Physician and Public Knowledge of Depression Among Older Adults

Abstract

This study examined primary care physicians' knowledge of geriatric mental health and whether it was quantitatively and/or qualitatively different from that of the general public. Physician and public responses to the Depression in Later Life Quiz were evaluated and compared using t-tests and chi-squared tests. While physicians were more knowledgeable than members of the general public regarding most facts associated with geriatric mental health issues, physicians were also more likely than the general public to associate depression with the aging process. Further investigation regarding the potential negative impact of geriatric medical education, which is frequently limited to acute care and nursing home settings, should be considered.     

Attitudes and Experiences With Older Adults: A Case for Service Learning for Undergraduates

The current study examined whether relationship quality with older adults currently and in childhood, as well as experience with older adults, was associated with biases toward older adults and interest in working with older adults as a possible career area. The authors sampled undergraduate students (N = 753, M = 18.97 years, SD = 2.11 years) from a Northern California university. In hierarchical regression analyses, higher perceived quality of relationships with older adult family members, higher perceived social support, and lower perceived conflict from relationships with older adults was significantly associated with positive attitudes toward older adults. Interest in working with older adults was significantly associated with taking courses in aging, providing care to an older adult, and volunteering with older adults. These results suggest that positive relationships with older adults are useful in reducing biases, though student interactions with older adults are key in helping to promote interest in working with older adults.     

Racial and Ethnic Differences in the Mental Health Needs and Access to Care of Older Adults in California

Little is known about the unmet mental health needs of minority older adults. Racial and ethnic differences in the prevalence rates of psychological distress and reported need and use of mental health services were examined in a population‐based sample of older adults using the 2005 California Health Interview Survey. The sample comprised 16,974 people aged 55 and older, with 13,974 non‐Hispanic whites, 719 African Americans, 1,215 Asians, and 1,066 Latinos. Respondents were compared in terms of prevalence of symptoms of mental distress and serious mental illness, reported need for help, and access to mental health services. African Americans, Asians, and Latinos were more likely to have mental distress than whites (21.2–24.2% vs 14.4%, P<.001) and a higher prevalence of serious mental illness (4.1–7.7% vs 2.5%, P<.001). After adjustment for age, sex, birthplace, marital status, education, limited English proficiency, chronic health conditions, and insurance status, older African‐American (adjusted odds ratio (aOR)=1.37, 95% confidence interval (CI)=1.04–1.81) and Asian (aOR=1.50, CI=1.13–2.00) adults still had greater odds of mental distress than whites. Furthermore, all three groups had worse access to mental health services than whites (African American aOR=0.64, 95% CI=0.43–0.96; Asian aOR=0.32, CI=0.16–0.63; Latino aOR=0.35, CI=0.17–0.70). Clinicians caring for older individuals should be aware of their high risk for mental health needs. Given that minorities' access to mental health services is worse than whites', even after adjusting for health insurance status, providing insurance alone will not eliminate this disparity. Innovative clinical and systemic strategies are needed to better identify individuals at risk and to provide needed services.     

Rural Older Adults’ Perspectives of Activities to Support Cognitive Health

ABSTRACT

Existing cognitive health literature focuses predominately on understanding the pathology and clinical treatment of older adults with dementia rather than cognitive health promotion and preventative activities. In addition, most of the work in the area remains urban-centric with little focus on cognitive health in rural communities. This study examined rural seniors’ perspectives of activities that they identified as supporting their cognitive health.

Using community-based research and an ethnographic methodology, participant observation and semi-structured interviews were conducted with 42 older adults in rural Saskatchewan, Canada. Participants discussed a variety of activities that they viewed as supporting their cognitive health. In particular, cognitive health promotion was identified as being strongly linked to keeping one’s brain active, thinking positively, mingling with others, and managing daily affairs. This study’s findings suggest that there is a need to move beyond focusing solely on clinical interventions to including older adults’ perspectives of preventative activities and cognitive health promotion.     

Clinical Geropsychology: Treatment and Research Approaches With Rural Older Adults

The proportion of older adults in rural settings continues to increase, with the proportion of older adults greater in rural versus urban areas. Rural elders often have greater mental health needs but live in areas with the greatest shortages of mental and behavioral health services. Furthermore, cultural barriers to treatment exist with a lack of understanding of rural older adults' cultural context contributing to a hesitation to seek help by rural elders. The current article will explore characteristics, need for treatment and research, barriers to delivering treatment and conducting research, public policy, and clinical implications related to the mental health needs of rural older adults.     

Health Promotion With Older Adults Experiencing Mental Health Challenges: A Literature Review of Strength-Based Approaches

Strength-based approaches may be utilized as a health promotion strategy for older adults with mental health challenges. Within this review, the results of an extensive literature search on strength-based approaches with this population are presented. While early evidence suggests the effectiveness of strength-based approaches, much work needs to be done to evaluate strength-based assessment tools, interventions, and models for older adults with mental health challenges.     

Psychological Resilience in Older Adults Following the 1997 Flood

Abstract

Thirty-seven older adults (14 male, 23 female) who experienced the 1997 Red River Flood were tested at three times following the flood (1997,1998, 2000) on measures of self-rated health, numbers of medications taken, depression (GDS-SF), and vocabulary ability (WAIS-R). Several 2 (gender) X 3 (time of measurement) ANOVAs revealed few main or interactions effects, providing some support for the inoculation hypothesis. This hypothesis states that prior experience with natural disasters tends to protect or insulate individuals from strong emotional reaction to future natural disasters. Results are discussed with regard to aging, mental health, and natural disasters.     

Leisure Patterns and Health Among Recently Widowed Adults

ABSTRACT

The purpose of this study was to examine how leisure involvement changes with the transition to widowhood and to determine if change in leisure involvement during this time has an impact on widows' physical and mental health. Adults age 50 and older who had transitioned into widowhood between Waves 1 and 2 or Waves 2 and 3 of the Americans' Changing Lives (ACL) dataset (N = 154) were included in the study. Results indicated that during this time widows experienced changes in their leisure repertoire (the types of leisure activities in which they participate), and the frequency of their leisure involvement. These changes in leisure behavior were associated with functional impairment, depressive symptoms, and life satisfaction, as well as their ability to cope with the loss of their spouse. Findings were interpreted in terms of effective strategies that appear to be employed by widows in utilizing leisure activities following loss of a spouse.     

Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use

The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.     

Self-Regulation and Adaptation of Leisure Activities Among Adults with Arthritis

This study explores the self-regulation and adaptation of leisure activities among adults with arthritis. A pilot study was conducted with a diverse sample of 178 adults to examine how their arthritis affects leisure involvement and health (physical, emotional, and social). Results from this study indicate that adults use strategies associated with the model of selective optimization with compensation (SOC) to adapt and self-regulate their leisure activities. In this study, use of each dimension of SOC with the exception of loss-based selection was associated with positive health outcomes. Our findings suggest that use of these strategies varies by individuals' resources and marital status.     

Correlates of Mental Illness and Health Categories among Older Adults in China: An Empirical Study Based on the Two Continua Model

Objective: Keyes’ two continua model is a useful concept in which mental health and mental illness exist on two separate axes. Based on this model, this study examined the prevalence and correlates of three mental health categories among older adults in China.

Methods: Cross-sectional data were derived from Wave 1 of the Study on Global AGEing and Adult Health. Participants were categorized into complete mental health (CMH), complete mental illness (CMI), and moderate mental health (MMH) groups. Multinomial logistic regressions were used.

Results: The prevalence of CMH, CMI, and MMH in China was 18%, 16%, and 66%, respectively. Being female, unmarried, younger, and feeling unhealthy were more likely to result in placement in the CMI category. Employment, education, and cognitive function were identified as important protective factors of CMH. Age, income, urban or rural residence, and physical function difficulty were associated with all three categories.

Discussion: We demonstrated the utility of the two continua model in identifying mental health needs in Chinese contexts. The findings suggest that future policy reforms and clinical interventions should establish a more comprehensive mental health category as a screening tool nationwide. The promotion of social engagement could play an important role in treating mental illness and improving positive mental health.     

Social Network and Mental Health Among Older Adults in Rural Uttar Pradesh,India: A Cross-Sectional Study

The rapid growth of the older population in India draws attention to the factors that contribute to their changing health realities. However, there has hardly been any study in India that has looked at the effects of specific social networks with children, relatives, friends and confidant on depression among older adults. The objective of the study is to investigate the association between social network and depression among the rural elderly. The study population comprised over 630 older adults (aged 60 and above) from the rural areas of Varanasi, Uttar Pradesh. We adopted Berkman's theoretical model of the impact of social relations on depression among the elderly in the Indian context. Results of the Confirmatory Factor Analysis (CFA) demonstrated that the four specific social network types: children, relatives, friends and confidant were tenable. The results showed that a better social network with 'friends/neighbours' was protective against depression among the rural elderly. This clearly points to the need for more social network centres for older adults, so that they can interact with friends within the community or between communities and participate in group activities.     

Primary Care Psychology: An Opportunity for Closing the Gap in Mental Health Services for Older Adults

Older adults, particularly in minority and lower income communities, continue to receive less mental health care relative to the general population. Concurrently, there has been increasing emphasis on the need to integrate mental health services into primary care settings. This push toward integration presents a unique opportunity to help close the gap in mental health services to underserved populations, including older adults. We discuss factors that have influenced this trend and specifically address the role of primary care–based psychologists in treating psychological disorders in older adults. A primary care psychology service at an urban training clinic is described and data are presented on 134 consecutive older adult patients who received services. Finally, two cases are presented to illustrate how integrated care can reach older adults who may not otherwise seek services or would get services only after psychological issues had become more acute. These cases support the view that integrated primary care can serve as a vital, flexible tool for enhancing timely mental health care for older adults, particularly within underserved populations. This population-based approach to providing brief services to a wide range of patients does not eliminate the need for more intensive services provided in mental health care settings but, rather, serves as a complement to those services.     

Meeting the Behavioral Health Needs of LGBT Older Adults

Lesbian, gay, bisexual, and transgender (LGBT) older adults face an increased risk of adverse behavioral health outcomes compared with the general population of older adults, yet little attention has been given to factors contributing to these disparities or to the ways in which clinicians can address these challenges. We present the case of a 75‐year‐old widowed lesbian woman with depression to illustrate how a lifetime of exposure to discrimination and stigma can produce high levels of stress and isolation while also fostering resilience. We then offer recommendations and resources for promoting psychological health among LGBT older adults by attending to the historical and cultural forces that affect LGBT health, and by implementing inclusive policies and programming. The article concludes with suggestions for advancing research and policy to help achieve greater health equity for LGBT older adults. J Am Geriatr Soc 67:1565–1570, 2019