A tail of two sides: Artificially doubled false positive rates in neuroimaging due to the sidedness choice with t‐tests

One‐sided t‐tests are widely used in neuroimaging data analysis. While such a test may be applicable when investigating specific regions and prior information about directionality is present, we argue here that it is often mis‐applied, with severe consequences for false positive rate (FPR) control. Conceptually, a pair of one‐sided t‐tests conducted in tandem (e.g., to test separately for both positive and negative effects), effectively amounts to a two‐sided t‐test. However, replacing the two‐sided test with a pair of one‐sided tests without multiple comparisons correction essentially doubles the intended FPR of statements made about the same study; that is, the actual family‐wise error (FWE) of results at the whole brain level would be 10% instead of the 5% intended by the researcher. Therefore, we strongly recommend that, unless otherwise explicitly justified, two‐sided t‐tests be applied instead of two simultaneous one‐sided t‐tests.     

Strengths in older adults: differential effect of savoring,gratitude and optimism on well-being

Objetive: The present study aimed to compare the efficacy of three separate strengths training-based interventions – Gratitude, Savoring, and Optimism – in older adults.

Method: The sample comprised 124 older adults, namely, 74 women and 50 men, non-institutionalized individuals who regularly attend day centers in the provinces of Jaén and Córdoba, southern Spain. Their ages ranged between 60 and 89 years. The measures used were Anxiety, Depression, Life Satisfaction, Positive and Negative Affect, Subjective Happiness, and Resilience.

Results: Training in Gratitude and Savoring increased scores in Life Satisfaction, Positive Affect, Subjective Happiness and Resilience, and reduced Negative Affect, whereas training in Optimism failed to produce a significant change in these variables. The Savoring and Optimism interventions decreased scores in Depression but, contrary to hypothesis, this was not the case for Gratitude.

Conclusion: These results represent an important step in understanding what type of strengths work best when it comes to enhancing well-being in older adults and consequently helping them tackle the challenges of everyday life and recover as quickly as possible from the adverse situations and events that may arise.     

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.     

Performance validity in undergraduate research participants: a comparison of failure rates across tests and cutoffs

Objective: This study compared failure rates on performance validity tests (PVTs) across liberal and conservative cutoffs in a sample of undergraduate students participating in academic research.Method: Participants (n = 120) were administered four free-standing PVTs (Test of Memory Malingering, Word Memory Test, Rey 15-Item Test, Hiscock Forced-Choice Procedure) and three embedded PVTs (Digit Span, letter and category fluency). Participants also reported their perceived level of effort during testing.Results: At liberal cutoffs, 36.7% of the sample failed ≥1 PVTs, 6.7% failed ≥2, and .8% failed 3. At conservative cutoffs, 18.3% of the sample failed ≥1 PVTs, 2.5% failed ≥2, and .8% failed 3. Participants were 3 to 5 times more likely to fail embedded (15.8–30.8%) compared to free-standing PVTs (3.3–10.0%). There was no significant difference in failure rates between native and non-native English speaking participants at either liberal or conservative cutoffs. Additionally, there was no relation between self-reported effort and PVT failure rates.Conclusions: Although PVT failure rates varied as a function of PVTs and cutoffs, between a third and a fifth of the sample failed ≥1 PVTs, consistent with high initial estimates of invalid performance in this population. Embedded PVTs had notably higher failure rates than free-standing PVTs. Assuming optimal effort in research using students as participants without a formal assessment of performance validity introduces a potentially significant confound in the study design.     

Positive affect and its relationship to free recall memory performance in a sample of older Dutch adults from the Maastricht Aging Study

OBJECTIVE: A Dutch translation of the Positive and Negative Affect Scale (PANAS) was used to measure Positive Affect (PA) and its relationship to episodic memory in a sample of Dutch adults between the ages of 40 to 82 years. Specifically, the role of PA was examined as a predictor of performance on a serial list learning task that included a recognition and free recall component. METHODS: Participants were divided into two age groupings representing middle-age (40 to 64 years) and older (65 to 82 years) adults with respect to the study sample. RESULTS: PA was not related to recognition performance in either age grouping. In the older age group, however, PA predicted free recall. CONCLUSIONS: PA facilitated episodic memory in older adults when unsupported tasks conditions were present that placed heavy demands on processing resources.     

Emotional complexity and emotional well-being in older adults: risks of high neuroticism

Older and midlife adults tend to report greater emotional complexity and greater emotional well-being than younger adults but there is variability in these factors across the lifespan. This study determined how the personality trait of neuroticism at baseline predicts emotional complexity and emotional well-being 10 years later; a goal was to determine if neuroticism is a stronger predictor of these emotion outcomes with increasing age in adulthood. Data were obtained from two waves of the MIDUS projects (N = 1503; aged 34-84). Greater neuroticism predicted less emotional complexity as indicated by associations between positive and negative affect, particularly for older participants. Neuroticism predicted lower emotional well-being and this association was stronger for older and midlife than for younger adults. Overall, high neuroticism may be a greater liability for poor emotion outcomes for older and perhaps for midlife adults than for younger persons. Clinical and theoretical implications of this conclusion are discussed.     

Performance of older depressed patients on two cognitive malingering tests: false positive rates for the Rey 15-item memorization and dot counting tests

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications.     

Influencing factors of loneliness among older adults in China: a systematic review and meta-analysis

China has a large and rapidly growing older population. Loneliness is associated with a range of negative health outcomes in older adults. However, to date, there is still a lack of comprehensive and systematic evidence on the factors influencing loneliness among older adults in China. Nine Chinese and English databases were searched by computer from inception to March 2022: China Knowledge Network, WanFang Data, Chinese Scientific Journal Database, SinoMed, PubMed, Embase, Web of Science, PsycINFO, and Cochrane Library. Studies on factors influencing loneliness among older adults in China were included. Two reviewers independently completed the literature screening, quality evaluation, and data extraction, and statistical analyses were performed using Review Manager 5.4 software. A total of 15 studies were included in the review, with 47 066 participants in total. Fifty-nine influencing factors of loneliness in older Chinese were involved. Twenty factors with a total of 30 subfactors that were involved in two or more studies and with extractable data were included in the data synthesis. Eleven subfactors were not statistically significantly associated with loneliness, namely, male, female, lower age, higher education level, health status—fair, health status—poor, social support—none/low, no health insurance, smoking, alcohol consumption, and body mass index—overweight and above (all P > 0.05), while the remaining 19 subfactors (concerning 15 factors) were significantly associated with loneliness in older adults in China (all P < 0.05). This study suggested that age, education level, marital status, living arrangement, having (no) children, receiving family support, relationship with family members, being with or without chronic diseases, health status, activities of daily living, social support, social activities, financial status, satisfaction with housing conditions, and the decision-making right for major household expenditures were the main influencing factors of loneliness among older adults in China.     

Deliberate self-harm in older adults: a review of the literature from 1995 to 2004

BACKGROUND: The prevention of suicide is a national and international policy priority. Old age is an important predictor of completed suicide. Suicide rates in old age differ markedly from country to country but there is a general trend towards increasing rates with increasing age. In 1996 Draper reviewed critically the evidence on attempted suicide in old age in the 10 years between 1985 and 1994. The review highlighted a need for prospective controlled studies in older people with more representative samples as well as studies examining the interaction of risk factors, precipitants, motivations, psychopathology and response to treatment. The aim of this paper is to update this review and to summarise the advances in our understanding of DSH in later life. METHOD: We have critically reviewed relevant studies published between 1995 and 2004 to summarise the advances in our understanding of factors associated with deliberate self-harm in later life. RESULTS: The main advances in understanding have been to clarify the effect of personality and cultural factors, service utilisation pre and post attempt, and the (lesser) impact of socio-economic status and physical illness. Methodological weaknesses continue to include inadequate sample sizes performed on highly selected populations, inconsistent age criteria and lack of informant data on studies relating to role of personality. CONCLUSIONS: Future studies should include prospective, cross-cultural research with adequate sample sizes and which are population-based. Such approaches might confirm or refute the results generated to date and improve knowledge on factors such as the biological correlates of deliberate self-harm, service utilisation, costs and barriers to health care, and the interaction of these factors. Intervention studies to elucidate the impact of modifying these factors and of specific treatment packages are also needed.     

The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults

Objectives: Suicide is a prevalent problem in older adults. One of the best predictors of suicide in older adults is suicide ideation; suicide ideation has been frequently associated with depression. However, suicide ideation is not always present when an older adult is depressed and is sometimes present when an older adult is not depressed. Perceived burdensomeness, a recently proposed risk factor [Joiner Jr, T.E. (2005)], has been linked to suicide ideation in depressed samples and in older adults. Thus, perceived burdensomeness may be the necessary risk factor for suicide ideation.

Method: The Geriatric Suicide Ideation Scale (GSIS; [Heisel et al. (2006)]), Center for Epidemiologic Studies Depression (CES-D; [Radloff, L.S. (1977)]) scale, and Suicide Cognitions Scale (SCS; [Rudd, M.D., Schmitz, B., McClenen, R., Joiner, T., Elkins, G., &; Claassen, C.A. (n.d.)]) were completed by a community sample of older adults recruited from primary care clinics (n?=?106). A regression analysis was conducted following Baron and Kenny's [1986] guidelines to test the hypothesis that perceived burdensomeness (measured by the SCS perceived burdensomeness subscale) mediates the relation between depression (assessed with the CES-D) and suicide ideation (measured by the GSIS suicide ideation subscale) in older adults.

Results: Perceived burdensomeness mediated the relation between depression and suicide ideation, accounting for 68.3% of the variance in suicide ideation.

Conclusion: Perceived burdensomeness may explain the relation between depression and suicide ideation. Clinicians seeing older adults should assess for depression and perceived burdensomeness when determining suicide risk. Future research directions include treatment studies for perceived burdensomeness as a way to reduce suicide ideation.     

Lifestyle factors and the course of depression in older adults: A NESDO study

Objectives

To investigate whether lifestyle indicators including physical exercise, sleep duration, alcohol use, body mass index, smoking status, and a composite lifestyle index are associated with the depression course in older adults.

Methods

Data of 283 older adults were used from the Netherlands Study of Depression in Older Persons. Depressive disorders at baseline were assessed with the Composite International Diagnostic Interview. The depression course at 2‐year follow‐up was assessed with the Inventory of Depressive Symptoms (IDS, score 0–84) every 6 months; physical exercise with the International Physical Activity Questionnaire; alcohol use with the Alcohol Use Disorders Identification Test; body mass index by anthropometry; and sleep duration and smoking status by interview questions. A composite lifestyle index was calculated by summing scores assigned to each lifestyle factor, with a higher score indicating healthier behavior.

Results

Of all participants, 61.1% had chronic depression (all IDS scores 14–84), 20.1% had intermittent depression (1 IDS score ≤ 14), and 18.7% remitted depression (last 2 IDS scores ≤14). None of the investigated lifestyle indicators, nor the composite lifestyle index was associated with depression course, after adjustment for covariates.

Conclusions

Lifestyle factors do not predict the course of depression at 2‐year follow‐up in older adults.     

Training to Enhance Adult Memory (TEAM): An investigation of the effectiveness of a memory training program with older adults

Objective: Prior research examining the effectiveness of memory enhancement programs targeting both objective and subjective memory has yielded results with varying degrees of success. The current investigation aimed to contribute to the present body of memory training literature through the evaluation of an in-home memory enhancement program for older adults.

Method: Fifty-three community-dwelling older adults were assigned to either a memory enhancement condition or a minimal social support condition.

Results: Those in the memory enhancement condition had significant improvement in remembering names with faces and not misplacing household objects. Additionally, those in the memory enhancement condition also reported being more content with their memory, having fewer lapses in memory, greater use of mnemonic strategies, and were less bothered by memory complaints. Regression analyses indicated that neither levels of positive nor negative affect were predictive of participants’ objective and subjective memory at post-treatment.

Conclusion: Results of these analyses provide support for the use of memory enhancement programs to improve older adults’ ability to keep track of items, remember names and faces, and to also feel better about their memory ability.     

Associations of objective versus subjective social isolation with sleep disturbance,depression, and fatigue in community-dwelling older adults

Objective: Older adults are at higher risk of experiencing social isolation, which has been linked to impaired physical and mental health. The link between social isolation and health might be due to objective deprivation of social network and/or subjective experience of loneliness. This community-based cross-sectional study examined whether the associations between social isolation and behavioral symptoms including sleep disturbance, depression, and fatigue are mostly explained by its subjective component.

Methods: Randomly selected 2541 community-dwelling individuals in Los Angeles aged ≥60 years were telephone-interviewed regarding their objective and subjective social isolation (respectively social network size and loneliness), sleep disturbance, depression, and fatigue.

Results: When objective and subjective social isolation were separately included in multivariate regression models, both were significantly associated with behavioral symptoms. However, once they were simultaneously included in the same multivariate models, while subjective social isolation remained strongly associated (adjusted beta 0.24 for sleep disturbance [P?<?0.001], 0.44 for depression [P?<?0.001], 0.17 for fatigue [P?<?0.001]), objective social isolation was weakly or non-significantly associated (-0.04 for sleep disturbance [P?=?0.03], -0.01 for depression [P?=?0.48], -0.003 for fatigue [P?=?0.89]). Additionally, those with objective social isolation were found to have worse symptoms mostly when they also experienced subjective social isolation.

Conclusions: Older adults with objective social isolation may experience sleep disturbance, depression, and fatigue because they feel socially isolated, not just because they are deprived of social networks. Interventions that target social isolation might serve as potential treatments for improving behavioral health of older adults, especially by targeting its subjective component.     

Helping older adults to help themselves: the role of mental health literacy in family members

Objectives: Family members may play an important role in the health and well-being of older adults. However, little is known about the factors that influence the likelihood of family members supporting older relatives to seek help from mental health professionals for mental health concerns. Mental health literacy is associated with people's help-seeking intentions regarding their own mental health concerns, and some studies have suggested it may play a role in help-seeking on behalf of others. The purpose of this study was to investigate whether mental health literacy is associated with adults’ likelihood of supporting an older relative to seek professional help for mental health concerns.

Method: Two hundred and sixty-three participants completed a measure of mental health literacy and responded to a hypothetical scenario by indicating their likelihood of supporting an older relative experiencing mental health problems to seek help from various sources.

Results: Mental health literacy was positively associated with intentions to support older relative's help-seeking.

Conclusions: Interventions to increase the mental health literacy of the relatives of older adults may lead to additional support for older adults’ help-seeking for mental health concerns.     

Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the elderly

Older adults represent a highly heterogeneous population, with multiple diverse subgroups. Therefore, an individualized approach to treatment is essential to meet the needs of each unique subgroup. Most comparative studies focusing on treatment of epilepsy in older adults have found that levetiracetam has the best chance of long-term seizure freedom. However, there is a lack of studies investigating other newer generation antiseizure medications (ASMs). Although a number of randomized clinical trials have been performed on older adults with epilepsy, the number of participants studied was generally small, and they only investigated short-term efficacy and tolerability. Quality of life as an outcome is often missing but is necessary to understand the effectiveness and possible side effects of treatment. Prognosis needs to move beyond the focus on seizure control to long-term patient-centered outcomes. Dosing studies with newer generation ASMs are needed to understand which treatments are the best in the older adults with different comorbidities. In particular, more high-level evidence is required for older adults with Alzheimer's disease with epilepsy and status epilepticus. Future treatment studies should use greater homogeneity in the inclusion criteria to allow for clearer findings that can be comparable with other studies to build the existing treatment evidence base.