A neuropsychological study of older adult first-time sex offenders

Background/Aims: The issue of whether sex offenders have cognitive deficits remains controversial. The objective of this study was to compare the neuropsychological function of older adult first time sex-offenders (FTSO), who had not previously been charged with a sexual offence prior to the age of 50, to historical long-term sex offenders (HSO) and non-sex offenders (NSO). The hypotheses were (a) that FTSO would demonstrate greater deficits in executive function, decision-making, and memory compared to non-sex offenders; and (b) the HSOs would present similar neuropsychological deficits to non-sex offenders.

Method: A battery of neuropsychological measures was administered to 100 participants comprising 32 FTSOs, 36 HSOs, and 32 NSOs.

Results: Both FTSOs and HSOs showed significant impairment on tests of executive function (including verbal fluency, trail-making, and the Hayling test of response inhibition) as well as on tests of verbal and verbal memory compared to NSOs; however, there was no difference between the two sex offender groups.

Conclusions: Older adult sex offenders, overall, demonstrated poorer neuropsychological performance than older adult non-sex offenders did, although there was no difference between older first-time and historical offenders. Cognitive deficits may increase the risk of sexual offending due to impaired capacity in self-regulation, planning, judgment, and inhibition. A proportion of older adult sex offenders may be harboring acquired frontal lobe pathology.     

The role of sex and autonomy-connectedness in internalizing and externalizing personality pathology,coping and axis-I pathology: among psychiatric and healthy elderly

Objectives: In the current study we investigated the relationship of sex and autonomy-connectedness with internalizing and externalizing personality disorder symptoms (PDS), coping and axis-I pathology in older age.

Method: A path model was tested which was based on neo-analytical object relation, attachment- and primary-personality theory, among 100 clinical and 106 non-clinical elderly.

Results: In line with our model, autonomy-connectedness (self-awareness and capacity of managing new situations) was strongly associated to internalizing PDS in both groups. In both groups, neither sex nor autonomy-connectedness predicted externalizing PDS. Sex, internalizing as well as externalizing PDS and reactive defensive coping were associated to axis-I psychopathology.

Conclusions: We conclude that sex and autonomy-connectedness were, similarly as in adult populations, associated to internalizing PDS and axis-I pathology. Treatment of elderly with internalizing PDS and axis-I psychopathology should therefore focus on enhancing autonomy-connectedness.     

Fire-setting performed in adolescence or early adulthood predicts schizophrenia: a register-based follow-up study of pre-trial offenders

Background: Aggressive and disruptive behaviours often precede the onset of serious mental illnesses. Fire-setting is a type of crime that is associated with psychotic disorders.

Aim: The aim of this prospective follow-up study was to investigate if fire-setting performed in adolescence or early adulthood was associated with future diagnoses of schizophrenia or schizoaffective disorder.

Methods: The consecutive sample consisted of 111 Finnish 15–25-year old males with fire-setting crimes, decreed to a pre-trial forensic psychiatric examination in 1973–1998, and showing no past nor current psychosis at the time of examination. For each firesetter, four age-, gender-, and place of birth-matched controls were randomly selected from the Central Population Register. The subjects were followed until the death of the individual, until they moved abroad, or until the end of 2012.

Results: Fourteen firesetters (12.6%) and five controls (1.1%) were diagnosed with either schizophrenia or schizoaffective disorder later in life, corresponding to a hazard ratio of 12.5. The delay between the fire-setting offense and the future diagnosis was on average nearly 10 years.

Conclusions: Young male offenders undergoing a forensic psychiatric examination because of fire-setting crimes had a significant propensity for schizophrenia and schizoaffective disorder. Accurate assessments should be made both during imprisonment and later in life to detect possible psychotic signs in these individuals.     

Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: a large-scale population-based study in Japan

Objective: To identify predictors for depression among family caregivers of community-dwelling older people under the Long Term Care Insurance (LTCI) program in Japan through a large-scale population-based survey.

Method: All 5938 older people with disabilities, using domiciliary services under the LTCI in the city of Toyama, and their family caregivers participated in this study. Caregiver depression was defined as scores of ≥16 on the Center for Epidemiological Studies Depression Scale (CES-D). Other caregiver measures included age, sex, hours spent caregiving, relationship to the care recipient, income adequacy, living arrangement, self-rated health, and work status. Care recipient measures included age, sex, level of functional disability, and severity of dementia. The data from 4128 pairs of the care recipients and their family caregivers were eligible for further analyses. A multiple logistic regression analysis was used to examine the predictors associated with being at risk of clinical depression (CES-D of ≥16).

Results: Overall, 34.2% of caregivers scored ≥16 on the CES-D. The independent predictors for depression by logistic regression analysis were six caregiver characteristics (female, income inadequacy, longer hours spent caregiving, worse subjective health, and co-residence with the care recipient) and one care-recipient characteristic (moderate dementia).

Conclusion: This is one of the first population-based examinations of caregivers of older people who are enrolled in a national service system that provides affordable access to services. The results highlighted the importance of monitoring caregivers who manifest the identified predictors to attenuate caregiver depression at the population level under the LTCI.     

Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

The impacts of community social capital on the life satisfaction of older adults in Hong Kong: the moderator role of intergenerational family capital

Objective: This study examined the moderator role of intergenerational family capital on the relationship between community social capital and life satisfaction of older Chinese adults.

Method: The data were derived from a quota sampling of 372 older adults aged 60 and above, who were interviewed at four districts in Hong Kong in 2011. Multiple group analysis was employed to examine the proposed model.

Results: For the low family capital group, community social capital was found to be a significant predictor of life satisfaction, even when the well-known covariates were controlled. However, the association between community social capital and life satisfaction was statistically non-significant among the high family capital group.

Discussion: The findings highlighted the interplay between community social capital and intergenerational family capital, which supported community social capital replacement theory in understanding the mechanism linking social capital to life satisfaction in older age in a Chinese context. Community social capital can play a compensatory role in maintaining the mental health of older people. It is particularly important for older adults who lack family support and/or suffer from social isolation and loneliness in local communities.     

Does social capital influence preferences for aging in place? Evidence from urban China

Objective: This study investigated the relationships between social capital and preferences for aging in place among older urban adults in eastern China.

Method: Quota sampling was used to recruit 456 respondents aged 60 and older from Gusu District, Suzhou City, in 2015. Random-effects logistic regression was used to test the proposed model.

Results: Respondents who had better quality family social capital, a higher level of social trust, and more organization memberships were more likely to choose to live in local communities, even after we controlled for individual characteristics.

Discussion: The findings highlight the important role of both family and community social capital in influencing preferences for aging in place among older adults in urban China. This is particularly important for developing long-term care systems for older adults living in naturally occurring retirement communities.     

The association between negative attitudes toward aging and mental health among middle-aged and older gay and heterosexual men in Israel

Objectives: The association between negative attitudes toward aging and mental health (indicated by depressive symptoms, neuroticism, and happiness) was explored among Israeli middle-aged and older gay and heterosexual men.

Method: In a community-dwelling sample, 152 middle-aged and older gay men and 120 middle-aged and older heterosexual men at the age range of 50–87 (M = 59.3, SD = 7.5) completed measures of negative attitudes toward aging, depressive symptoms, neuroticism, and happiness.

Results: After controlling for socio-demographic characteristics, the association between negative attitudes toward aging and mental health was moderated by sexual orientation, demonstrating that negative attitudes toward aging were more strongly associated with adverse mental health concomitants among middle-aged and older gay men compared to middle-aged and older heterosexual men.

Conclusions: The findings suggest vulnerability of middle-aged and older gay men to risks of aging, as their mental health is markedly linked with their negative attitudes toward aging. This vulnerability should be addressed by clinicians and counselors who work with middle-aged and older gay men.     

Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Objective: Analysis of three case reports of nerve root anomalies detected intra-operatively and its implications.

Design: Data collected during one year prospective non-randomised study using hospital records.

Setting: Single tertiary care centre.

Subjects: 3 patients in one year period.     

Moderating effect of communication difficulty on the relationship between depression and pain: a study on community-dwelling older adults in Hong Kong

Objectives: This study examined the relationship between depression and pain, and the moderating effect of communication difficulty on this relationship, among community-dwelling older adults in Hong Kong.

Method: We used logistic regression to analyze secondary data regarding 12,402 Chinese older adults applying for long-term care service in Hong Kong in 2012.

Results: Approximately 30% of participants were depressed and 37% experienced communication difficulty. Depression was associated with increased pain. Communication difficulty was found to moderate the relationship between depression and pain. Pain scores increased more when individuals who experienced communication difficulty reported being depressed, compared to those who did not experience communication difficulty.

Conclusion: The moderating effect of communication difficulty may be explained by the interaction between depression and communication difficulty. Participants who were depressed and concurrently experienced communication difficulty may be more likely to catastrophize their pain and may tend to report or experience more pain. Health care professionals need to be aware of the different effects of communication difficulty on the pain experiences of older adults. Psychosocial intervention may be provided to minimize older adults’ communication barriers to pain management.     

Marital satisfaction and depressive symptoms among Chinese older couples

Background: Depression is one of the most prevalent mental disorders among older people. Consistent with the Marital Discord Model of Depression (MDMD), research in Western cultures has found that marital distress is one of the risk factors for depression among older adults. However, the effect of marital distress on depression among older adults has not been examined in a collectivistic society, such as China.

Objectives: The purpose of this study was to examine the relationship between marital satisfaction and depressive symptoms in a sample of Chinese older adults. Considering the dyadic nature of the data, the Actor–Partner Interdependence Model was used to test for the actor and partner effects.

Methods: The study investigated 139 older couples who were recruited from communities in Beijing, the capital of China. The Lock–Wallace Marital Adjustment and the CES-D scales were administered to the participants.

Results: The results indicated that neither of the actor effects was significant. One of the partner effects was significant, with the husbands’ marital satisfaction predicting their wives’ depressive symptoms.

Conclusions: The MDMD was only partially supported among older couples in China. An asymmetrical pattern of cross-spouse effects was found, suggesting that the husbands’ perception of marital dissatisfaction could significantly predict their wives’ depressive symptoms.     

Death ideation in older adults: psychological symptoms of depression,thwarted belongingness,and perceived burdensomeness

Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation.

Objectives: The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation.

Method: A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression.

Results: The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled.

Conclusion: This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.     

Living with ‘Hwa-byung’: the psycho-social impact of elder mistreatment on the health and well-being of older people

Objectives: Elder abuse and neglect is an increasing concern that adversely affects the health and well-being of older people in most societies. The purpose of this paper is to describe the psycho-social impact of elder mistreatment on the health and well-being of older Korean people living in New Zealand.

Method: Data were collected from in-depth interviews. The lived experiences of elder abuse and neglect were studied with 10 older people who were, or who had been, mistreated in their family context. To analyse the data collected, a combined analysis approach was employed using traditional code-based techniques and a concept-mapping method.

Results: The findings of the study show that the effects of elder mistreatment were complex and multidimensional. The older persons who were mistreated in family settings experienced a range of emotional, psychological distress and physical symptoms. Many of them identified ‘Hwa-byung’ (literally anger disease) as a health issue associated with suppressed emotions of anger, demoralisation, heat sensation and other somatised symptoms.

Conclusion: Elder abuse and neglect is a traumatic life event that has considerable psycho-social impacts on older people experiencing the problem. It is important to recognise the power of multidimensional challenges caused by elder mistreatment in health and well-being.     

Let's talk about sex: a critical narrative analysis of heterosexual couples' accounts of low sexual desire

Background/Aims: Low desire for sex is common in the lives of women and causes distress where there is desire discrepancy in a relationship. Very little research, however, has investigated low sexual desire in the context of couple relationships. Aims of this research were to explore couples' narratives of low sexual desire and to connect these findings to therapeutic practice.

Methodology: Eight narratives were gathered individually from the members of four heterosexual couples in which the woman was experiencing low sexual desire. Narratives were analysed using critical narrative analysis.

Results: Six main themes arose from the narratives, including shared experiences of blame and problematic communication patterns. Entitlement, doubt, and conflation of love and sex emerged as men-only themes, while anxiety over abnormality and seeking causes of low sexual desire were prevalent for women. Identity-focused analysis of the narratives showed the men adopting a role of victim, with the women occupying a role of self-sacrifice. Applying a feminist critique highlighted pathologisation of normal sexual variation, and the dominance of male-centred views about sexuality.

Implications: The results underlined the importance of a systemic approach, normalisation of experience, and the importance of arriving at a shared narrative of low sexual desire.     

A light in a sea of darkness: the moderating role of emotional complexity in the PTSD symptoms-successful aging association

Objectives: This study aimed to assess the underexplored effects of posttraumatic stress disorder (PTSD) symptoms on objective and subjective successful aging and to inquire whether emotional complexity moderates these effects.

Methods: Community-dwelling older adults (N = 127, mean age = 67.86, SD = 11.07) rated their PTSD symptoms and completed measures of objective and subjective successful aging. They further reported their emotions on a daily basis over 14 days.

Results: After controlling for background characteristics, self-rated health and cumulative lifetime adversity, results showed that higher PTSD symptoms were related to less successful aging, both objective and subjective. However, this relationship existed only amongst older adults with low emotional complexity, but not amongst those with high emotional complexity.

Conclusion: The findings suggest that high emotional complexity buffers against the negative effects of PTSD symptoms on successful aging. Interventions that empower emotional complexity amongst traumatized older adults may attenuate these negative effects.     

Race differences in the association of spiritual experiences and life satisfaction in older age

Objectives: The primary objective of this study was to examine an African American ‘faith advantage’ in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites.

Method: The data came from 6864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale.

Results: In a regression model adjusting for age, sex, marital status, education, income and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race by spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans.

Conclusion: The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource – distinct from worship attendance – that enable older African Americans to overcome decrements in life satisfaction and, in fact, that lower spiritual experiences may be especially harmful for older African American's life satisfaction.     

Does participation in art classes influence performance on two different cognitive tasks?

Objectives: Effects of two mentally stimulating art interventions on processing speed and visuo-spatial cognition were compared in three samples.

Method: In a randomized 10-week art intervention study with a pre-post follow-up design, 113 adults (27 healthy older adults with subjective memory complaints, 50 healthy older adults and 36 healthy younger adults) were randomly assigned to one of two groups: visual art production or cognitive art evaluation, where the participants either produced or evaluated art. ANOVAs with repeated measures were computed to observe effects on the Symbol-Digit Test, and the Stick Test.

Results: Significant Time effects were found with regard to processing speed and visuo-spatial cognition. Additionally, there was found a significant Time × Sample interaction for processing speed. The effects proved robust after testing for education and adding sex as additional factor.

Conclusion: Mental stimulation by participation in art classes leads to an improvement of processing speed and visuo-spatial cognition. Further investigation is required to improve understanding of the potential impact of art intervention on cognitive abilities across adulthood.     

Exploring the relationships among humility,negative interaction in the church,and depressed affect

Objective: The purpose of this study is to test three hypotheses involving humility. The first hypothesis specifies that people who are more deeply involved in religion will be more humble than individuals who are not as involved in religion. The second hypothesis predicts that humility will offset the effects of negative interaction in the church on depressed affect scores. The third hypothesis specifies that there will be a positive relationship between age and humility.

Methods: The data come from the Religion, Aging, and Health Survey, a nationwide survey of middle-aged and older Christians who attend church on a regular basis (N = 1154).

Results: The findings suggest that people who are more committed to their faith tend to be more humble. The results also reveal that negative interaction in the church is greater for people with lower humility scores than individuals with higher humility scores. In contrast, the data indicate that older adults are not more humble than middle-aged people.

Conclusions: The findings are noteworthy because they identify a source of resilience that may help middle-aged and older adults cope more effectively with the effects of stress.     

Intergenerational financial exchange and the psychological well-being of older adults in the Republic of Korea

Objectives: This study examined whether the exchange of instrumental support (i.e., financial resources) among older adults and their children was related to the psychological well-being of older Koreans.

Methods: Data from the Korean Longitudinal Study of Ageing were employed. Older adults who were aged 65 and older and who had at least one living child who did not live in the respondent's household were included (N = 3791). Well-being was measured with depressive symptoms (CES-D-10) and life satisfaction. For the direction model of exchange, giving and receiving support was assessed with financial aid (cash and non-cash). For the reciprocity model of exchange, four patterns of financial exchanges were identified: both giving and receiving, receiving only, giving only, and no exchange.

Results: The results from the direction model showed that older adults who give financial support were less likely to be depressed and reported higher levels of life satisfaction. The effect of receiving support was not significant for depression but was related to higher levels of life satisfaction. The results from the reciprocity model showed that those who gave and received support had better psychological health compared to those who only received support.

Conclusions: Both giving and receiving were positively related to the psychological well-being of older adults. Our results provide support for identity theory and equity theory as frameworks for understanding intergenerational exchange and well-being of older Koreans.     

Self-perceived coping resources of middle-aged and older adults – results of a large population-based study

Objectives: Psychosocial resources (personal resources, social resources, and other) are important for coping with aging and impairment. The aim of this study was to describe the resources of older adults and to compare subgroups with frailty, complex health care needs, and/or mental disorders.

Method: At the third follow-up of the large population-based German ESTHER study, 3124 elderly persons (aged 55–85) were included. Psychosocial resources were assessed during a home visit by trained study doctors by using a list of 26 different items. Resources were described for the total group, separated by sex, and for the three subgroups of persons with frailty, complex health care needs, and mental disorders.

Results: Family, self-efficacy, and financial security were the most frequently reported resources of older adults. Women and men showed significant differences in their self-perceived resources. Personal resources (self-efficacy, optimism, mastery), social resources, and financial security were reported significantly less frequently by frail persons, persons with complex health care needs, and mentally ill older adults compared to non-impaired participants. Apart from external support, patients who experienced complex health care needs reported resources less frequently compared to frail and mentally ill patients.

Conclusion: Coping resources in older adults are associated with sex and impairment. Evaluation and support of personal resources of frail or mentally ill persons or individuals with complex health care needs should be integrated in the therapeutic process.