Does Mental Health Care Integration Affect Primary Care Clinician Burnout? Results from a Longitudinal Veterans Affairs Survey

BackgroundBurnout among primary care clinicians (PCPs) is associated with negative health and productivity consequences. The Veterans Health Administration (VA) embedded mental health specialists and care managers in primary care to manage common psychiatric diseases. While challenging to implement, mental health integration is a team-based care model thought to improve clinician well-being.ObjectiveTo examine the relationships between PCP-reported burnout (and secondarily, job satisfaction) and mental health integration at provider and clinic levelsDesignAnalysis of 286 cross-sectional surveys in 2012 (n = 171) and 2013 (n = 115)Participants210 PCPs in one VA regionMain MeasuresOutcomes were PCP-reported burnout (Maslach Burnout Inventory emotional exhaustion subscale), and secondarily, job satisfaction. Two independent variables represented mental health integration: (1) PCP-specialty communication rating and (2) proportion of clinic patients who saw integrated specialists. Using multilevel regression models, we examined PCP-reported burnout (and job satisfaction) and mental health integration, adjusting for PCP characteristics (e.g., gender), PCP ratings of team functioning (communication, knowledge/skills, satisfaction), and organizational factors.Key ResultsOn average, PCPs reported high burnout (29, range = 9–54) across all VA healthcare systems. In total, 46% of PCPs reported “very easy” communication with mental health; 9% of primary clinic patients had seen integrated specialists. Burnout was not significantly associated with mental health communication ratings (β coefficient = − 0.96, standard error [SE] = 1.29, p = 0.46), nor with proportion of clinic patients who saw integrated specialists (β = 0.02, SE = 0.11, p = 0.88). No associations were observed with job satisfaction either. Among study participants, PCPs with poor team functioning, as exhibited by low team communication ratings, reported high burnout (β = − 1.28, SE = 0.22, p < 0.001) and low job satisfaction (β = 0.12, SE = 0.02, p < 0.001).ConclusionsAs currently implemented, primary care and mental health integration did not appear to impact PCP-reported burnout, nor job satisfaction. More research is needed to explore care model variation among clinics in order to optimize implementation to enhance PCP well-being.KEY WORDS: burnout, primary care, mental health, communication, veterans     

Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility,accomplishment of social activities and frequency of leisure activities in older adults having disabilities

BackgroundSocial participation, a determinant of health in older adults, requires innovative interventions. The personalised citizen assistance for social participation (APIC) involves weekly three-hour personalised stimulation sessions targeting significant social and leisure activities difficult to accomplish. Recently adapted for older adults, the APIC’s impact on this population is unknown.ObjectiveThis study explored the impact of APIC on older adults with disabilities.MethodsA mixed-method design including a pre-experimental component was used with 16 participants (11 women) aged 66–91 (79.4 ± 8.7) with disabilities, living at home. They completed functional autonomy, social participation, leisure and quality of life questionnaires, and semi-structured interviews.ResultsAPIC increased older adults’ functional autonomy (p = 0.02), accomplishment (p < 0.01) and satisfaction (p = 0.02) with social participation, and frequency of leisure practice (p < 0.01). Post-intervention, participants wished to modify the practice (p < 0.01) and frequency (p < 0.01) of leisure activities, and difficulties in their social environment diminished (p = 0.03). Their attitude toward leisure (p = 0.04) as well as their health (p < 0.01) and psychological (p = 0.03) quality of life improved. Older adults thought APIC helped them resume, maintain, explore and experiment with significant social activities. It also increased their psychological and physical well-being, feeling of control, connectedness, self-esteem and motivation to accomplish activities. Finally, APIC can compensate for an unavailable and crumbling social network.ConclusionAPIC is a promising intervention that leads to new opportunities for older adults to increase community integration and enhance the social component of their lives. It can also optimise how the needs of older adults are met, including utilisation of personal and environmental resources.     

Association between physical activity participation and perceived social isolation at older ages: Do social participation,age and sex differences matter?

BackgroundPhysical inactivity is a major risk factor for poor health. However, it is unclear how physical activity (PA) is associated with perceived social isolation (PSI) in older age. This study aims to explore 1) association between PA and PSI among older people in Ghana and 2) if social participation (SP), age and sex modify any associations.MethodsThe study focused on 1,201 men and women aged ≥50 years in the AgeHeaPsyWel-HeaSeeB Study. Multivariate ordinary least squares (OLS) models were specified to estimate the regression coefficients and standard errors for the associations of PA and SP with PSI adjusting for potential confounders.ResultsMultivariate OLS regressions showed that engagement in SP (b = -0.442; SE = 0.140; p < 0.001) and regular PA (b = -0.338; SE = 0.152; p < 0.005) were independently associated with decreasing PSI. Also, SP modified the PA—PSI association such that resourceful SP reinforced the link between PA and PSI (b = -0.709; SE = 0.276; p < .005). Finding revealed sex (men: b= -0.712; SE = 0.266; p < 0.005; women: p = 0.083) and age differences (65+: b = -0.437; SE = 0.206; p < 0.005; 50-64: b = -0.502; SE = 0.252; p < 0.05) in the effect of PA on PSI.ConclusionsFindings provide insight into the importance of specific and combined effects of SP and PA on PSI in older age. Public health, clinical practice, and social policy efforts should target social healing and group PA interventions to improve older adults' emotional health.     

Longitudinal associations between cancer history and cognitive functioning among older adults

ObjectivesThis study aimed to examine (1) whether cancer history accelerates older adults’ rates of cognitive decline over time and (2) whether chemotherapy increases older cancer patients’/ survivors’ rates of cognitive decline over time.MethodsThis longitudinal study drew a subsample of 8811 adults aged 65 or older from Wave 6 of the Health and Retirement Study in 2002 and followed biennually until Wave 13 in 2016. Linear mixed-effects models were performed to test whether cancer history and chemotherapy were associated with accelerated rates of cognitive decline over time among older adults in different age groups.ResultsMiddle-old adults (aged 75–84) with a cancer history had significantly reduced rates of cognitive decline over time, including the global measure of cognitive functioning (B = 0.16, p< .01), mental status (B = 0.08, p< .01), and episodic memory (B = 0.09, p< .05) compared to their counterparts without a cancer history. This effect was not significant for the youngest-old (aged 65–74) or oldest-old adults (aged 85 or older). Also, chemotherapy was not significantly associated with older cancer patients’/survivors’ cognitive functioning at baseline or over time in different age groups.ConclusionsThis study finds that cancer history and chemotherapy do not further exacerbate older adults’ cognitive functioning over time. On the contrary, cancer history shows a “protective” effect on middle-old adults’ cognitive functioning. This encouraging finding indicates that older adults can be more actively engaged in the decision-making of treatments and following care plans. Future mediation studies are needed to further investigate underlying mechanisms.     

Exploring the Psychological Impact of HIV: Health Comparisons of Older Australian HIV-Positive and HIV-Negative Gay Men

Little is known about the impact of HIV on the mental health of older gay men. In a nationwide online survey, 1,135 Australian gay men aged 40 years and older reported on their physical and mental health. Compared with HIV-negative men, those with HIV were more likely to report currently receiving treatment for a mental health condition (37 vs. 25 %, p = 0.001), but no more likely to report treatment for a major physical health condition other than HIV (39 % vs. 40 %). On a measure of psychological distress, more HIV-positive men were highly distressed (14 vs. 8 %, p = 0.01). There were no significant differences in mental health across age groups for either HIV-positive or HIV-negative men. Underlying factors for poorer mental health included lower income (p = 0.003), not working (p = 0.004), living alone (p = 0.03), treatment for a major physical health condition (p < 0.001), recent experiences of discrimination (p = 0.03), and regarding one’s sexual orientation as an essential part of self-identity (p < 0.001). With disparities between older HIV-positive and HIV-negative gay men greater for mental than physical health, more attention may need to be given to the psychological well-being of those living with HIV, particularly by addressing underlying psychosocial factors.     

Do Collaborative Care Managers and Technology Enhance Primary Care Satisfaction with Care from Embedded Mental Health Providers?

BackgroundTo improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration.Objective(1) To determine primary care clinical leaders’ overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology).DesignCross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018.ParticipantsSixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate).Main MeasuresWe assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ² tests and multivariable regressions.Key ResultsMost primary care clinical leaders were “very satisfied” with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with “very satisfied” responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with “very satisfied” responses to suicide risk management (p = .002).ConclusionsCare from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-05660-1) contains supplementary material, which is available to authorized users.KEY WORDS: primary care, mental health, care management, collaborative care, health information technology, health informatics, Veterans     

What are the sociodemographic and health determinants for older adults continue to participate in work?

ObjectiveThis study aimed to determine the sociodemographic and health factors that influence older adults who continue to participate in the workforce.MethodsData were collected and evaluated for 1762 older adults aged 65 years and older who were living in the community and were enrolled in a population-based study (FIBRA Network Study). Older adults who participated in the workforce were compared with those who did not in terms of sociodemographic characteristics, physical and mental health, and physical functioning and performance in advanced and instrumental activities characteristic of daily living. A multivariate hierarchical logistic regression analysis was performed.ResultsFactors associated with not participating in the workforce were aged (OR: 1.71, [95% CI: 1.26–2.30], p < 0.001), female gender (OR: 1.70, [95% CI: 1.22–2.37], p = 0.002), poor visual perception (OR: 1.31, [95% CI: 1.00–1.72], p = 0.046), using 4 or more medications regularly (OR: 1.41, [95% CI: 1.489–2.247], p = 0.034), having 3 or more comorbidities (OR: 1.44, [95% CI: 1.01–2.04], p = 0.040), and a handgrip strength below 24.6 kg/f (18.1–24.6 kg/f (2nd tertile): OR: 1.52, [95% CI: 1.06–2.18], p = 0.022; 0–18 kg/f (1st tertile): OR: 1.60, [95% CI: 1.08–2.38], p = 0.019). The probability estimates of the final model explained 67.9% of the events related to not participating in the workforce, as observed by the area under the ROC curve.ConclusionOur results highlight that work in later life is influenced by sociodemographic characteristics, intrinsic capacity, and multimorbidity. We suggest that strategies for optimizing healthy and active aging may help older people to continue participating in the workforce and contributing toward their communities.     

Serum high-density lipoprotein cholesterol concentration and functional state: The Korean Urban Rural Elderly (KURE) Study

BackgroundFunctional state and cholesterol metabolism are important for older adults; however, this association has not been fully investigated among community-dwelling older adults. Thus, we investigated the association of HDL cholesterol with multiple functional state measures in an elderly Korean population.MethodsThis cross-sectional analysis included 3514 participants, aged 65 years or older, who participated in baseline health assessment for the Korean Urban Rural Elderly cohort study from 2012 to 2015. HDL cholesterol concentration was analyzed using both continuous and categorical variables. Functional state was assessed by the mini-mental state examination (MMSE), activities of daily living (ADL) scale, instrumental activities of daily living (IADL) scale, timed up-and go (TUG) test, and chair-rise test (CRT). Multiple logistic regression models were used to investigate independent association between HDL cholesterol and functional state, after adjusting for sex, age, body mass index, systolic blood pressure, fasting glucose, lipid-lowering drug, history of cancer and cardiovascular disease, and health behaviors.ResultsHDL cholesterol concentration was significantly associated with MMSE, ADL, IADL, TUG, and CRT in the unadjusted model. After adjustment for covariates, the association remained significant for MMSE (standardized β = 0.059, p = 0.001), ADL (standardized β = −0.053, p = 0.004), and CRT (standardized β = −0.037, p = 0.037). In fully-adjusted model, Participants who had a lower HDL concentration (<40 mg/dL) showed significantly increased odds for having MMSE decline (OR 1.451, 95% CI 1.119–1.883) and ADL dependency (OR 2.251, 95% CI 1.119–4.526), compared reference group (≥60 mg/dL).ConclusionsHigher HDL cholesterol concentration was associated with better functional state among Korean older adults.     

Urban-rural differences in physical performance and health status among older Japanese community-dwelling women

Background/PurposeAssessment of physical performance allows the identification of health and functional independence among older adults. Several factors, such as environmental conditions, influence the results; therefore our objective was to compare the physical performance and the health status between older Japanese women living in urban and rural communities.MethodsThe Japanese women were aged ≥65 years, and recruited in urban (n = 41, age = 73.8 ± 3.92 years) and rural (n = 54, age = 73.8 ± 4.15 years) locations through the local press. Physical performance was assessed by the Timed Up and Go (TUG), one leg stand (OLS), repeated chair stands (CS) and handgrip strength (HGS) tests. Health status was investigated using socio-demographic characteristics; anthropometric measures and body composition; physical activity, a pedometer, Life-Space Assessment (LSA); Geriatric Depression Scale; incidence of falls, fear of falling; and medical information. Variables were compared by χ² test, Independent-Samples t test and Mann Whitney U-test.ResultsRural individuals presented a better performance in the HGS test (p = 0.01) than urban individuals, who had a better performance in the CS test (p < 0.001). No statistical differences were found in the TUG or OLS tests. Rural women also had a higher body mass index (p = 0.04), waist circumference (p < 0.01), and body fat percentage (p = 0.014) than urban women, who showed higher scores in LSA (p < 0.001). Concerning medical information, more rural women complained of low back pain (p = 0.01) and gastrointestinal problems (p = 0.02).ConclusionOur findings showed that the physical performance and health status varied according to the place. Rural individuals had worse results in the CS test, but a better performance in the HGS test than urban individuals. We emphasize that health interventions should address the specific demand of each location.     

Prevalence and risk factors for insomnia in community-dwelling elderly in northern Taiwan

Background/PurposeTo determine the prevalence and risk factors for insomnia among community-dwelling elderly in northern Taiwan.Materials and methodsA cross-sectional survey was conducted among 1358 elderly people (601 men, 44.3%; and 757 women, 55.7%) who had received a senior-citizen health examination between March 2009 and November 2009. Responses to a clinical questionnaire on insomnia (Chinese version of the Athens insomnia scale), mental health (brief symptom rating scale), and 14 physical symptoms were measured.ResultsInsomnia syndrome was found in 41% of individuals; it was more common in women than in men (63.3.0% vs. 36.7%). Multivariate models showed that aging [≥80 years old, odds ratio (OR) = 0.67, 95% confidence interval (CI): 0.46–0.93], living with family (OR = 0.51, 95% CI: 0.35–0.76), and perceived good health status (OR = 0.58 and 0.71, p<0.05) were associated with a decreased risk of insomnia. Meanwhile, female gender (OR = 1.70, 95% CI: 1.37–2.12), receipt of medication for chronic diseases (OR = 1.64, 95% CI: 1.29–2.08), high brief symptom rating scale score (1.45, 95% CI: 1.32–1.86), perceived poor health status (OR = 1.92 and 1.80, p<0.05), and total physical symptoms (OR = 1.34, 95% CI: 1.08–1.70) were associated with an increased risk of insomnia.ConclusionThe results indicate that the aging process itself is not responsible for the increased prevalence of insomnia often reported in older people. Instead, physical symptoms, receipt of medication for chronic diseases, mental health status, living status, and perceived level of well-being affected the risk of insomnia.     

The longitudinal association between weight change and health‐related quality of life in adults and children: a systematic review

This systematic review examined longitudinal associations between weight change (weight gain and loss) and both physical and mental aspects of health‐related quality of life (HRQOL) compared with stable weight in adults and children of the general population. MEDLINE, EMBASE, PsycINFO and PubMed databases were searched. Longitudinal observational studies measuring HRQOL with six predefined instruments were synthesized according to type of association: weight change and change in HRQOL (change‐on‐change association) and weight change and HRQOL at follow‐up (predictive association). Twenty studies of adults (n = 15) or children (n = 5) were included. Fifteen studies used the SF‐12 or SF‐36. Results of nine studies in adults examining the change‐on‐change association were combined through a tallying of 606 analyses. Weight gain was most often associated with reduced physical, but not mental HRQOL, across all baseline body mass index categories and in both men and women. Weight loss may be associated with improved physical, but not mental HRQOL, among adults with overweight and obesity. Weight gain was more strongly associated with HRQOL than weight loss, implicating a greater need for preventative strategies to tackle obesity. Results in children and for the predictive association generally reflected these findings but require further research.     

Self-perception of uselessness and mortality among older adults in China

BackgroundNegative self-perceptions of aging among older adults have been associated with higher mortality in developed countries. However, it is unclear whether an association exists in developing countries where living to older age is more selective.Design and methodsUsing five waves of data (2000, 2002, 2005, 2008, and 2011) from a national survey of adults aged 65 and older in China (n = 30,948), this study investigates how self-perceived feelings of uselessness are associated with subsequent mortality. Analyses were stratified by sex and age group (65–79, 80–89, 90–99, and 100+), and adjusted for a wide range of covariates.ResultsCompared with women who never reported perceived uselessness, results from adjusted models shows that women who always reported perceived uselessness had 42% (p < 0.001), 31% (p < 0.001), and 24% (p < 0.001) higher risks of mortality in each of the three oldest age groups, respectively. These associations were only slightly attenuated when covariates were adjusted, but non-significant once baseline health was further controlled for. For men, compared with those who never reported perceived uselessness, the adjusted models for those who always reported perceived uselessness had 62% (p < 0.001), 62% (p < 0.001), 69% (p < 0.001), and 25% (p < 0.1) higher risks of mortality in each of the four sequential age groups, respectively. The association was only slightly diminished—and many remained statistically significant—with further adjustments for psychological disposition and baseline health.ConclusionsSelf-perceived uselessness is associated with higher mortality risks in older adults in China. The association is stronger in men than in women and persists at very old ages.     

A mixed methods study describing the self-care practices in an older working population with cardiovascular disease (CVD): Balancing work,life and health

BackgroundSelf-care is essential to cardiovascular disease (CVD) health outcomes, but may be challenging for older working adults.ObjectiveDescribe self-care and the relationship of work-related characteristics to self-care among older workers with CVD.MethodsConvergent mixed methods design (n = 108) assessed self-care, organization of work, job-level and clinical factors; qualitative data (n = 40) explored self-care and working. Data integrated in the final analytic phase.ResultsSixty-eight percent reported adequate self-care maintenance (SC-CHDI maintenance ≥70); only 22% had adequate self-care management (SC-CHDI management ≥ 70). Controlling for physical capacity, work-related factors explained 22% variance in self-care maintenance; physical capacity was only significant determinant of self-care management. Individuals with poor self-care described low job control, job stress and work-life imbalance that interfered with routine self-care. Individuals with poor self-care management reported “feeling stressed out” and “extreme fatigue” attributed to their job.ConclusionsInterventions targeting self-care, stress management and work-life balance among older workers with CVD are needed.     

Gastroparesis in geriatrics population: A United States population study

BackgroundOlder patients with upper gastrointestinal diseases may lack disease-specific symptoms that are required to make the correct diagnosis. This study aimed to compare the gastroparesis demographics, clinical presentation, and surgical management between the older adult and young populations.MethodsThe National Inpatient Sample database was used between the years 2012 and 2014 with the primary diagnosis of gastroparesis. Patients were further divided based on their age into two groups: 70 years or older and younger than 70 years.ResultsThe older adults were more likely to have early satiety and bloating compared to younger population with an odds ratio (OR) = 3.79; 95% Confidence Interval (95%CI) 2.80- 5.11, p < 0.0001 and OR = 2.80, 95%CI 2.07–3.78, p<0.0001 respectively. Older adults had low odds of having nausea with vomiting (OR = 0.86, 95%CI 0.76–0.95, p = 0.003), or abdominal pain (OR = 0.56, 95%CI 0.50–0.63, p<0.0001).ConclusionsOlder adults had more early satiety and bloating, whereas younger patients had more nausea with vomiting and abdominal pain.     

Adults with type 2 diabetes benefit from self-management support intervention regardless of depressive symptoms

AimsElevated depressive symptoms are common among adults with type 2 diabetes (T2D). In a secondary analysis from an RCT of a diabetes self-management support intervention that did not target depressive symptoms, we sought to determine if depressive symptoms were reduced by the intervention (i.e., depressive symptoms an outcome) or, alternatively, if intervention effects on hemoglobin A1c were lesser among persons with clinically elevated depressive symptoms (i.e., depressive symptoms an effect modifier).MethodsWe evaluated a text messaging intervention, REACH, in a diverse (half non-white, half underinsured) sample of N = 506 adults with T2D. Participants completed the Patient Health Questionnaire-8 (PHQ) and A1c tests at baseline and 6 months. We conducted a factor analysis to identify somatic- and cognitive-affective symptoms on the PHQ. We tested our hypotheses with regression models, using interaction terms and subgroup analyses.ResultsREACH improved depressive symptoms among participants with lower baseline A1c (<8.5%; β = −0.133, p = .007; cognitive β = −0.107, p = .038; somatic β = −0.131, p = .014) but not among participants with higher baseline A1c (≥8.5%; β = 0.040, p = .468). Baseline depressive symptoms did not modify the effect on A1c.ConclusionsWe found support for the hypothesis that depressive symptoms – both somatic- and cognitive-affective – may be an outcome, rather than an effect modifier, of effective diabetes self-management support interventions.     

Inverse association between circulating adiponectin levels and skeletal muscle strength in Japanese men and women

Background and aimsIncreased levels of circulating adiponectin in the elderly cause a negative impact on physical function and health status, which suggests that circulating adiponectin may be related to skeletal muscle function. However, data on the relationship between circulating adiponectin levels and skeletal muscle function is limited. Our objective was to investigate the association between serum adiponectin levels and muscle strength in adults.Methods and resultsThis cross-sectional study is a part of the Oroshisho Study of adult employees in Japan from 2008 to 2011. In our study, we used data gathered in 2008–2010 that had included serum adiponectin measurements (n = 1378; age, 19–83 years). From this population, 1259 subjects were evaluated for grip strength (949 men, 310 women), and 965 subjects were evaluated for leg extension power (716 men, 249 women). Multivariate linear regression analyses showed that adiponectin was associated significantly and negatively with both grip strength (β and standard error [SE]: men, −0.09 [0.01], p = 0.010; women, −0.20 [0.03], kg, p = 0.002) and leg extension power (men, −0.09 [0.02], p = 0.014; women, −0.14 [0.07], W, p = 0.032) after adjusting for age, physical activity, nutrient intake, depressive symptoms, metabolic syndrome, C-reactive protein, body mass index, and other lifestyle-related potential confounders.ConclusionThis population-based cross-sectional study indicates an inverse association between serum adiponectin levels and muscle strength in adults. Further studies are necessary to confirm this association and to clarify causality.     

Impact of Early Life Socioeconomic Status on Decision Making in Older Adults Without Dementia

ObjectivesA growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project.Materials and MethodsCross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy.ResultsEarly life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029).ConclusionsFindings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.     

Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing Longitudinal Study of Aging

Differences in frailty between rural and urban older adults have been demonstrated in developed countries. It is not understood how the apparently greater differences in living conditions between different types of regions in China may affect health and outcomes of older Chinese adults. Here, a frailty index (FI) based on the accumulation of health deficits was used to investigate health and survival differences in older Chinese men and women. We studied rural (n = 1121) and urban (n = 2136) older adults (55-97 years old) in the Beijing Longitudinal Study of Aging (BLSA), of whom 48.9% (rural) and 35.4% (urban) died over 8 years of follow-up. The FI was generated from 35 self-reported health deficits. The mean FI increased exponentially with age (r² = 0.87) and was higher in women than in men. The death rate increased significantly with increases in the FI, but women showed a lower death rate than did men. The mean FI in urban older adults (0.12 ± 0.10) was lower than that in their rural counterparts (0.14 ± 0.12, p < 0.001). Urban dwellers showed better survival compared with their counterparts in the rural areas. Adjusted by age, sex, and education level, the hazard ratio for death for each increment of the FI was 1.28 for urban people and 1.27 for rural people. Chinese urban dwellers showed better health and survival than rural dwelling older adults. The FI readily summarized health and mortality differences among different geographic regions, reflecting the impact of the environment, socioeconomics, and medical services on deficit accumulation and on survival.     

Predictors of mental health literacy in older people

ObjectivesOlder adults exhibit poorer mental health literacy than younger adults, including less accuracy at identifying symptoms of mental disorders, and endorsing fewer sources of treatment for a mental disorder. The current study’s intention was to determine if the executive component of cognition is associated with mental health literacy in older adults, when controlling for other established predictors (sex, age, education, and proximity to someone with a mental disorder).MethodThe sample included 85 cognitively healthy adults aged 60 and over. Participants completed the Mini-Addenbrooke’s Cognitive Examination III, the Trail Making Test, a Phonemic Verbal Fluency Test, and the Mental Health Literacy Scale.ResultsA multiple regression indicated that age and mental health proximity significantly and uniquely predicted total mental health literacy (Age: β = -0.22, t = −2.04, p < 0.05; Proximity: β = 0.31, t = 2.78, p < 0.01). Older age predicted poorer PTSD mental health literacy (β = −0.31, t = −2.90, p < 0.01).ConclusionIn neurologically healthy older adults, level of executive function did not contribute to mental health literacy. Older adults in closer proximity to someone with a mental disorder were more likely to have better mental health literacy, a finding that has the potential to inform mental health education and promotion strategies in this population.