Food activities and identity maintenance in old age: a systematic review and meta-synthesis

Objectives: Services provided to older people should be developed based on active ageing policies. Nutrition is one aspect of active ageing, but little is known about how food activities contribute to psychological well-being in later life. This is a systematic review of qualitative and quantitative research that answers the question ‘What is known about the relationship between food activities and the maintenance of identities in old age?’.

Methods: We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and used quality assessment parameters to complete a systematic review and narrative synthesis. Academic Search Premier, MEDLINE, CINAHL Plus, and PsycINFO databases were searched.

Results: We initially identified 8016 articles, of which 167 full-text articles were screened for inclusion. Twenty-two articles were included in the review. There was moderate evidence from nine qualitative and two quantitative studies, of variable quality, that food activities contribute to the maintenance of women's gendered identities, the ethnic identities of men and women, and community identities. There was moderate evidence from 10 qualitative studies, of variable quality, that a change in food choice and deteriorating health changed food activity participation. These changes threatened identities. Most studies included both younger adults and older adults.

Conclusion: In later life, there are many life experiences leading to change. Further research is needed to develop understanding of how identity and mental well-being are maintained, despite changes in everyday activities like cooking and eating. This may enable health care professionals to meet psychological needs alongside biological needs during nutritional interventions.     

Consumer perspectives on community aphasia groups: a narrative literature review in the context of psychological well-being

Background: Community aphasia groups (CAGs) for people living with chronic aphasia are known to be efficacious for improving various aspects of communication and psychological functioning based on empirical quantitative evidence. However, the specific mechanisms and processes involved are not well understood and only a small number of groups exist. Further, there is a paucity of evidence on this topic from consumers, potentially limiting the development and uptake of these services. In order to proliferate and maintain groups of high quality, a deeper understanding of the potential mechanisms of positive outcomes is required.

Aims: The aim of this study was to investigate consumer (people with aphasia (PWA) and family member) experiences of CAGs within the qualitative literature in relation to the theoretical construct of psychological well-being.

Methods & Procedures: An extensive review of qualitative research relating to consumer views of CAGs was conducted in a systematic fashion. Study quality was evaluated using the Critical Appraisal Skills Programme, and content was interpreted in the context of a theoretical model for psychological well-being.

Outcomes & Results: Eleven key studies and 35 secondary studies were found to include consumer perspectives of CAGs. The findings of the 11 key studies are presented as a narrative literature review. Overall, evidence suggests CAGs contribute positively to the psychological well-being of PWA and their caregivers. Outcomes relate to forming positive relations with others, purpose in life, environmental mastery, autonomy, personal growth, and self-acceptance. CAG characteristics and mechanisms proposed to mediate psychological well-being are discussed. However, the review is limited by a range of methodological issues in the literature.

Conclusions: In order to optimise CAGs in practice, clinicians should consider group characteristics and aim to manipulate the possible mechanisms underlying positive outcomes. Further research is needed to understand the long-term lived experience of CAGs members, including those currently under-represented in the literature.     

Semantic loss without surface dyslexia

Abstract

Recent models of reading, including some computational models, suggest that error-free performance in reading aloud may be reliant, at least in part, on support from the semantic system. Such models predict that, following semantic impairment, a pattern of acquired dyslexia known as ‘surface dyslexia’ will be an inevitable consequence. We present data from a patient with dementia of Alzhelmer type who shows a severe semantic impairment but near error-free performance on reading aloud real words (including low-frequency, irregular, abstract words) and non-words. The data are discussed in light of various models of reading and in relation to previously reported cases.     

Is exercise effective in promoting mental well-being in older age? A systematic review

Background: Promoting the mental well-being of older people has been neglected.

Aim: To examine the clinical and cost-effectiveness of exercise and physical activity interventions on mental well-being in people aged 65+.

Design: Systematic review, meta-analysis, economic model.

Methods: Reports published in English, identified by searching 25 databases, 11 websites and references lists of systematic reviews. Eligible studies were those with a comparison or control group or offering qualitative evidence; exercise and physical activity interventions for people aged 65 and above living at home, in the community, in supported housing or in residential care homes; including outcome measures of mental well-being, not simply measures of depression or anxiety. Low-quality studies were excluded from the data synthesis.

Results: An overall effect of exercise on mental well-being was found (standardised effect size = 0.27; CI = 0.14–0.40). The included interventions were designed for older people, targeted those who are sedentary and delivered in a community setting, primarily through a group-based approach led by trained leaders. As a minimum, the evidence would suggest two exercise sessions per week, each of 45 min duration. There is some indication that exercise can also improve the mental well-being of frail elders. Economic evidence indicated incremental cost-effectiveness ratios (compared with minimal intervention) of £7300 and £12,100 per quality adjusted life year gained for community-based walking and exercise programmes, respectively.

Conclusions: Mental well-being in later life is modifiable through exercise and physical activity. To generalise the findings, there is a need for more evidence of effectiveness from older people in the UK.     

Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis

Abstract

Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers’ experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories—‘stigma’, ‘help-seeking’, ‘service encounter’, ‘emotional challenges’, ‘on becoming a caregiver’ and ‘making sense of experience’—were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers’ experiences of their relative’s first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.     

A systematic review of Bell’s Palsy as the only major neurological manifestation in COVID-19 patients

BackgroundBell’s palsy is an acute idiopathic paralysis of the facial nerve. The disease is caused by many viruses like Herpes simplex virus-1, Varicella zoster, Epstein-bar virus, Cytomegalovirus, Usutu virus, Human immunodeficiency virus, etc. Literature has reported few cases of COVID-19 patients with Bell’s palsy as the only major neurological manifestation indicating the possible role of another virus in the etiopathogenesis of Bell’s Palsy. This paper aims to evaluate the reported cases of COVID-19 positive patients, presented with Bell’s palsy as the only major neurological manifestation from March 2020 to December 2020, and to investigate the association of SARS-CoV2 and Bell’s palsy.Materials and methodsA systematic review of the published literature was performed using an electronic search in PubMed/Medline, Science Direct, Web of Science, Embase, J- STAGE, Google Scholar, China National Knowledge Infrastructure (CKNI) and Scopus databases, from March 2020 to Dec 2020 using keywords like ‘COVID-19’, ‘SARS-CoV-2’, ‘Coronavirus’, ‘Bell’s palsy’, ‘Facial nerve’, ‘First’, ‘Only’,‘ Neurological’, ‘Manifestation’. The studies reviewed were case series and case reports regarding the subject.ResultsSearch strategy revealed thirteen articles from March 2020 to Dec 2020 with a total of 20 cases of COVID-19 with Bell’s palsy as the only major neurological manifestation.ConclusionEvidence of Bell’s palsy as the only major neurological manifestation in COVID-19 patients signifies an important clinical finding but robust research is needed to investigate their association and the exact mechanisms by which SARS-CoV2 causes Bell’s Palsy.     

ICT-based applications to improve social health and social participation in older adults with dementia. A systematic literature review

ABSTRACT

Objectives: Information and communication technologies (ICT) developers, together with dementia experts have created several technological solutions to improve and facilitate social health and social participation and quality of life of older adults living with dementia. However, there is a need to carry out a systematic literature review that focuses on the validity and efficacy of these new technologies assessing their utility to promote ‘social health’ and ‘active ageing’ in people with dementia.

Method: Searches in electronic databases identified 3824 articles of which 6 met the inclusion criteria and were coded according to their methodological approach, sample sizes, type of outcomes and results.

Results: Six papers were identified reporting the use of 10 different interventions with people with dementia. Qualitative studies (four) showed a benefit of the use of technologies to foster social participation in people with dementia. At the same time, barriers to a widespread use of these technologies in this population were identified. A quantitative study and a mixed-method study with quantitative outcomes showed that ICT-based interventions promote more social behaviours than non-technology-based interventions.

Conclusions: In the last years, several technological devices for living independently and fostering social health and social participation in people with dementia have been developed. However, specific outcome measures to assess social health and social participation are needed. Even though the analysed studies provided some evidence-base for the use of technology in this field, there is an urge to develop high quality studies and specific outcome measures.     

Social capital as a resource for mental well-being in older people: A systematic review

Social capital has previously been reviewed in relation to mental health. However, none have focused specifically on positive aspects of mental health such as mental well-being. This review aimed to explore the relationship between social capital and mental well-being in older people. Ten relevant databases were systematically searched using an extensive search strategy for studies, analyzing the link between social capital and mental well-being. Criteria for inclusion in the systematic review were: the study sample included older people (≥50 years); the study reported a mental well-being outcome; social capital was an exposure variable; and empirical research using quantitative methods and published in English, between January 1990 and September 2011. Eleven studies met the inclusion criteria. Each study was assessed against seven possible exposure measures (structural, cognitive; bonding, bridging, linking; individual, collective). The results showed that all included studies found positive associations between parts of social capital and aspects of mental well-being. Typically, the relationship between social capital and mental well-being differed within as well as between studies. Our results highlight that there is no ‘gold standard’ of how to measure social capital or mental well-being. Social capital is generated in the interaction between individual and collective life. A possibility for future research is therefore to follow Bronfenbrenner's classical division into macro, meso, and micro levels. We consider family and friends at the micro level to be the key factors in generating social capital and well-being in older people.     

Living positively with dementia: a systematic review and synthesis of the qualitative literature

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.     

Evaluación de las afasias: consideraciones dialectales y culturales en neurología

IntroductionIn the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is performed. Dialectal variables constitute a ‘forgotten’ topic. This review aims to provide resources and working guidelines to overcome this limitation.DevelopmentThe study was conducted as follows: 1) review of basic concepts of dialectology (language, dialect, isogloss line, idiolect, register, ‘standard variant’, bilingualism); 2) characterisation of Spanish and Catalan dialectologies and search for online resources for the development of neurological assessment tools; 3) ad hoc search on the PubMed database (keywords ‘dialect’, ‘aphasia’ and ‘multilingual’).ConclusionsWe provide online resources to promote adequate development of assessment tools in Spanish and Catalan, accounting for Dialectal considerations. We propose a set of working guidelines for the introduction of Dialectal variables in language tests to ensure their ultimate objective: to evaluate the real use of the language, and not cultural knowledge of the standard language.     

Sleep and circadian alterations in people at risk for bipolar disorder: A systematic review

BackgroundSleep and circadian abnormalities have been mostly demonstrated in bipolar patients. However, it is not clear whether these alterations are present in population at high risk for bipolar disorder (BD), indicating a possible risk factor for this condition.ObjectiveThis systematic review aims to define current evidence about sleep and rhythm alterations in people at risk for BD and to evaluate sleep and circadian disorders as risk factor for BD.MethodsThe systematic review included all articles about the topic until February 2016. Two researchers performed an electronic search of PubMed and Cochrane Library. Keywords used were ‘sleep’ or ‘rhythm’ or ‘circadian’ AND ‘bipolar disorder’ or ‘mania’ or ‘bipolar depression’ AND ‘high-risk’ or ‘risk’.ResultsThirty articles were analyzed (7451 participants at risk for BD). Sleep disturbances are frequent in studies using both subjective measures and actigraphy. High-risk individuals reported irregularity of sleep/wake times, poor sleep and circadian rhythm disruption. Poor sleep quality, nighttime awakenings, and inadequate sleep are possible predictive factors for BD. A unique study suggested that irregular rhythms increase risk of conversion. People at risk for BD showed high cortisol levels in different times of day. Studies about anatomopathology, melatonin levels, inflammatory cytokines and oxidative stress were not identified. The most important limitations were differences in sleep and rhythm measures, heterogeneity of study designs, and lack of consistency in the definition of population at risk.ConclusionSleep and circadian disturbances are common in people at risk for BD. However, the pathophysiology of these alterations and the impact on BD onset are still unclear.     

Self-efficacy and health-related quality of life in family carers of people with dementia: a systematic review

Objectives: This review aims to explore the role of self-efficacy (SE) in the health-related quality of life (QoL) of family carers of people with dementia.

Methods: A systematic review of literature identified a range of qualitative and quantitative studies. Search terms related to caring, SE, and dementia. Narrative synthesis was adopted to synthesise the findings.

Results: Twenty-two studies met the full inclusion criteria, these included 17 quantitative, four qualitative, and one mixed-method study. A model describing the role of task/domain-specific SE beliefs in family carer health-related QoL was constructed. This model was informed by review findings and discussed in the context of existing conceptual models of carer adaptation and empirical research. Review findings offer support for the application of the SE theory to caring and for the two-factor view of carer appraisals and well-being. Findings do not support the independence of the negative and positive pathways. The review was valuable in highlighting methodological challenges confronting this area of research, particularly the conceptualisation and measurement issues surrounding both SE and health-related QoL.

Conclusions: The model might have theoretical implications in guiding future research and advancing theoretical models of caring. It might also have clinical implications in facilitating the development of carer support services aimed at improving SE. The review highlights the need for future research, particularly longitudinal research, and further exploration of domain/task-specific SE beliefs, the influence of carer characteristics, and other mediating/moderating variables.     

Is physical activity a potential preventive factor for vascular dementia? A systematic review

Background: Physical exercise has several beneficial effects, including reduced risk for Alzheimer's disease. Although several studies of potential risk factors for vascular dementia (VaD) exist, including physical activity, the studies have usually included few participants and there are no meta-analyses addressing this key topic.

Methods: The MEDLINE database was searched using the key words ‘physical exercise’ ‘activity’ or ‘walking’ in combination with ‘dementia’ and ‘vascular dementia’. Potentially relevant studies were assessed and summarised by two of the authors, and longitudinal studies with operationalised definition of physical activity providing risk for VaD in both groups were included in the meta-analysis using pooled estimates from a random effects model.

Results: A total of 24 longitudinal studies, including 1378 patients with VaD, were included in the review. The majority of individual studies did not report significant associations. Five studies fulfilled criteria for meta-analysis, including 10,108 non-demented control subjects and 374 individuals with VaD. The meta-analysis demonstrated a significant association between physical exercise and a reduced risk of developing VaD: OR 0.62 (95% CI 0.42–0.92).

Conclusions: We conclude that there is evidence supporting the hypothesis that physical activity is likely to prevent the development of VaD, and should be highlighted as part of secondary prevention programmes in people at risk for cerebrovascular disease.     

Vitamin D and the nervous system

ABSTRACT

Objective: to summarise the activities that Vitamin D (VD) carries out in the brain and to clarify the potential role of VD in neurological diseases.

Methods: a literature research has been performed in Pubmed using the following keywords: ‘Vitamin D’, ‘nervous system’, ‘brain’.

Results: the studies reviewed show that VD contributes to cerebral activity in both embryonic and adult brain, helping the connectivity of neural circuits responsible for locomotor, emotional and reward-dependent behavior. Low VD serum levels have been found in patients affected by Alzheimer Disease, Parkinson Disease, Multiple Sclerosis, Autism Spectrum Disorders, Sleep Disorders and Schizophrenia.

Discussion: findings are controversial and should be interpreted with caution, since most of the studies performed have observational study set and few interventional studies are available, producing conflicting results. Overall, it can be stated that the potential role of Vitamin D in neurological diseases is mostly unclear and further randomised controlled trials are needed to understand better whether Vitamin D supplementation treatment can be useful in brain disorders.     

Associations among sensory hyperresponsiveness,restricted and repetitive behaviors,and anxiety in autism: An integrated systematic review

BackgroundAutistic individuals exhibit core and co-occurring features that can be disabling to daily functioning and impede quality of life. The combined expression of three closely related features: sensory hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety, may be a sign to practitioners that experiences in the environment are particularly challenging. These are investigated through many approaches, including animal modelling, neurological or physiological measures, behavioral observation, and first-hand accounts. However, little work has been done to review evidence across approaches to better understand their expression.MethodThis study was an integrated systematic review to identify factors that contribute to the collective expression of three constructs of interests (COIs; hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety). Twenty-two articles were analyzed for both structural and thematic patterns. This review is unique in its inclusion of articles from a variety of disciplines and grouping of studies based on similarities over methodological techniques (i.e. quantitative, qualitative, or mixed methods).ResultsThree overall structural approaches relating the constructs of interest were identified (parallel, relational, and contingent). Three overarching themes also emerged: 1) the broader social context, 2) predictability of environmental factors, and 3) overlap with cognitive and behavioral coping strategies.ConclusionsResults highlight clinically relevant information about the combined expression of the three COIs and demonstrate possibilities for increased collaboration across disciplines through common themes and study structures to further understand the experiences of autistic people.     

Awareness in people with severe dementia: Review and integration

Objective: Although awareness has been extensively researched in relation to people with dementia, studies have focussed mainly on people who have dementia of mild to moderate severity. Consequently, relatively little is known about awareness in people with severe dementia, and there is no clear conceptual framework to indicate how this should be understood or investigated.

Method: This review presents a conceptual framework for considering awareness in people with moderate to severe dementia which distinguishes fundamental awareness of sensory and perceptual stimuli and three levels of awareness involving more complex cognitive operations, termed ‘on-line monitoring’, ‘evaluative judgement’ and ‘meta-representation’, and provides an integration of the available evidence regarding each level.

Results: Findings indicate that sensory and perceptual awareness can be detected even in people with very severe or end-stage dementia, while some aspects of complex awareness may be retained into the severe stages.

Conclusions: The environmental context and the nature of caregiving interactions influence the extent to which awareness is expressed. There may be scope for enhancing the expression of some aspects of awareness in people with moderate to severe dementia, but this should only be undertaken where it is likely to improve quality of life. Understanding more about awareness is an important element in the provision of high-quality care for people with moderate to severe dementia.     

Semantic anomia without surface dyslexia

Abstract

A computational model of oral reading developed by Plaut et al. (1996) proposes that reading aloud low-frequency exception words (e.g. yacht) relies upon a reading pathway that maps semantic representations directly onto output phonology. One prediction of this model is that, if the semantic reading pathway is damaged following brain damage, a pattern of surface dyslexic reading will be observed, characterized by frequent regularization errors when reading aloud low-frequency exception words (e.g. shoe → ‘show’). We report the oral reading of a semantic anomic patient (B.P.) who makes frequent semantic intrusion errors on confrontation naming tasks as well as semantic errors on word-picture and picture-picture matching tasks. Contrary to the prediction of the Plaut et al. (1996) model, B.P.'s oral reading of exception words, including his oral reading of picture names that are exception words, is intact. An important additional feature of B.P.'s language profile is that his oral reading of non-words is poor, suggesting that there is impairment to a phonological reading pathway. We argue that B.P.'s preserved oral reading reflects the operation of a lexical, non-semantic reading pathway.     

Profiles in emotional aging: does age matter?

ABSTRACT

Objectives: The aim of this research project was to define emotional profiles in elderly people and to analyze the presence of each one in different age groups (from 65 to 74, 75 to 84, 85 to 94 and 95 to 104).Method: The sample group comprised 257 elderly people not suffering from cognitive impairment who were independent in the Basic and Instrumental Activities of Daily Living. The following emotional variables were analyzed: positive and negative affect, life satisfaction, loneliness, and regulation strategies.Results: Cluster analyses revealed three emotional profiles: ‘dissatisfied’ (elderly people with high levels of negative affect and loneliness who are unhappy with their lives and use problem solving to regulate their emotions), ‘happy’ (those with good levels of positive affect and life satisfaction, low levels of loneliness and negative affect and little use of passive strategies), and ‘resilient’ (those with low levels of positive and negative affect and medium levels of loneliness who are more or less satisfied with their lives and who use passive strategies to regulate their emotions). A relationship was observed between age and profile. Among the under 85s, the most common profile was ‘happy’, while among the over 85s, the most common profile was ‘resilient.’ The ‘happy’ profile was also observed in participants over the age of 85, although to a lesser extent. The prevalence of the ‘dissatisfied’ profile decreased with age.Conclusion: These results highlight the fact that although age seems to be a key factor in determining profile, individual differences should not be overlooked, even among the oldest old.     

Attributions of People with Intellectual Disabilities of Their Own or Other Clients’ Challenging Behavior: A Systematic Review of Qualitative Studies

ABSTRACT

Introduction: As opposed to studies focusing on staffs’ attributions of challenging behavior (CB), relatively few studies have looked at how people with intellectual disabilities (ID) attribute such behaviors themselves, and a systematic overview is currently lacking. The aim of this review was to synthesize the evidence from qualitative studies on the attributions people with ID have concerning their own or other clients’ CB.

Methods: A systematic literature search was conducted in Embase, Medline Ovid, Web of science, Cochrane CENTRAL, PsychINFO Ovid, and Google Scholar. Studies were included if they focused on people with ID who report on attributions of their own or other clients’ actual CB. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist.

Result: A total of 10 studies were included. Three main types of factors subdivided in 13 sub-types were reported by clients as potential causes of CB: interpersonal factors (1 support staff, 2 other clients, 3 general, 4 life history), environmental factors (1 ward, 2 social exclusion, 3 situational factors) and intrapersonal factors (1 syndrome or diagnosis, 2 medical or physical symptoms, 3 psychological reasons, 4 emotions and feelings, 5 coping, 6 other).

Conclusions: This thematic synthesis shows that clients with ID report a diverse range of attributions regarding their own or other clients’ CB. This spectrum can be used as a framework for interpreting CB and for the development of appropriate support systems for people with ID demonstrating CB.