Psychiatric morbidity and its correlates among informal caregivers of older adults

ObjectiveThis present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions.MethodsData from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who ‘knew the older adult best’ and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥ 8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score < or ≥ 8) was used as a dependent variable and all other variables served as independent covariates.ResultsAmong informal caregivers, 8.8% exhibited psychiatric morbidity. Higher proportions of spousal caregivers and caregivers of older adults having more care needs and BPSD exhibited psychiatric morbidity. After adjusting for all covariates, caregivers' marital status, and the presence of BPSD and dementia in the older adults were identified as the strongest correlates of caregivers' psychiatric morbidity. The prevalence of psychiatric morbidity was 10%, 13.9% and 12.7% respectively in these groups. Married caregivers had higher odds of psychiatric morbidity (OR 2.50, 95% CI: 1.13–5.52). In addition, caregivers of older adults' with any BPSD (OR 5.87, 95% CI: 2.60–13.24) and dementia (OR 2.28, 95% CI: 1.23–4.20) were also associated with higher odds of psychiatric morbidity.ConclusionInformal caregivers' marital status and presence of any BPSD and dementia in the older adults in their care were identified as the strongest correlates of caregivers' psychiatric morbidity. Clinicians should be cognizant of the risk in this group of caregivers and assess and intervene to alleviate caregivers' psychological problems.     

Sleep and its disorders in older adults.

For many older adults, aging is associated with significant changes in sleep. There are a variety of potential causes, including primary sleep disorders, circadian rhythm disturbances, insomnia, depression, medical illness, and medications. As with younger adults, the diagnosis requires a thorough sleep history and an overnight sleep recording when appropriate. Treatment should address the primary sleep problem and can result in significant improvement in quality of life and daytime functioning in older adults.     

Fear of falling and its predictors among community-living older adults in Korea

Objectives: To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea.

Methods: Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF.

Results: In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996–4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063–2.858), being female (OR = 2.335, 95% CI = 2.023–2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625–2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230–2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357–1.997), living without a spouse (OR = 1.626, 95% CI = 1.357–1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356–1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150–1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150–1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065–1.114).

Conclusion: A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.     

Prevalence of hypotension and its association with cognitive function among older adults

Background and Objective: The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates.

Methodology: The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled “Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly”, conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0.

Results: The mean age of the respondents was 68.27 (SD?=?5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD?=?4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta?=??0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis.

Conclusion: The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.     

Gambling participation and problems among older adults

Few studies have evaluated rates of gambling participation and problems in older adults. This study recruited 492 adults aged 65 years and older from bingo sites (n = 132) and senior centers (n = 360). Compared to those recruited from senior centers, participants recruited at bingo events had higher South Oaks Gambling Screen (SOGS) scores and greater gambling frequency and expenditures. Lifetime rates of combined problem and pathological gambling were 12.9% in the bingo sample and 9.7% in the senior center sample (10.6% overall). Compared to non-problem gamblers, problem and pathological gamblers were more likely to be younger (73 versus 76 years) and male (52% versus 27%). Overall, 39.1% reported gambling at least twice per month over the past year, and 33.7% wagered dollars 50 or more over the prior 2 months. This study suggests that subsets of active older adults have high rates of gambling participation and problems.     

Psychometric validation of the Geriatric Suicide Ideation Scale (GSIS) among older adults with bipolar disorder

Objectives: Across age groups, bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions; 25%–50% of those with BD will make one or more suicide attempt. Psychometrically sound instruments are required to reliably measure suicide ideation and risk of self-harm for older adults with BD. For this study, we validate the geriatric suicide ideation scale (GSIS) with adults 50+ years with BD.

Methods: We recruited a global sample of 220 older adults with BD (M = 58.50 years of age) over 19 days using socio-demographically targeted, social media advertising and online data collection. To demonstrate the construct validation of GSIS responses by older adults with BD, we computed correlations and performed regression analyses to identify predictors of suicide ideation.

Results: Our analyses support a four-factor model of responses to the GSIS (ideation, death ideation, loss of personal and social worth, and perceived meaning in life) measuring a higher order latent construct. Older adults with BD reporting low satisfaction with life and current depressive symptoms, and who misuse alcohol, report significantly higher levels of suicide ideation. Sleep quality and cognitive failures are also correlated with GSIS responses.

Conclusions: Results support the factorial validity of the GSIS with older adults with BD. Similar to other populations, the GSIS measures a four-factor structure of suicide ideation. Across BD subtypes, the GSIS appears to reliably measure suicide ideation among older adults with BD.     

Depression and body composition among older adults

Objectives: Recent investigations have reported an association between depression and geriatric syndromes associated with low body mass, including frailty and osteoporosis. The objective of this study was to explore the relationship between depression and body composition among older adults.

Methods: Data were from a case-cohort study (n?=?98) of adults aged 60 and older nested within the Baltimore Epidemiologic Catchment Area (ECA) Study. Lifetime depression syndrome was assessed using the Diagnostic Interview Schedule (DIS). Body composition (total and central lean and fat mass) was assessed by dual-energy x-ray absorptiometry (DEXA). The association between depression and body composition was evaluated using linear regression with bootstrap standard errors.

Results: Overall, there was no association between depression and total fat or total lean body mass. Among women, depression was associated with reduced central fat (B?=??3.6?kg, p?p?

Conclusions: Depression is associated with significantly lower central fat and lean mass among older women. These findings are consistent with the hypothesis that depression and frailty are interrelated in later life, particularly among women.     

Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults

Objectives: To investigate the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults.

Method: We recruited 173 voluntary participants, 65 years and older, into a 2+ year longitudinal study of the onset or exacerbation of depressive symptoms and suicide ideation. We assessed the internal consistency of the GSIS and its four component subscales, and its shorter and longer duration test–retest reliability, convergent (depression, social hopelessness, and loneliness), divergent (psychological well-being, life satisfaction, perceived social support, and self-rated health), discriminant (basic and instrumental activities of daily living and social desirability), criterion (history of suicide behavior), and predictive validity (future suicide ideation).

Results: The GSIS demonstrated strong test–retest reliability and internal consistency. Baseline GSIS scores were significantly positively associated with suicide risk factors, negatively associated with potential resiliency factors, and not associated with functional impairment or social desirability. GSIS scores significantly differentiated between participants with as compared to those without a history of suicide behavior. Baseline GSIS scores significantly predicted suicide ideation at a 2+ year follow-up assessment.

Conclusion: Findings suggest strong measurement characteristics for the GSIS with community-residing older adults, including impressive consistency over time. These results are consistent with research attesting to the empirical and pragmatic strengths of this measure. These findings have implications for the monitoring of suicide risk when aiming to enhance mental health and well-being and prevent suicide in later life.     

Correlates of self-rated successful aging among community-dwelling older adults.

OBJECTIVE: There is no consensus on how to define successful aging. The authors sought to determine the correlates of self-rated successful aging as well as its correspondence with major researcher-defined criteria. METHODS: Participants were 205 community-dwelling adults over age 60. A questionnaire survey asked the participants to rate their own degree of successful aging and inquired about demographic characteristics, medical history, activity levels, resilience, daily functioning, and health-related quality of life (Medical Outcomes study 36-item Short-Form [MOS-SF-36]). Participants' subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined. RESULTS: Ninety-two percent of the participants rated themselves as aging successfully. A majority of them also met other research criteria for successful aging such as independent living, mastery/growth, and positive adaptation but not those requiring an absence of chronic medical illness or physical disability. Higher SF-36 scores as compared with a published sample indirectly corroborated participants' subjectively rated successful aging. Subjective ratings of successful aging were significantly correlated with higher scores on health-related quality of life as well as resilience, greater activity, and number of close friends but not with several demographic characteristics. CONCLUSION: Most community-dwelling older adults viewed themselves as aging successfully despite having chronic physical illnesses and some disability. Longitudinal studies of the reliability and validity of subjective ratings of successful aging are warranted.     

Personality disorders and coping among anxious older adults

This study examined the interrelationships among anxiety, personality disorders, and coping strategies in anxious older adults (n = 28; age range = 55-89; mean = 66.0), nonanxious older adults (n = 100, age range = 55-79, mean = 64.6 ), and anxious younger adults (n = 132; age range = 17-30; mean = 20.2). Younger participants were college students and older participants were community-based family members of the students or recruits from local senior centers. Participants completed the Coolidge Axis II Inventory, the Coping Orientations to Problems Experienced scale, and the Brief Symptom Inventory. Results indicated that the prevalence of generalized anxiety states was relatively low and similar in both older and younger groups and dependent on measurement scale and criterion. At least one personality disorder was found in 61% of the older persons group; obsessive-compulsive, schizoid, and avoidant were the most frequently assigned personality disorders. Anxious older adults had elevated rates of dependent and avoidant personality disorder compared with nonanxious older adults. Younger anxious persons were found to have significantly greater personality dysfunction compared with older anxious persons. Finally, coping differences existed between older anxious and older nonanxious adults and between older anxious and younger anxious adults. Implications for diagnosis and treatment of anxiety in older adults were discussed.     

Leisure education reduces stress among older adults

Objectives: The objectives of this study were to examine whether a leisure education program could facilitate leisure competence among older adults and whether it could also reduce their stress.Methods: A pre-test–post-test randomized experimental design was conducted. Subjects were randomly assigned to either an experimental group (n = 30) or a control group (n = 30). A leisure education program was used to serve as the intervention. A day before this experiment was carried out, pre-test data were collected using leisure competence and stress scales. Thirty minutes after this experiment ended, post-test data were collected using the same scales. These data were analyzed using an analysis of covariance.Results: The results indicated that the average post-test scores of leisure competence in the experimental group were significantly higher than those in the control group and that the average post-test scores of stress in the experimental group were significantly lower than those in the control group.Conclusion: Healthcare practitioners should adopt the provision of leisure education as a priority to facilitate leisure competence and reduce stress among older adults.     

Prevalence of frailty and its association with depressive symptoms among older adults in Singapore

Objectives: The aims of the study were to (1) estimate the prevalence of frailty among community-dwelling older adults , and (2) investigate the independent association between level of frailty and depressive symptoms.

Methods: A total of 721 older adults (aged 60 and above ) were included in this study. Severity of frailty was determined using the Clinical Frailty Scale and further classified into four levels (CFS1-3: F1, CFS4: F2, CFS5: F3, and CFS6-7: F4). The depressive symptoms were assessed using the Patient Health Questionnaire-9. The prevalence of frailty by four levels was described and the association between level of frailty and depressive symptoms was assessed using multiple linear regression.

Results: The prevalence of frailty among the study population was 24.5% (F2: 14.4%, F3:3.7%, F4: 6.4%). There was no significant difference in level of frailty between male and female. With the increase in severity level of frailty, older adults reported substantially higher depressive symptom scores (p < .001), even after controlling for socio-demographics, number of non-mental chronic conditions, and number of medications taken regularly.

Conclusions: Level of frailty is independently associated with depressive symptoms among community-dwelling older population, which is not fully explained by symptom overlap, socio-demographic, and comorbidity covariates.     

Major and subthreshold depression among older adults seeking vision rehabilitation services.

OBJECTIVE: Authors examined the potential risk factors of major and subthreshold depression among elderly persons seeking rehabilitation for age-related vision impairment. METHODS: Participants (N=584), age 65 and older, with a recent vision loss, were new applicants for rehabilitation services. Subthreshold depression was defined as a depressive syndrome not meeting criteria for a current major depression (i.e., minor depression, major depression in partial remission, dysthymia) or significant depressive symptomatology. RESULTS: Seven percent of respondents had a current major depression, and 26.9% met the criteria for a subthreshold depression. Poorer self-rated health, lower perceived adequacy of social support, decreased feelings of self-efficacy, and a past history of depression increased the odds of both a subthreshold and major depression, versus no depression, but greater functional disability and experiencing a negative life event were significant only for a subthreshold depression. Only a history of past depression was significant in increasing the odds of having a major versus a subthreshold depression. CONCLUSION: Results highlight similarities in characteristics of, and risk factors for, subthreshold and major depression. Future research is needed to better understand both the trajectory and treatment of subthreshold depression, relative to major depressive disorders.     

Suicide among older psychiatric inpatients: an evidence-based study of a high-risk group.

OBJECTIVE: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted to a psychiatric hospital. METHOD: All persons aged 60 and older living in Denmark who were hospitalized with psychiatric disorders during 1990-2000 were included in the study. Using a case-control design and logistic regression analysis, the authors calculated the suicide risk associated with specific patient characteristics. RESULTS: Affective disorders were found to be associated with an almost twofold higher risk of suicide among psychiatric inpatients than other types of disorders (95% confidence interval [CI]: 1.5-2.6). Patients with dementia had a significantly lower risk ratio of 0.2 (95% CI: 0.1-0.3). In combination with other types of disorder, affective disorders were found to modify an increased risk of suicide. First versus later admission for depression was a better predictor for suicide than age at first hospitalization for depression (before or after age 60 years). More than half of suicides occurred either within the first week of admission or discharge (chi(2) [1] = 27.70, p <0.001) compared with the distribution of patient days. CONCLUSIONS: Our findings underline the important role of affective disorder in combination with other types of disorders. Assessment of suicide risk among older psychiatric inpatients should take current or previous episodes of affective illness into consideration and pay special heed to the time shortly after admission and discharge.     

Suicide risk among adults with epilepsy in Kaduna,Nigeria

Objective

There is paucity of information on epilepsy and suicide in Nigeria. The objective of this study therefore was to assess the prevalence and determinants of suicide risk among adults with epilepsy (AWE) in Kaduna, Nigeria.

Method

We administered the suicidality module of the Mini International Neuropsychiatric Interview, the three-item Oslo Social Support Scale and the Hospital Anxiety and Depression Scale to 170 consecutive AWE attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, between January and June 2011 to determine the prevalence of suicide risk, the level of social support and the psychological symptoms, respectively. We also recorded the sociodemographic and clinical characteristics of the subjects.

Results

There are 99 males and 71 females. The subject’s mean age was 28.7±12.1 years. The prevalence of suicide risk was 20.0%. Short seizure-free periods (χ²= 4.658, P= .031), previous suicide attempts (χ²= 12.216, P< .001), anxiety symptoms (χ²= 5.075, P= .024) and depressive symptoms (χ²= 5.093, P= .016) were significantly associated with suicidal tendencies. However, after a logistic regression analysis, none of the above variables predicted suicide risk.

Conclusion

Suicide risk is common among AWE. Poor seizure control, previous suicidal attempts and emotional distress are associated factors.     

Visual attention and self-regulation of driving among older adults

BACKGROUND: With the number of older drivers increasing, self-regulation of driving has been proposed as a viable means of balancing the autonomy of older adults against the sometimes competing demand of public safety. In this study, we investigate self-regulation of driving among a group of older adults with varying functional abilities. METHOD: Participants in the study comprised 1,543 drivers aged 75 years or older. They completed an objective measure of visual attention from which crash risk was estimated, and self-report measures of driving avoidance, driving exposure, physical functioning, general health status, and vision. Crash records were obtained from the State Department of Public Safety. RESULTS: Overall, participants were most likely to avoid driving in bad weather followed by driving at night, driving on high traffic roads, driving in unfamiliar areas, and making left-hand turns across oncoming traffic. With the exception of driving at night, drivers at higher risk of crashes generally reported greater avoidance of these driving situations than lower risk drivers. However, across all driving situations a significant proportion of higher risk drivers did not restrict their driving. In general, self-regulation of driving did not result in reduced social engagement. CONCLUSION: Some older drivers with visual attention impairments do not restrict their driving in difficult situations. There is a need for physicians and family members to discuss driving behaviors with older adults routinely to ensure their safety. The association between visual attention and driving restriction also has implications for interventions aimed at preserving mobility in the elderly.