Age of onset and progression of hoarding symptoms in older adults with hoarding disorder

Objectives: We investigated (1) age of onset of hoarding disorder (HD) symptoms and diagnosis, (2) late-onset HD, (3) progression of HD symptoms, and (4) association between demographics and hoarding progression.

Method: Eighty-two older adults with HD provided retrospective ratings of their hoarding symptoms for each decade of life. Age of onset of symptoms (saving, difficulty discarding, and clutter) was operationalized as the first decade in which the participant reported at least minor symptom severity, and age of onset for possible HD diagnosis was operationalized as the first decade in which the participant reported all three symptoms. We used mixed effects modeling to examine the progression of HD symptoms.

Results: The median age of onset for symptoms was between 10 and 20 years, and the median age of onset for possible HD diagnosis was between 20 and 30 years. Twenty-three percent of participants reported onset of possible HD diagnosis after the age of 40. All HD symptoms increased in severity over time. Men reported higher initial clutter and a slower increase in hoarding severity for all symptoms. Increased education was associated with slower increase in saving. Having at least one parent with hoarding tendencies was associated with higher initial hoarding symptoms.

Conclusion: Generally, symptoms of HD begin relatively early and worsen across the lifespan. However, approximately one fourth of older adults with HD reported a possible onset after the age of 40.     

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

Abstract

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age ≥60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD.

Methods: The study included 158 participants in three groups: (1) older adults (60–75 years of age) with ADHD (n?=?42), (2) healthy controls of the same age (n?=?58), and (3) younger adults (age 18–45 years of age) with ADHD (n?=?56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests.

Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels.

Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.     

Functioning in older adults with bipolar disorder: A report on recommendations by the International Society of bipolar disorder (ISBD) older adults with bipolar disorder (OABD) task force

Objectives

Despite the importance of psychosocial functioning impairment in Bipolar Disorder (BD), its role among Older Adults with BD (OABD) is not well known. The development of guidelines for the assessment of psychosocial functioning helps to facilitate a better understanding of OABD and can lead to better tailored interventions to improve the clinical outcomes of this population.

Methods

Through a series of virtual meetings, experts from eight countries in the International Society of Bipolar Disorder (ISBD) on OABD task force developed recommendations for the assessment of psychosocial functioning.

Results

We present (1) a conceptualization of functioning in OABD and differences compared with younger patients; (2) factors related to functioning in OABD; (3) current measures of functioning in OABD and their strengths and limitations; and, (4) other potential sources of information to assess functioning.

Conclusions

The task force created recommendations for assessing functioning in OABD. Current instruments are limited, so measures specifically designed for OABD, such as the validated FAST-O scale, should be more widely adopted. Following the proposed recommendations for assessment can improve research and clinical care in OABD and potentially lead to better treatment outcomes.     

Group cognitive behavioral therapy targeting intolerance of uncertainty: a randomized trial for older Chinese adults with generalized anxiety disorder

Objectives: China has entered the aging society, but the social support systems for the elderly are underdeveloped, which may make the elderly feel anxiety about their health and life quality. Given the prevalence of generalized anxiety disorder (GAD) in the elderly, it is very important to pay more attention to the treatment for old adults. Although cognitive behavioral therapy targeting intolerance of uncertainty (CBT-IU) has been applied to different groups of patients with GAD, few studies have been performed to date. In addition, the effects of CBT-IU are not well understood, especially when applied to older adults with GAD.

Method: Sixty-three Chinese older adults with a principal diagnosis of GAD were enrolled. Of these, 32 were randomized to receive group CBT-IU (intervention group) and 31 were untreated (control group). GAD and related symptoms were assessed using the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale–Chinese Version, Beck Anxiety Inventory, Beck Depression Inventory, Why Worry-II scale, Cognitive Avoidance Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and Generalized Anxiety Disorder Severity Scale across the intervention. The changes between pre and after the intervention were collected, as well as the six-month follow-up. F test and repeated-measures ANOVA were conducted to analyze the data.

Results: Compared to control group, the measures’ scores of experimental group decreased significantly after the intervention and six-month follow-up. Besides the main effects for time and group were significant, the interaction effect for group × time was also significant. These results indicated the improvement of the CBT-IU group and the persistence of effect after six months.

Conclusion: Group CBT-IU is effective in Chinese older adults with GAD. The effects of CBT-IU on GAD symptoms persist for at least six months after treatment.     

Life-crossroads on stage: integrating life review and drama therapy for older adults

Objective: This paper examines the contribution of a new group of therapeutic interventions for older adults, based on a rudimentary life-review intervention.

The intervention includes narrative elements together with drama therapy. The current study examines the influence of this therapeutic intervention on key indicators of mental health and psychological well-being among older adults.

Method: Fifty-five people (n = 55), ranging in age from 62 to 93, participated in a before–after study design. The following indices – meaning in life, self-acceptance, relationships with others, depressive symptoms, and experience of successful aging – were compared between an intervention group (n = 27) and a care-as-usual control group (n = 28).

Results: Repeated measures analyses of variance showed a significant improvement over time in the experimental group. In addition, results also showed time-group interaction regarding the treatment's effectiveness for self-acceptance, relationships with others, sense of meaning in life, sense of successful aging, and depressive symptoms.

Conclusion: Our findings confirm that the new therapeutic intervention, which integrates life-review with drama therapy, increases self-acceptance, relationships with others, sense of meaning in life, and sense of successful aging; in turn, it also decreases depressive symptoms among older adults. The contribution of this research is based on the development of a therapeutic intervention that combines narrative together with drama therapy tools, which can be used in focused and short-term group treatments with the elderly.     

Movement in mind: the relationship of exercise with cognitive status for older adults in the Swedish National Study on Aging and Care (SNAC)

The purpose of this study was to investigate the relationship of light and strenuous exercise, and self-reported change in exercise status, with different components of cognitive function, and gender differences in this relation, in a large, representative sample included in the Swedish National study on Aging and Care (SNAC). Eight-hundred-and-thirteen participants in age-cohorts from 60-96 years completed a wide range of cognitive function tests, the Mini Mental State Exam (MMSE) and survey questions concerning exercise behaviour and exercise change with light or strenuous intensity. ANCOVA, controlling for age, education, depression, functional status and co-morbidity, demonstrated a main effect for light exercise, but not for strenuous exercise, on five of the six cognitive tests and the MMSE, for men but nor for women. A negative change in exercise status was associated with lower MMSE scores for men but not for women. Individuals exercising with light intensity several times a week had the highest cognitive test and MMSE scores and the inactive group had the lowest scores. The results of the study may contribute to increased knowledge in the exercise-mental health relationship for elderly and spawn new research specifically on gender differences in this relation.     

Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: a mixed-methods study

ABSTRACT

Objectives: In a rapidly aging world population, an increasingly large group faces age-related decline in cognitive functioning. Cognitive complaints of older adults are often related to worries and concerns associated with age-related functional decline. Mindfulness-Based Stress Reduction (MBSR) can successfully target stress, worry and ruminative thinking, but the applicability of this method in middle-aged and older adults with memory complaints is unclear.

Method: Patients of a university hospital memory clinic (n = 13), aged 45–85 years, with memory complaints but no diagnosis of cognitive disorder, participated in a standard 8-week MBSR program, consisting of weekly group meetings and a one-day silent retreat. After completion, semi-structured qualitative interviews were conducted. Questionnaires (administered before, one week after and five weeks after the intervention) assessed quality of life, psychological distress (stress, anxiety and depressive symptoms), mindfulness, self-compassion, and subjective memory functioning. Neurocognitive functioning was assessed online, before and after the intervention.

Results: The qualitative analysis showed positive effects of the training (e.g. increased serenity), many participants worrying less about memory complaints. The self-reported measures were in line with the results of the qualitative analysis.

Conclusion: This exploratory mixed-methods study suggests that MBSR is feasible and well received among older individuals with cognitive complaints.     

Rhythmic stepping exercise under cognitive conditions improves fall risk factors in community-dwelling older adults: Preliminary results of a cluster-randomized controlled trial

Objective: The purpose of this pilot trial was to evaluate whether a 24-week program of rhythmic stepping exercise (RSE) would be effective in improving physical function and reducing fear of falling in older adults.

Participants: Four units (n?=?52) randomized into an RSE group (two units, n?=?25) and a non-rhythmic stepping exercise (NRSE) group (two units, n?=?27) participated in a pilot cluster randomized controlled trial.

Methods: Each exercise group received 60?min group training sessions once a week for 24 weeks. Measurement was based on the difference in physical functions between the RSE and NRSE groups.

Results: Significant differences were observed between the two groups for locomotive function with significant group?×?time interaction. Relative risk was calculated as 2.778 (95% CI: 1.030–7.492) for fear of falling for participants in the NRSE group compared with patients in the RSE group (p?=?0.037).

Conclusions: The results of this pilot trial suggest that the RSE program is more effective in improving locomotive function and fear of falling.     

The influence of social factors and health on depressive symptoms and worry: a study of older Vietnamese adults

Objectives: Vietnam has a growing older population, many of whom experienced war and social upheavals in their lives. Prior research has described the health of the older population, but little work has explored mental health. The current study examines the frequency and correlates of two mental health indicators: depressive symptoms and worry.

Method: A representative sample of 600 adults 55 and older stratified by gender (50% women), age (mean?=?70.33), and rural/urban (50% rural) was recruited in Da Nang, Vietnam and surrounding rural districts. Participants were interviewed in their homes by trained interviewers. Dependent variables were a Vietnamese version of the CES-D and a culturally specific worry scale.

Results: Forty-seven percent of the sample had scores above the cut-off for clinical depression and scores on the worry scale were high. Using multiple linear regressions we found that women, the less educated and individuals with more material hardship had higher depressive symptoms whereas rural residents, women, married, and young-old individuals were more worried. Pain, ADL assistance and emotional support were significant predictors of both depressive symptoms and worry, though the direction of the association for emotional support differed. Illnesses were only a predictor of depressive symptoms.

Conclusion: The high reports of depressive symptoms and worry suggests the need for incorporating mental health screening as part of health programs for older adults in Vietnam. Attention to factors associated with depressive symptoms and worry, such as economic hardship, health problems and lack of emotional support, may contribute to alleviation of symptoms.     

Therapist and client race/ethnicity match: An examination of treatment outcome and process with rural older adults in the deep south

Abstract

This study investigated the effects of race/ethnicity (r/e) match in cognitive-behavioral therapy with rural older adults. Races/ethnicities represented in this study were African-American and White. Treatment followed a CBT treatment protocol and was provided by MSWs to clients in their homes. Results indicated little evidence of differences in outcome and process for matched and non-matched dyads for number of sessions attended, changes in quality of life and psychological symptoms, overall quality of therapy sessions, or the number of sessions considered of unsatisfactory quality. Our findings are consistent with recent research on r/e matching and extend these findings to a sample of rural older adults.     

Functional connectivity associated with social networks in older adults: A resting-state fMRI study

Poor social networks and decreased levels of social support are associated with worse mood, health, and cognition in younger and older adults. Yet, we know very little about the brain substrates associated with social networks and social support, particularly in older adults. This study examined functional brain substrates associated with social networks using the Social Network Index (SNI) and resting-state functional magnetic resonance imaging (fMRI). Resting-state fMRI data from 28 non-demented older adults were analyzed with independent components analyses. As expected, four established resting-state networks—previously linked to motor, vision, speech, and other language functions—correlated with the quality (SNI-1: total number of high-contact roles of a respondent) and quantity (SNI-2: total number of individuals in a respondent’s social network) of social networks: a sensorimotor, a visual, a vestibular/insular, and a left frontoparietal network. Moreover, SNI-1 was associated with greater functional connectivity in the lateral prefrontal regions of the left frontoparietal network, while SNI-2 was associated with greater functional connectivity in the medial prefrontal regions of this network. Thus, lateral prefrontal regions may be particularly linked to the quality of social networks while medial prefrontal regions may be particularly linked to the quantity of social networks.