Assistive Technologies for Older Adults in Urban Areas: A Literature Review

Assistive technologies have the potential to address problems that older adults encounter when living alone. However, challenges arise when technologies are embedded into urban areas, e.g., restrictions emerging from networking structures, which potentially influence the success of implementing technologies. The development of such technologies requires the consideration of urban structures, including architectural and spatial environments as well as social factors. The goal of this contribution is to analyze the impact of Ambient Assisted Living systems on urban areas and point out challenges for future research. We investigated literature on assistive technology of the past decade, focusing on their potential application in urban areas, and propose a set of categories to classify the extracted approaches. While many contributions support individual users or social interaction, few consider urban structures. Future research is explored, with challenges emerging from novel network technologies, market uptake or adaptation, and the support of social neighborhood structures.     

Older Adults and Gambling: A Review

This paper uses the social cognitive theory model to review the literature on older adult gambling, and related personal and environment characteristics. Results show that lottery is the kind of gambling most frequently played by older adults, followed by casino games. Older adults take trips to casinos to socialize, find excitement, and win money. Although prevalence estimate studies suggest that older adults exhibit the same gambling problems as other groups, studies on the impact of problem gambling show that older adults who gamble are also faced with health impairment, and social and psychological issues. Future research should focus on theory, prevalence estimates, longitudinal studies of the impact of gambling and problem gambling, online gambling, and cross-cultural research. Harm minimization methods may be used to reduce older adult gambling involvement.     

A Review of the Validity of Laboratory Cognitive Tasks Used to Assess Symptoms of ADHD

Reviewed the validity of frequently used laboratory assessment measures of ADHD symptoms using research published since 1991. Emphasized examining the validity of the tasks as they are commonly used by clinicians and researchers. Tasks evaluated included the Continuous Performance Test (CPT) and the Gordon Diagnostic System (GDS), the Children's Checking Task (CCT), Delay of Gratification Tasks, the Choice-Delay Task, (C-DT), and the Stop Signal Task (SST). Results showed that the CPT, C-DT, and the SST had the most support, yet further efforts to evaluate the validity of these measures are needed before they can be used for more than experimental purposes.     

Hallucinations in Older Adults: A Practical Review

Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.     

Cognitive Deficits in Older Adults With Psychotic Depression: A Meta-Analysis

A major depressive disorder with psychotic features, that is, psychotic depression (PD), is often accompanied by cognitive deficits, particularly in older patients. We aimed to assess to what extent various cognitive domains are affected in older patients with PD compared to those with nonpsychotic depression (NPD). Therefore, a systematic search was conducted in Medline, Embase, Web of Science, the Cumulative Index to Nursing and Allied Literature (CINAHL), Google Scholar, and Cochrane for all relevant studies. Hereafter, we conducted a meta-analysis of seven studies on cognitive deficits in older adults (55+ years), comparing patients with PD and patients with NPD. Compared to patients with NPD, those with PD not only showed a significantly poorer performance on overall cognitive function, with a Hedges’ g effect size of ?0.34 (95% confidence interval: ?0.56; ?0.12; p = 0.003), but also on nearly all separate cognitive domains, with Hedges’ g effect sizes ranging from ?0.26 to ?0.64 (all p's <0.003), of which attention was most adversely affected. Verbal fluency showed no significant effect, although this analysis may have been underpowered. The funnel plot suggested no significant publication bias (Egger test intercept: ?2.47; 95% confidence interval: ?5.50; 0.55; p = 0.09). We conclude that older patients with PD show more cognitive deficits on all cognitive domains, except for verbal fluency, compared to patients with NPD. It is crucial that clinicians and researchers take cognitive deficits into consideration in older adults with PD.     

A Scoping Review of Interventions for Spousal Bereavement in Older Adults

The loss of a spouse is a common and natural life event for older adults. Nearly one of four older bereaved spouses experience prolonged grief, impaired function or chronic depression. Mechanisms underlying these and other long-term health risks are not well understood. We conducted a scoping literature review to examine the interventions and outcomes that have been studied for late-life spousal bereavement to date. We identified 22 studies of group and individual-level interventions with most studies concerning grief processes within the first year. Nearly all studies evaluated emotional and psychological symptoms of loss and a small number evaluated the restoration of adaptive functioning. Four interventions addressed the treatment of complicated grief or grief with major depressive disorder. Qualitative studies explored themes of spirituality and mindfulness. There were 17 controlled studies, including 13 randomized controlled trials. Findings were eclectic, with evidence supporting mindfulness techniques in a group format for emotional and life satisfaction outcomes; an individual, function-based therapy addressing sleep to improve emotion and function; an individual, writing-based emotional expression therapy for short-term improvement in emotion and function; nortriptyline for the treatment of bereavement-related major depressive disorder; a group-based, complicated grief therapy for this condition; an internet-based CBT intervention for prolonged grief; and pharmacotherapy for cardiovascular changes during bereavement. These findings highlight the small literature of methodologically strong intervention studies addressing spousal bereavement in older adults and the need for greater exploration of relevant biological, social, cognitive and behavioral factors to improve short and long term health outcomes.     

One-Week Practice Effects in Older Adults: Tools for Assessing Cognitive Change

Although neuropsychologists are frequently asked to evaluate cognitive change in a patient, this can be a complex determination. Using data from 167 non-demented older adults tested twice across one week, the current study sought to provide a variety of reliable change indices for a brief battery of commonly used neuropsychological measures. Statistically significant improvements were observed on seven of nine scores examined over this short retest interval, with the largest changes occurring on memory measures. Information is provided on simple discrepancy scores, standard deviation index, reliable change index (with and without correcting for practice effects), and standardized regression based change formulae for each cognitive score. Even though a one-week retesting interval is a less typical clinical scenario, these results may give clinicians and researchers more options for assessing short-term change in a variety of settings.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Longitudinal Change in Performance on the Montreal Cognitive Assessment in Older Adults

Objective: The Montreal Cognitive Assessment (MoCA) is a brief screening measure commonly used to determine cognitive status among older adults. Despite the popularity of the MoCA, there has been little research into how performance on the MoCA changes over time in healthy older adults. Methods: The present study examined a sample of older adults (n = 53) recruited for a longitudinal study of healthy aging. Change in total MoCA score at three time points (baseline, 12 months, and 48 months) and scores from the Repeatable Battery for the Assessment of Neuropsychological Status at five time points (RBANS; baseline 12 months, 24 months, 36 months, and 48 months) were assessed using repeated measures analyses. Results: Total MoCA score significantly increased across time, particularly between the first and second administrations. Scores did not significantly differ between the second (12 month) and third (48 month) administrations. When grouped by baseline performance, individuals who scored low at baseline significantly improved performance at 12-month testing, but had little change between 12- and 48-month testing. Conversely, individuals who scored high at baseline did not significantly change between baseline and 12-month testing, but improved between 12- and 48-month testing. RBANS scores did not significantly change over time. Conclusions: These results suggest that the MoCA may be susceptible to practice effects, particularly between the first and second administrations. These practice effects should be taken into consideration when repeatedly employing the MoCA to screen for cognitive status in healthy older adults.     

Cognitive Benefit of a Multidomain Intervention for Older Adults at Risk of Cognitive Decline: A Cluster-Randomized Controlled Trial

ObjectiveWe sought to assess cognitive benefits of a community-based multidomain intervention for improving cognition among older adults at risk of cognitive decline (COMBAT).DesignA two-armed cluster-randomized controlled trial.Setting and ParticipantsCommunity-dwelling older adults aged 60 years or older and were at risk of cognitive decline (n = 209).InterventionIn this 9-month intervention study, 10 community hospitals in Beijing, China, were randomized (1:1) to receive either a multidomain intervention of meditation, cognitive training, exercise, and nutrition counseling or usual care. The intervention was delivered with weekly 1-hour group training sessions and weekly home homework.MeasurementsPrimary outcome was change in cognition as measured by a composite Z score of seven cognitive tests. Secondary outcomes included subjective cognitive abilities, positive and negative affective experiences, physical activity, and dietary habits. Assessments were administered at baseline, end of the intervention, and 1 year after completing the intervention (1-year follow-up).ResultsImmediately after the intervention, the intervention group showed significant enhancement in cognitive performance (p = 0.026). The between-group difference in the Z score of change of cognition was 0.20 (95% CI: 0.053, 0.35), with a Hedges’ g of 0.40 (95% CI: 0.29, 0.50). However, this cognitive benefit was not significant at 1-year follow-up.ConclusionThis multidomain intervention was effective to improve cognition for at-risk individuals. Long-term effects on cognitive function and individual differences in response to the intervention deserve further investigation.     

Cognitive and Psychosocial Predictors of Subjective Well-Being in Urban Older Adults

Prior research indicates that physical health and social support have substantial influences on subjective well-being among older adults. However, little research has examined the influences of coping style and cognitive functioning on subjective well-being among older adults. This study investigated cognitive and psychosocial predictors of subjective well-being among 129 adults, ages 65-89 years. Canonical correlation indicated that subjective well-being was characterized by two dimensions: life satisfaction and affective balance (happiness). The use of emotion-focused coping strategies and poor perceived health were associated with diminished perceptions of life satisfaction, whereas task-oriented and avoidance-oriented coping were positively related to happiness. Cognitive functioning was positively related to life satisfaction and pleasant emotions independent of education and income.     

Diagnostic Validity of Sensory Over-Responsivity: A Review of the Literature and Case Reports

Atypical responses to sensory stimulation are frequently reported to co-occur with diagnoses such as autism, ADHD, and Fragile-X syndrome. It has also been suggested that children and adults may present with atypical sensory responses while failing to meet the criteria for other medical or psychological diagnoses. This may be particularly true for individuals with over-responsivity to sensation. This article reviews the literature related to sensory over-responsivity and presents three pediatric cases that present a profile of having sensory over-responsivity without a co-occurring diagnosis. Findings from these cases provide very preliminary evidence to support the suggestion that sensory over-responsivity can occur as a sole diagnosis. Within this small group, tactile over-responsivity was the most common and pervasive form of this condition.     

The Role of Inflammation in the Pathogenesis of Delirium and Dementia in Older Adults: A Review

Aims: To review recent evidence that suggests inflammation plays a similar role in the pathogenesis of delirium and dementia. Methods: We performed a literature search of original research and review articles in PubMed using the keywords: delirium, dementia, and inflammation. We summarized the evidence linking inflammation to the pathogenesis of delirium and dementia. Discussion: Delirium and dementia share similarities in clinical and pathogenic features, leading to the speculation that instead of being distinct clinical entities, the two age‐related conditions may be linked by a common pathogenic mechanism. Inflammatory markers have been shown to be elevated in both delirium and dementia, thereby implicating inflammation as a possible mediating factor in their genesis. There is evidence in both basic science and clinical research literature that elevated cytokines play a crucial role in the development of cognitive dysfunction observed in both dementia and delirium. Conclusion: Mounting evidence supports the role of inflammation in the development of both dementia and delirium. Further studies are needed to elucidate the mechanisms underlying these relationships.