We hypothesized that elevated Neuroticism, lower Openness, and lower Conscientiousness would be independently associated with risk of AD. Hypotheses were supported. The finding that AD risk is associated with elevated Neuroticism and lower Conscientiousness can be added to the accumulating literature documenting the pathogenic effects of these two traits. The link between lower Openness and AD risk is consistent with recent findings on cognitive activity and AD risk. Findings have implications for prevention research and for the conceptualization of the etiology of AD.     

Forgiveness in adolescents, young, middle-aged, and older adults

The evolution of the propensity to forgive an offense was studied in a sample of 236 people from various age groups. The effect of a number of circumstances connected with the offense was considered: intent to harm, severity of consequences, cancellation of consequences, social proximity to the offender, apologies from the offender, and the attitude of others. The method was an application of information integration theory. A global increase in the propensity to forgive from adolescence to old age was observed. Several interactions between age and circumstances were found: (a) The effect of the cancellation factor was higher in young adolescents and in the very old than in the middle-aged, (b) the attitude of others and the restoration of harmony factors were important only in adolescents. Finally, the structure of the Forgiveness schema was shown to be an additive one, regardless of the age of the participants.     

Exercise therapy for depression in middle-aged and older adults: predictors of early dropout and treatment failure.

Psychosocial factors predicting treatment dropout or failure to benefit from treatment were identified in a randomized trial of exercise therapy and pharmacotherapy for major depression. One hundred fifty-six men and women over age 50 diagnosed with major depressive disorder were assigned to a 16-week program of aerobic exercise, medication (sertraline), or a combination of exercise and medication. Thirty-two patients (21%) failed to complete the program and were considered treatment "dropouts." At the end of 16 weeks, 83 patients (53%) were in remission; the remaining patients not in remission were considered treatment "failures." Baseline levels of self-reported anxiety and lift satisfaction were the best predictors of both patient dropout and treatment success or failure across all treatment conditions.     

Predictors of personal investment in physical activity among middle-aged and older adults

The purpose of this study was to determine the relationship between the social psychological components of Personal Investment Theory and exercise behaviors among 47 middle-aged and older men and women participating in an organized exercise program. Specifically, the degree to which personal incentives for exercise, perceptions of sense of self (i.e., physical self-efficacy, fitness locus of control, self-motivation, social identity), and the congruence between program and participants' goals predict present physical activity and estimated future physical activity was examined. Multiple regression analyses indicated that present and future exercise behaviors significantly related to social psychological variables reflecting personal investment.     

Personality change profiles and changes in cognition among middle-aged and older adults

Research on the relationship between personality traits and cognitive abilities has primarily used cross-sectional designs and considered personality traits individually in relation to cognitive dimensions. This study (N = 2652) examined the relationship between Big Five personality change profiles and change in cognitive factors, episodic memory and executive functioning. Latent profile analysis was used to capture patterns of change across the Big Five traits. Three profiles of personality change were defined: Decreasers, Maintainers, and Increasers. The Decreasers declined more in episodic memory compared to the Increasers and Maintainers. Also, the Decreasers declined more in executive functioning compared to the Increasers, but not the Maintainers. The findings advance our understanding of the links between patterns of personality change and cognitive aging.     

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.