Depression, Psychological Resources, and Health-Related Quality of Life in Older Adults 75 and Above

The purposes of this study were (1) to compare psychological resources and health-related quality of life between two groups of community-dwelling elders, 75 years of age and older, with similar chronic illnesses, but with varying levels of depression, and (2) to examine the relationships among depression, psychological resources, and health-related quality of life. Fifty-two elders (14 men and 38 women) were divided into mildly (n = 18) and severely (n = 34) depressed groups based on their depression scores. There were no significant differences between the two groups for demographic and illness characteristics. There were significant differences for number of medications, mastery, health perceptions, mental health functioning, and well-being. Severely depressed elders had poorer health perceptions, and decreased mastery, functioning, and well-being as compared with mildly depressed elders. An explanatory model was developed using factor analysis that fit the data well. Health perceptions and mastery had direct influences on depression, and depression directly impacted well-being.     

Degree of cognitive impairment and the dissociation of implicit and explicit memory

One group of normal elderly adults and two groups of cognitively impaired elderly adults were compared on an implicit and an explicit memory task. Degree of impairment affected explicit memory; the mildly and moderately impaired elderly adults demonstrated significantly reduced recognition performance. Degree of impairment also affected implicit memory priming performance, particularly for low frequency items, as measured by a word completion task. Explicit memory performance declined for both cognitively impaired groups, but implicit memory performance was sensitive to the degree or severity of impairment, causing a decline in performance only in the moderately impaired group.     

The Culture-Embedded Social Problem of Elder Mistreatment: A Review of International Literature on Asian Elders

Elder mistreatment is now recognized as a worldwide social problem occurring in all racial and ethnic groups. The research on elder mistreatment started in the late 1970s and expanded its focus to ethnic elderly groups including Asian elders in the mid-1980s. Many researchers have explored the issues of elder mistreatment in conjunction with Asian elders’ culture and immigration backgrounds. This article reviews the state of the literature on elder mistreatment among Asians living in Asia or abroad to identify future directions of research, prevention, intervention, and policy. This research indicates that prevention, education, and intervention must take into account the cultural backgrounds of Asian elders and their family members. There is clearly a need for greater research into appropriate elder mistreatment prevention and intervention with Asian elders and their family members.     

Definition of Financial Abuse: A Culture-Centered Construct among Korean Elders

One of the critical issues in addressing financial abuse in Korea is the absence of an appropriate definition voiced by the elderly. This study is designed to explore how Korean elders define financial abuse in given social and cultural contexts. Face-to-face, in-depth interviews were conducted with 124 elders, aged 60 to 79, residing in Korea. The results of qualitative data analysis using grounded theory revealed that a vast majorty of Korean elderly respondents defined financial abuse as lack of provision of financial support to elder parents, and a small portion of respondents defined it as financial exploitation by adult children. The definition of financial abuse reflects cultural beliefs based on filial piety about financial expectations within the parent–child relationship. Education on financial abuse for both elders and their adult children and establishment of income support programs are urgently needed efforts to increase the financial well-being of elderly Koreans.     

Perceived Health Barriers and Health Value in Seniors: Implications for Well-Being and Mortality1

There is growing evidence to suggest that the ways in which people think about their health problems may have significant implications for psychological and physical well-being. This possibility has the greatest consequences for those groups facing health problems on a daily basis, in particular, the elderly. This study examined the role of perceived health barriers and value for health in later life. A Perceived Health Barriers (absent, present) by Health Value (low, medium, high) 2.3 factorial design was analyzed for younger and older seniors on: number of life-threatening diseases, need for health care, and life satisfaction. In addition, a longitudinal design was used to examine the joint roles of perceived health barriers (PHBs) and health value (HV) on mortality. Findings generally indicated that individuals’ PHBs and HV are associated with health-related outcomes; however, the results differed for young and old elders. Among young elders, those with PHBs and those with high HV had the most negati e profile. That is, they had more diseases, higher health care needs, and lower life satisfaction. Among older elders, the findings were more complicated in that the relationship between PHB and the outcomes depended on HV. Overall, the patterns for old elders suggest that perceived health barriers are most relevant among those with medium value for health and least relevant among those with low value for health.     

老年人心理韧性与幸福感的关系:一项元分析

采用元分析方法探讨老年人心理韧性和幸福感之间的关系, 通过文献检索和筛选, 共有42篇中英文文献, 75个独立样本纳入元分析(N = 12856)。结果显示, 老年人心理韧性和幸福感、生活满意度、积极情感呈显著正相关关系, 与消极情感之间呈显著负相关关系; 两者之间的关系受心理韧性的测量工具、文化背景、文献质量、文献年份、样本量和样本人群年龄的影响。研究结果为心理韧性如何影响老年人幸福感提供了较为精确的估计, 对于提高老年人幸福感进而实现成功老化具有重要意义。     

Personality and alcohol dependence

In this study, groups of ‘alcoholic’ subjects were independently rated as to their degree of dependence by a technique previously validated. The two groups of moderately and severely dependent subjects were then given the 101-item EPQ. In keeping with other similar studies, the data suggested that high N, high P and low E in men were related to the Clinical Alcohol Personality. Further analysis of these and other data suggest that whilst raised N scores may be a spurious artefact which is a consequence of heavy alcohol consumption, the E and P findings may reflect stable predispositions. There were no sex differences, but there was a major group difference on P, with both severely dependent men and women scoring significantly higher than their less dependent counterparts.     

Gray, black, and blue: the state of research and intervention for intimate partner abuse among elders

Though not as common as in younger populations, intimate partner abuse (IPA) among elders is a significant and often overlooked problem. In this article, we focus on problems for research and intervention. We begin with a brief review of the phenomena of elder abuse and IPA, highlighting problems resulting from definitional issues and inconsistencies in research methodology. The balance of the paper comprises a discussion of problems for intervention. Drawing from the IPA and elder abuse literatures, risk factors unique to IPA among elders are presented, and limitations of existing screening and risk assessment instruments for use within this context are identified. The focus then shifts to legal considerations when working with elders who have experienced or perpetrated IPA. Our goals are to synthesize the elder abuse and IPA literatures, identify limitations within both, and to reflect upon the state of knowledge regarding IPA among elders. Copyright (c) 2007 John Wiley & Sons, Ltd.     

Elder abuse by family caregivers: Processes and intervention strategies

This study of 104 family caregivers who provided care to 119 elderly kin discusses the stress and conflict that can result when the older person, the caregivers, and the family are unprepared to fulfill the caregiving tasks. Sources of stress that contribute to physical and psychological abuse of the elderly are examined. Suggestions such as setting guidelines, establishing support groups, providing respite and household care, and increasing awareness about the aging process and elder abuse are offered as mechanisms for preventing abusive interactions and increasing the quality of life for the elderly and their families.Revision of a paper presented at the 1986 Groves Conference on Marriage and the Family, London, England.     

Dual-task attention deficits in dysphoric mood

The attentional functioning of nondysphoric, mildly dysphoric, and moderately to severely dysphoric college students was tested using the attentional blink (AB) paradigm. These groups performed equally well at reporting a single target appearing in a rapidly presented stream of stimuli. All groups showed an AB, with report sensitivity for a 2nd target being reduced when the 2 targets were presented less than 0.5 s apart. Nondysphoric and mildly dysphoric participants showed the same size ABs, but the ABs for moderately to severely dysphoric participants were larger and longer. As predicted, the results showed that moderately to severely dysphoric individuals have attentional impairments. These impairments, however, were evident only in the more demanding dual-task condition.     

Invisible Household Labor and Ramifications for Adjustment: Mothers as Captains of Households

We address the issue of invisible labor in the home by examining how the distribution of the mental and emotional labor inherent in managing the household between spouses may be linked with women’s well-being, including their satisfaction with life, partner satisfaction, feelings of emptiness, and experiencing role overload. In a sample of 393 U.S. married/partnered mothers, mostly of upper-middle class backgrounds with dependent children at home, results showed that a majority of women reported that they alone assumed responsibility for household routines involving organizing schedules for the family and maintaining order in the home. Some aspects of responsibilities related to child adjustment were primarily handled by mothers, including being vigilant of children’s emotions, whereas other aspects were shared with partners, including instilling values in the children. Responsibility was largely shared for household finances. Regression analyses showed that after controlling for dimensions of emotional and physical intimacy, feeling disproportionately responsible for household management, especially child adjustment, was associated with strains on mothers’ personal well-being as well as lower satisfaction with the relationship. The implications of our work highlight the need to consider the burden of household management on mothers’ well-being and speak to mothers’ own needs for support and care as the primary managers of the household. In future research on division of labor, it will be useful to measure these critical but often neglected dimensions of who coordinates the household, given potential ramifications of this dimension for the quality of marriages and women’s personal well-being.

     

Prevalence of Cognitively Intact Individuals Residing in Extended Care Nursing Facilities

There appears to be a relative absence of studies that have examined the prevalence of cognitively intact individuals who reside in extended care facilities. Prevalence data were collected on 296 persons who resided in 3 extended care nursing facilities in Central Virginia. Cognitive intactness was evaluated via the Minimum Data Set Cognitive Performance Scale (CPS) and an author-generated survey (i.e., Cognitively Intact Survey [CI Survey]) of select nursing staff members at each facility. The Mini-Mental State Examination (MMSE) was utilized to examine the accuracy of the two measures in identifying cognitive intactness. Findings indicated that prevalence rates of cognitively intact residents varied as a function of the measures utilized to assess intactness. Specifically, a significantly greater proportion of the total sample of residents was judged to be cognitively intact via the CI Survey (34.12%) as compared to the CPS (26.01%). The level of interjudge agreement between the two measures was found to be moderately high (K = 0.68). When the MMSE was employed to verify individuals' levels of intactness, the percentages of residents predicted to actually be cognitively intact were somewhat lower for each measure. Specifically, based on the data obtained via the CI Survey, 22.75% of the total sample were predicted to actually be cognitively intact, whereas 17.85% of the sample were predicted to be intact based on the CPS results. Findings are discussed in light of factors that may have contributed to the differential prevalence rates of cognitively intact individuals obtained across the measures utilized in this study. Concerns regarding the utilization of the MMSE as a criterion measure of cognitive intactness in persons residing in extended care nursing facilities are provided, along with data on the living environments/roommate statuses of those residents judged to be intact via the CI Survey. Implications for the design of future extended care nursing units, as well as future research, are also included.     

Third‐Party Dispute Resolution in India and the United States1

This study investigates the dispute‐resolution approaches of 50 Indian panchayats (a team of 5 male elders), 50 Indian elders, and 50 U.S. informal mediators. A literature review as well as preliminary interviews with Indian students in the United States (n = 90) and with villagers in India (n = 60) established that Indian villagers rely principally on a panchayat or male elder to handle their disputes. Our subsequent study of panchayats and elders in India indicated that they do manage disputes and that their approaches differ in several distinctive ways. Subsequent qualitative and quantitative comparisons of the Indian elders' techniques with those of the U.S. mediators indicated that Indian elders were more assertive in their approaches.     

Development of a Brief Cognitive Screen for Mild Cognitive Impairment and Neurocognitive Disorder

Abstract

The purpose of this study was to develop and evaluate a brief cognitive screen for possible Mild Cognitive Impairment (MCI) and other neurocognitive impairment in a sample of general medical patients. Two hundred community-dwelling general medical patients aged 65 or older participated in this study. Age and education corrected scores from the Rey Auditory Verbal Learning Test and Mattis Dementia Rating Scale were used to classify participants into three groups: MCI, neurocognitive disorder, cognitively intact. Groups were then compared on an independent set of measures: the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery, Mini-Mental State Examination, and Clock Drawing Test. The MCI group constituted 9% of the sample, while 10.5% of the sample was classified into the neurocognitive disorder group. The CERAD Verbal Category Fluency and CERAD Word List Memory Test Delayed Recall measures were individually and collectively the most effective in differentiating cognitively intact elders from persons in both the MCI and neurocognitive disorder groups. We conclude that these two brief measures appear to be effective for detecting possible MCI or neurocognitive disorder, thereby facilitating identification of candidates who would benefit from more detailed neuropsychological assessment.     

Early Childhood Care Trends and Associations with Child Health Well-being in China: Evidence from the CHNS 1991 to 2011 Data

It has become increasingly common for young children to be taken care of by multiple caregivers in China after the socio-economic reforms. Complex migration patterns and high female labour force participation have led to children receiving care from various individuals in different contexts. However, little is known about how childcare arrangements are associated with child health well-being. This study examines various early childhood caregivers and their influences on children’s physical health in China. Using data from the China Health and Nutrition Survey (CHNS 1991–2011) with 3,470 children aged 2 to 6, we first identified different types of childcare arrangements in and outside of the household based on who provides the care, where they provide the care, and the intensity of the care. Then we examined the relationship between various childcare arrangements and health outcomes for children. Overall, household members undertook early childhood care tasks in China, with an increase in grandparents as primary caregivers between 1991 and 2011. The proportion of children receiving formal childcare fluctuated around 20% during this period. The findings suggest that: 1) primary caregiver in the household other than parents is not associated with undesirable physical health outcomes; 2) formal childcare outside the household is associated with higher height and lower BMI scores; 3) primary caregivers in the household, particular grandparents, moderate the association between childcare arrangements outside the household and children’s health outcomes. It yields an implication that early childhood care policies incorporating multiple caregivers would benefit children’s well-being in China.

     

Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.     

Arab American Elders: Network Structure,Perceptions of Relationship Quality,and Discrimination

The metropolitan Detroit area is home to the largest concentration of Arab Americans in the United States and continues to receive immigrants from the Middle East. The nature of aging and social relations among this immigrant/ethnic group is a neglected area of study. In this article, I compared immigrant and U.S.-born Arab American elders in metropolitan Detroit with regard to social integration, relationship quality, and perceptions of discrimination. Using analyses of variance, I compared social network characteristics, revealing that immigrants report smaller, denser networks. I also evaluated quality of social relations; results demonstrate that immigrants are less likely to report that their relationships with their child and best friend are good but more likely to perceive the ability to confide in their spouse. U.S.-born elders are more likely to report that their spouse gets on their nerves and makes too many demands as well as to report experiencing ethnic discrimination. Findings highlight diversity among elder Arabs in America, documenting vulnerabilities as well as strengths in social relationships.     

Interpretation of the personality inventory for children-revised (PIC-R): Influence of cognitive impairment

The Personality Inventory for Children-Revised (PIC-R) is a parent-report measure of social-emotional adjustment for children 3 to 16 years of age. The present study examined the clinical value of the PIC-R by exploring the impact of age and developmental status on PIC-R profiles, particularly on the Psychosis (PSY) scale, within a sample of preschool and school-age children referred for assessment of suspected cognitive impairment and learning problems. Compared to school-age children, significantly more preschoolers obtained elevated scores on the Psychosis scale; those preschoolers with cognitive impairments were even more likely to obtain significantly elevated Psychosis scale scores, despite the absence of diagnosed childhood psychosis. No significant relationship was found between Psychosis scale elevations and cognitive impairment in the school-age group. The PIC-R was moderately accurate in identifying cognitively impaired preschoolers but only minimally accurate in identifying cognitively impaired school-age children.     

Social embeddedness and psychological well-being among African Americans and whites

Using data from the National Medical Expenditure Survey, a household survey of more than 18,000 respondents, this study examined racial and gender differences in social embeddedness, an indicator of community well-being and social support. The study hypothesized that higher levels of social embeddedness would be found among African Americans than among Whites and that the association between social embeddedness and psychological well-being would be stronger among African Americans than among Whites. African American men reported themselves more socially embedded overall than White men and, in one instance, their social involvement was especially important in predicting psychological well-being. African American women were more likely than White women to report attending meetings of churches and community groups, but otherwise were less socially involved than White women. There was no evidence of a difference between African American and White women in strength of the connection between social embeddedness and psychological well-being. African American social involvement is more selective than previously believed and generalizations must be qualified on the basis of gender.     

Clinical Utility of the Mattis Dementia Rating Scale in Older,Urban Medical Patients: An Expanded Study

This study investigated the clinical utility of the Mattis Dementia Rating Scale (DRS), using a sample of 138 cognitively intact and 151 cognitively impaired patients at an urban medical center. The 172 young-old patients (ages 60-79) and the 117 older-old patients (ages 80 and above) were predominantly African American elders who had completed significantly less education than had Mattis’s normative samples. Results show that, despite lower mean scores in our sample versus Mattis’s normative samples, the best cut-off score is nearly identical to Mattis’s in the young-old patients, while a lower cut score provided optimal classification for the older-old patients.