Aging is associated with numerous stressors that negatively impact older adults’ well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.

A pragmatic modified stepped-wedge trial design.

Five senior housing communities in three states in the US.

Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.

Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.

Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).

Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.

This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.

This study aims to adapt and validate the most common measure of self-esteem, the Rosenberg Self-Esteem Scale (RSES), in the elderly Spanish population based on the initial one-factor model proposed by the author of the scale.

The factorial validity of the scale was tested using confirmatory factor analysis.

The study was carried out in the city of Valencia (Spain).

A total of 231 elderly people with a mean age 72.68 (SD=8.55).

The participants completed the questionnaire RSES for the validation process, sociodemographic data and Mini-Mental State Examination.

Confirmatory factor analysis with a five-item structure for the one-factor structure showed good fit indexes (Chi square [5] = 217.20, p < .05; CFI = .965; GFI = .980; RMSEA = .070 [90% confidence interval of RMSEA, .022-.087]), and reliability, as internal consistency, measure with Cronbach’s alpha was .732.

The adaptation of the RSES showed a unifactorial structure with good internal consistency. This reduced adaptation/version of the scale may facilitate clinical practice and be useful in research in older people.

The demographic transition is a global event intensified during the last decades that represents population aging. Thus, the studies directed to the elderly 80 years of age or more with preserved cognitive functions (named SuperAgers) emerges as a possible path to full comprehension of the health of those aging with acceptable levels of functionality and independency.

To evaluate the cognitive performance of the elderly over 80 years old, associating the results to their educational level.

We evaluated 144 healthy elders with 80 years or more through the following cognitive tests Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clock Drawing Test (CDT), and Verbal Fluency Test (VF) and compared the tests’ scores with their educational level segmented in years of formal education, being the groups ILLITR (<1 year of schooling), 1TO4 (from 1 to 4 years of schooling), and 5MORE (>5 years of schooling).

There was positive influence of educational level on the cognitive tests’ score, which indicates higher cognitive reserve of the elderly with higher educational levels.

The functionality and independence of the so-called SuperAgers is determined by the cognitive reserve acquired throughout life, mainly developed by the years of formal education.

Although it is known that certain emotion regulation processes produce a buffering effect on the relationship between life events and well-being, this issue has been poorly studied in the elderly population. Thus, the aim of the present study is to test and confirm a comprehensive model of the impact that past life events have on older adults’ psychological distress, exploring the possible mediating roles of emotion regulation processes. These include rumination, experiential avoidance, and personal growth.

In this cross-sectional study, 387 people over 60 years old residing in the community were assessed on life events, physical functioning, emotion regulation variables, psychological well-being, as well as symptoms of anxiety and depression.

The structural model tested achieved a satisfactory fit to the data, explaining 73% of the variance of older adults’ psychological distress. In addition, the main results suggest possible mediation effects of both the physical functioning and the emotional variables: rumination, experiential avoidance, and personal growth in the face of hardship.

These findings confirm the importance of emotion regulation processes in the final stages of life. They reveal the various adaptive and maladaptive mechanisms that underlie the relationship between life events and psychological distress. The findings suggest – both in the explanatory models of psychological well-being and in psychotherapeutic interventions – the importance of emotion regulation in the elderly population’s health.

In medical practice, a patient’s loss of competency is a major obstacle when choosing a treatment and a starting treatment program smoothly. A large number of studies have revealed the lack of medical competency in patients with dementia. However, there have been only a few reports focusing on the capacity of patients with mild cognitive impairment (MCI) to make a medical choice.

In this study, we evaluated the competency of 40 patients with amnestic MCI (aMCI) and 33 normal subjects to make a medical choice using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). We compared the judgement of a team conference using the recorded semi-structured interview with the clinical judgement of a chief clinician.

A team conference concluded that 12 aMCI patients had no competency, and the clinical judgement, without any special interview, judged that five aMCI patients had no competency. All subjects in the control groups were judged to be competent to consent to treatment by both clinicians and the team conference.

Without supplementary tools such as explanatory documents, not a few patients with aMCI were judged by a team conference to have no competency to consent to therapy even in a relatively simple and easy case. In contrast, clinical physicians tended to evaluate the competency of aMCI patients in a generous manner.

More people remain in the workforce into their late life as people’s life expectancy increases. This study examined the relationship between work stress and depressive symptoms of older workers in mainland China, focusing on the interplay between work stress with family and community factors in three (i.e., urban, rural, and migrant) settings.

National representative survey data on the Chinese labor force collected by the Social Science Research Center of Sun-Yetsen University in 2014 were used. The sample consisted of 5,751 workers aged 50 and above recruited from 29 out of 31 provinces in mainland China.

Work stress had a consistent and robust effect on depressive symptoms across older worker groups. Moreover, it interacted with family and community factors differentially in three settings. For migrant older workers, work stress was a dominant factor affecting their depressive symptoms. Among rural older workers, the influence of work stress on depressive symptoms depended on their family debt and neighborhood cohesion levels.

Stressors from work, family, and community comprised a general model that explains depressive symptoms in Chinese older workers. Interventions or service programs aimed at reducing work stress and improving mental health among older adults should consider the complexity of intertwining family and community dynamics as well as respective strengths in urban, rural, and migrant communities.

Providing care for an older family member is a common experience for women and has been linked with increased depression, anxiety, and stress for some caregivers. This study aimed to investigate the role of self-reassurance and self-efficacy for controlling upsetting thoughts in mitigating the negative effects of caregiving stressors on mental health.

Measures were collected during a pre-intervention assessment for a larger study in the U.S.A. evaluating online interventions for intergenerational caregivers. Hierarchical linear regressions were used to examine the contribution of self-reassurance and self-efficacy for controlling upsetting thoughts on mental health outcomes, after controlling for caregiving-related contextual variables and stressors.

Participants completed online questionnaires on a computer or tablet at their convenience.

Participants were 150 help-seeking adult women providing health-care assistance to older relatives living in the community.

Measures were completed for the mental health outcomes of depression, anxiety, and stress. Measures also included contextual factors of caregiving and demographics. Cognitive impairment, caregiver assistance, role overload, percentage of care provided, family conflict, self-reassurance, and self-efficacy for controlling upsetting thoughts were also measured.

Regression models revealed that both self-reassurance and self-efficacy for controlling upsetting thoughts predicted depression, anxiety, and perceived stress after controlling for caregiving contextual factors and stressors.

The results indicate that self-reassurance and self-efficacy for controlling upsetting thoughts are effective resources linked to mental health outcomes. Although results were obtained with cross-sectional data, these findings suggest the potential of targeting these resources in transdiagnostic interventions for family caregivers.

The USA and UK governmental and academic agencies suggest that up to 35% of dementia cases are preventable. We canvassed dementia risk and protective factor awareness among New Zealand older adults to inform the design of a larger survey.

The modified Lifestyle for Brain Health scale quantifying dementia risk was introduced to a sample of 304 eligible self-selected participants.

Two hundred and sixteen older adults (≥50 years), with mean ± standard deviation age 65.5 ± 11.4 years (50–93 years), completed the survey (71% response rate). Respondents were mostly women (n = 172, 80%), European (n = 207, 96%), and well educated (n = 100, 46%, with a tertiary qualification; including n = 17, 8%, with a postgraduate qualification). Around half of the participants felt that they were at a future risk of living with dementia (n = 101, 47%), and the majority felt that this would change their lives significantly (n = 205, 95%), that lifestyle changes would reduce their risk (n = 197, 91%), and that they could make the necessary changes (n = 189, 88%) and wished to start changes soon (n = 160, 74%). Only 4 of 14 modifiable risk or protective factors for dementia were adequately identified by the participants: physical exercise (81%), depression (76%), brain exercises (75%), and social isolation (83%). Social isolation was the commonly cited risk factor for dementia, while physical exercise was the commonly cited protective factor. Three clusters of brain health literacy were identified: psychosocial, medical, and modifiable.

The older adults in our study are not adequately knowledgeable about dementia risk and protective factors. However, they report optimism about modifying risks through lifestyle interventions.

To conceptualize a “good end of life” for people with dementia from the perspectives of bereaved family caregivers in Japan.

A qualitative study using in-depth, semi-structured interviews focused on the family caregivers’ perceptions of their loved one’s experiences. Family caregivers who had lost their relatives with dementia more than six months previously were recruited using maximum variation sampling by cultural subpopulation. A thematic analysis was conducted.

From 30 interviews held, four main themes emerged. A good end of life for people with dementia means experiencing a “Peaceful Death” while “Maintaining Personhood” at a “Preferred Place” allowing for feelings of “Life Satisfaction.” A “Preferred Place” emerged as a basic requirement to achieving a good end of life according to the three other themes, in particular, “Maintaining Personhood.” However, the interviewees experienced difficulties in ensuring that their loved ones stayed at a “Preferred Place.”

Despite different cultural backgrounds, perceptions of a good end of life with dementia were remarkably similar between Japan and Western countries. However, recent societal changes in family structures and long-term care access in Japan may explain the theme of a comfortable place taking a central position. We suggest that these themes be considered and translated into care goals. They could supplement established end-of-life care goals for quality of life in dementia, which aim to maximize functioning and increase comfort.

Ethics Committee of the Graduate School and Faculty of Medicine, Kyoto University (R0808-2)

To identify, in caregivers of patients with Alzheimer’s disease (AD) dementia, factors associated with subjective (personal, physical, emotional, and social) and objective (informal caregiver time and costs) caregiver burden.

Prospective longitudinal European observational study: post-hoc analysis.

Clinic.

Community-dwelling patients in France and Germany aged ≥ 55 years (n = 969) with probable AD and their informal caregivers.

Mini-Mental State Examination (MMSE), Alzheimer’s Disease Cooperative Study—Activities of Daily Living (ADCS-ADL), 12-item Neuropsychiatric Inventory (NPI-12), Zarit Burden Interview (ZBI), informal caregiver basic and instrumental ADL hours (Resource Utilization in Dementia instrument), and informal caregiver costs. Mixed-effect models of repeated measures (MMRM) were run, including baseline and time-dependent covariates (change from baseline [CFB] to 18 months in MMSE, ADCS-ADL, and NPI-12 scores) associated with CFB in ZBI score/informal caregiver time over 36 months (analyzed using linear regression models) and informal caregiver costs over 36 months (analyzed using generalized linear models).

Greater decline in patient function (ADCS-ADL) over 18 months was associated with increased subjective caregiver burden (ZBI), hours, and costs over 36 months. Increased behavioral problems (NPI-12) over 18 months also negatively impacted ZBI. Cognitive decline (MMSE) over 18 months did not affect change in caregiver burden.

Long-term informal caregiver burden was driven by worsening functional abilities and behavioral symptoms but not cognitive decline, over 18 months in community-dwelling patients with AD dementia. Identifying the drivers of caregiver burden could highlight areas in which interventions may benefit both caregivers and patients.

Behaviours associated with agitation are common in people living with dementia. The Cohen-Mansfield Agitation Inventory (CMAI) is a 29-item scale widely used to assess agitation completed by a proxy (family carer or staff member). However, proxy informants introduce possible reporting bias when blinding to the treatment arm is not possible, and potential accuracy issues due to irregular contact between the proxy and the person with dementia over the reporting period. An observational measure completed by a blinded researcher may address these issues, but no agitation measures with comparable items exist.

Development and validation of an observational version of the CMAI (CMAI-O), to assess its validity as an alternative or complementary measure of agitation.

Fifty care homes in England.

Residents (N = 726) with dementia.

Two observational measures (CMAI-O and PAS) were completed by an independent researcher. Measures of agitation, functional status, and neuropsychiatric symptoms were completed with staff proxies.

The CMAI-O showed adequate internal consistency (α = .61), criterion validity with the PAS (r = .79, p = < .001), incremental validity in predicting quality of life beyond the Functional Assessment Staging of Alzheimer’s disease (β = 1.83, p < .001 at baseline) and discriminant validity from the Neuropsychiatric Inventory Apathy subscale (r = .004, p = .902).

The CMAI-O is a promising research tool for independently measuring agitation in people with dementia in care homes. Its use alongside the CMAI could provide a more robust understanding of agitation amongst residents with dementia.