Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions.

To describe the efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults.

Systematic review.

We searched MEDLINE, EMBASE, Cochrane Libraries, PsycINFO, and gray literature from inception to July 5, 2021.

We included randomized trials (RCTs) comparing the efficacy of virtual interventions to any other virtual intervention or usual care in community-dwelling adults ≥60 years old experiencing symptoms of depression or depression as an outcome.

The primary outcome was change in symptoms of depression measured by any depression scale.

We screened 12,290 abstracts and 830 full text papers. We included 15 RCTs (3100 participants). Five RCTs examined persons with depression symptoms at baseline and ten examined depression as an outcome only. Included studies demonstrated feasibility of interventions such as internet or telephone cognitive behavioral therapy with some papers showing statistically significant improvement in depressive symptoms.

There is a paucity of studies examining virtual interventions in older adults with depression. Given difficulty in accessing in-person therapies in a pandemic and poor access for people living in rural and remote regions, there is an urgent need to explore efficacy, effectiveness, and implementation of virtual therapies.

The current study examined the effects of a 16-week creative expression program on brain activity during a story creating task and resting-state functional network connectivity in mild cognitive impairment (MCI) adults.

Thirty-six MCI adults were allocated to either the creative expression program (CrExp, n = 18) or control group (CG,n = 18). Before and after intervention, all participants were scanned with functional magnetic resonance imaging (fMRI) during story creating task performance and a resting state. The two-group comparison was calculated between the blood oxygenation level-dependent (BOLD) signal changes for each cluster to investigate the differences in fMRI activation and functional connectivity (FC) between two groups.

Task activation analyses showed an increase in the right anterior cingulate gyrus (ACG), right medial frontal gyrus (MFG), right lentiform nucleus (LN), left hippocampus (HIP), left middle occipital gyrus (MOG), and left cerebellum posterior lobe (CPL) (p < 0.05). Story creating performance improvements were associated with greater activation in the left HIP region. Resting-state functional connectivity (FC) between left HIP and certain other brain areas shown a significant interaction of creative expression group versus control group. Moreover, connectivity between the right angular gyrus (ANG), right inferior temporal gyrus (ITG), right superior occipital gyrus (SOG), left ANG, and left MFG were related to improved cognitive performance (p < 0.05).

These data extend current knowledge by indicating that the creative expression program can improve cognitive activation in MCI, and these enhancements may be related to the neurocognitive network plasticity changes induced by creative expression training.

This study examined the effectiveness of an integrated care pathway (ICP), including a medication algorithm, to treat agitation associated with dementia.

Analyses of data (both prospective and retrospective) collected during routine clinical care.

Geriatric Psychiatry Inpatient Unit.

Patients with agitation associated with dementia (n = 28) who were treated as part of the implementation of the ICP and those who received treatment-as-usual (TAU) (n = 28) on the same inpatient unit before the implementation of the ICP. Two control groups of patients without dementia treated on the same unit contemporaneously to the TAU (n = 17) and ICP groups (n = 36) were included to account for any secular trends.

ICP.

Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory Questionnaire (NPIQ), and assessment of motor symptoms were completed during the ICP implementation. Chart review was used to obtain length of inpatient stay and rates of psychotropic polypharmacy.

Patients in the ICP group experienced a reduction in their scores on the CMAI and NPIQ and no changes in motor symptoms. Compared to the TAU group, the ICP group had a higher chance of an earlier discharge from hospital, a lower rate of psychotropic polypharmacy, and a lower chance of having a fall during hospital stay. In contrast, these outcomes did not differ between the two control groups.

These preliminary results suggest that an ICP can be used effectively to treat agitation associated with dementia in inpatients. A larger randomized study is needed to confirm these results.

Higher inflammation has been linked to poor physical and mental health outcomes, and mortality, but few studies have rigorously examined whether changes in perceived stress and depressive symptoms are associated with increased inflammation within family caregivers and non-caregivers in a longitudinal design.

Longitudinal Study.

REasons for Geographic And Racial Differences in Stroke cohort study.

Participants included 239 individuals who were not caregivers at baseline but transitioned to providing substantial and sustained caregiving over time. They were initially matched to 241 non-caregiver comparisons on age, sex, race, education, marital status, self-rated health, and history of cardiovascular disease. Blood was drawn at baseline and approximately 9.3 years at follow-up for both groups.

Perceived Stress Scale, Center for Epidemiological Studies-Depression, inflammatory biomarkers, including high-sensitivity C-reactive protein, D dimer, tumor necrosis factor alpha receptor 1, interleukin (IL)-2, IL-6, and IL-10 taken at baseline and follow-up.

Although at follow-up, caregivers showed significantly greater worsening in perceived stress and depressive symptoms compared to non-caregivers, there were few significant associations between depressive symptoms or perceived stress on inflammation for either group. Inflammation, however, was associated with multiple demographic and health variables, including age, race, obesity, and use of medications for hypertension and diabetes for caregivers and non-caregivers.

These findings illustrate the complexity of studying the associations between stress, depressive symptoms, and inflammation in older adults, where these associations may depend on demographic, disease, and medication effects. Future studies should examine whether resilience factors may prevent increased inflammation in older caregivers.

People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal.

This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms.

The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis.

Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures.

This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.

Pandemics and their public health control measures have generally substantially increased the level of loneliness and social isolation in the general population. Because of the circumstances of aging, older adults are more likely to experience social isolation and loneliness during pandemics. However, no systematic review has been conducted or published on the prevalence of loneliness and/or social isolation among the older population. This systematic review and meta-analysis aims to provide up-to-date pooled estimates of the prevalence of social isolation and loneliness among older adults during the COVID-19 pandemic and other pandemics in the last two decades.

EMBASE, PsychoINFO, Medline, and Web of Science were searched for relevant studies from January 1, 2000 to November 31, 2021 published in a variety of languages. Only studies conducted during the COVID-19 pandemic were selected in the review.

A total of 30 studies including 28,050 participants met the inclusion criteria. Overall, the pooled period prevalence of loneliness among older adults was 28.6% (95% CI: 22.9–35.0%) and 31.2% for social isolation (95% CI: 20.2–44.9%). Prevalence estimates were significantly higher for those studies conducted post 3-month from the start of the COVID-19 pandemic compared to those conducted within the first 3 months of the pandemic.

This review identifies the need for good quality longitudinal studies to examine the long-term impact of pandemics on loneliness and social isolation among older populations. Health policymaking and healthcare systems should proactively address the rising demand for appropriate psychological services among older adults.

Depression is common in persons experiencing mild cognitive impairment (MCI), with 32% (95% Cl 27, 37) overall experiencing depression. Persons with MCI who have depression have more cognitive changes compared to those without depression. To understand how we can detect depressive symptoms in persons with MCI, we undertook a systematic review to identify tools that were validated compared with a reference standard.

We searched MEDLINE, EMBASE, PsycINFO, and Cochrane from inception to April 25, 2021, and conducted a gray literature search. Title/abstract and full-text screening were completed in duplicate. Demographic information, reference standards, prevalence, and diagnostic accuracy measures were then extracted from included articles (PROSPERO CRD: CRD42016052120).

Across databases, 8,748 abstracts were generated after removing duplicates. Six hundred and sixty-five records underwent full-text screening, with six articles included for data extraction. Nine tools were identified compared to a reference standard, with multiple demonstrating a sensitivity of 100% (Brief Assessment Schedule Depression Cards, Beck Depression Inventory-II, Cornell Scale for Depression in Dementia, Zung Self-Rated Depression Scale, and the Neuropsychiatric Inventory). The second highest sensitivity reported was 89% (Patient Health Questionnaire-9). Too few studies were available for a meta-analysis.

Multiple depression detection tools have been examined amongst MCI outpatients, with several showing high sensitivity. However, this evidence is only present in single studies, with little demonstration of how differing MCI types affect accuracy. More research is needed to confirm the accuracy of these tools amongst persons with MCI. At this time, several tools could be suitable for use in cognitive clinics.

Shared decision making is the process in which the person, their representative, and health care professional share information with each other, participate in the decision-making process, and agree on a course of action. At present, very little is known about shared decision making (SDM) in medication management from the perspective of long-term care facility residents. The objective of this study was to identify residents’ beliefs, motivation, and aspects of the environment that facilitate or impede SDM.

A qualitative study was conducted using face-to-face semi-structured interviews, and data analysis was carried out using a thematic approach.

Six long-term care facilities in Sydney, Australia.

Thirty-one residents.

Enablers to resident involvement in SDM were resident beliefs in exercising their right to take part in medication-related decisions, preference to maintain control over decisions, and motivation to raise concern about medication. Residents were not motivated to be involved in SDM if they believed they had no control over life circumstance, perceived that medications were necessary, or experienced no problems with their medications. Participation in SDM was hindered by limitations in opportunities for resident involvement, engagement with staff and primary care physician to discuss issues related to medications, and continuity of care with their regular physician.

This study highlights that the residents’ beliefs in control over decisions and concerns about medication are a significant function of the SDM process. It is important that residents are given the choice to take part in SDM, their beliefs and values regarding SDM are understood, and the culture of the care facility respects residents’ right to participate in SDM.

The literature on Alzheimer’s disease (AD) provides little data about long-term cognitive course trajectories. We identify global cognitive outcome trajectories and associated predictor variables that may inform clinical research and care.

Data derived from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set were used to examine the cognitive course of persons with possible or probable AD, a Mini-Mental State Examination (MMSE) of ≥10, and complete annual assessments for 5 years.

Thirty-six Alzheimer’s Disease Research Centers.

Four hundred and fourteen persons.

We used a hybrid approach comprising qualitative analysis of MMSE trajectory graphs that were operationalized empirically and binary logistic regression analyses to assess 19 variables’ associations with each trajectory. MMSE scores of ±3 points or greater were considered clinically meaningful.

Five distinct cognitive trajectories were identified: fast decliners (32.6%), slow decliners (30.7%), zigzag stable (15.9%), stable (15.9%), and improvers (4.8%). The decliner groups had three subtypes: curvilinear, zigzag, and late decline. The fast decliners were associated with female gender, lower baseline MMSE scores, a shorter illness duration, or receiving a cognitive enhancer. An early MMSE decline of ≥3 points predicted a worse outcome. A higher rate of traumatic brain injury, the absence of an ApoE ϵ4 allele, and male gender were the strongest predictors of favorable outcomes.

Our hybrid approach revealed five distinct cognitive trajectories and a variegated pattern within the decliners and stable/improvers that was more consistent with real-world clinical experience than prior statistically modeled studies. Future investigations need to determine the consistency of the distribution of these categories across settings.

To investigate factors associated with suicidal ideation (SI) around the time of dementia diagnosis. We hypothesised relatively preserved cognition, co-occurring physical and psychiatric disorders, functional impairments, and dementia diagnosis subtype would be associated with a higher risk of SI.

Cross-sectional study using routinely collected electronic mental healthcare records.

National Health Service secondary mental healthcare services in South London, UK, serving a population of over 1.36 million residents.

Patients who received a diagnosis of dementia (Alzheimer’s, vascular, mixed Alzheimer’s/vascular, or dementia with Lewy bodies) between 1 Nov 2007–31 Oct 2021: 18,252 people were identified during the observation period.

A natural language processing algorithm was used to identify recorded clinician recording of SI around the time of dementia diagnosis. Sociodemographic and clinical characteristics were also measured around the time of diagnosis. We compared people diagnosed with non-Alzheimer’s dementia to those with Alzheimer’s and used statistical models to adjust for putative confounders.

15.1% of patients had recorded SI, which was more common in dementia with Lewy bodies compared to other dementia diagnoses studied. After adjusting for sociodemographic and clinical factors, SI was more frequent in those with depression and dementia with Lewy bodies and less common in those with impaired activities of daily living and in vascular dementia. Agitated behavior and hallucinations were not associated with SI in the final model.

Our findings highlight the importance of identifying and treating depressive symptoms in people with dementia and the need for further research into under-researched dementia subtypes.

Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR).

Observational cohort study.

Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal.

The final sample included 499 participant–informant dyads.

Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/− individuals, as was the association between cognitive scores and MBI symptom severity.

Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity.

These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.

Informal carers play an essential role in the care of individuals with Parkinson’s disease (PD). This role, however, is often fraught with difficulties, including emotional, physical, and financial. Coping styles and relationship quality have been hypothesized to influence the impact of stressors. The aim of this study is to examine the relationship between carers’ coping style, relationship quality, and carer burden.

Cross-sectional.

Thirty-nine PD patient carer dyads were included in the study.

Participants completed self-rated questionnaires including the Dyadic Adjustment Scale, Zarit Burden Interview, and Brief Coping Orientation to Problems Experienced Inventory.

Correlational analyses found significant and positive correlation between carer burden and all three coping styles (problem-focused, emotion-focused, and dysfunctional). There was also a moderate association between carers’ perceived relationship quality and satisfaction and carer burden. Regression analyses found that carer’s gender, severity of PD, relationship quality, emotion-focused, and dysfunctional coping styles did not predict carer burden. Conversely, problem-focused coping style predicted carer burden.

The results highlight that there is no perfect way to react and care for a loved one and serves as important information for practitioners who design and implement interventions.

Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief.

(Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized.

Family non-paid carers of somebody with any dementia type.

Validated measures of pre-death and/or post-death grief.

We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6–26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported.

Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.

The coronavirus disease-2019 (COVID-19) pandemic and accompanying lockdown restrictions impacted social life significantly. We studied associations of sociodemographic factors, mental and social health markers, and brain structure with social health trajectories during the COVID-19 pandemic.

Prospective longitudinal population-based cohort study.

Community-dwelling inhabitants of Rotterdam, the Netherlands.

Repeated questionnaires including questions on social health were sent to Rotterdam Study participants from April 2020 onwards. Social health data at study baseline were available for 5017 participants (mean age: 68.7 ± 11.3; 56.9% women).

Determinants were assessed in routine Rotterdam Study follow-up (1990–2020), including global brain volumes in a subset of participants (N = 1720). We applied linear mixed models and generalized estimating equations to quantify associations between determinants and trajectories of loneliness, perceived social isolation and social connectedness over three time points from April 22nd to July 31st 2020.

Loneliness prevalence was 27.9% in April 2020 versus 12.6% prepandemic. Social isolation (baseline mean 4.7 ± 2.4) and loneliness scores (baseline mean 4.9 ± 1.5) decreased over time, whereas social connectedness trajectories remained stable. Depressive symptoms, female sex, prepandemic loneliness, living alone, and not owning a pet were independently associated with lower social connectedness and higher social isolation and loneliness at COVID-19 baseline, but recovery of social health was similar for all determinants. Larger intracranial volume was associated with higher social connectedness.

Despite baseline differences for specific determinants, older adults showed similar recovery of loneliness and social isolation alongside stable social connectedness over time during the pandemic. Social health is multidimensional, especially during a global health crisis.

To explore and compare the experiences of care home visits during the pandemic in the UK and the Netherlands.

Qualitative semi-structured interview studies

Family carers of relatives residing in care homes in the UK and the Netherlands were interviewed remotely.

Family carers were asked about their experiences of care home visits during the pandemic, and specifically in the Netherlands after care homes had reopened. Transcripts were analyzed in each country separately in the native language using thematic analysis, before discussing findings at multiple analysis meetings.

Across 125 interviews, we developed four themes: (1) different types of contact during lockdown; (2) deterioration of resident health and well-being; (3) emotional distress of both visitors and residents; and (4) compliance to guidelines and regulations. Visiting in both the UK and the Netherlands was beneficial, if possible in the UK, yet was characterized by alternative forms of face-to-face visits which was emotionally distressing for many family carers and residents. In the Netherlands, government guidance did enable early care home visitation, while the UK was lacking any guidance leading to care homes implementing restrictions differently.

Early and clear guidance, as well as communication, is required in future pandemics, and in this ongoing pandemic, to enable care home visits between residents and loved ones. It is important to take learnings from this global pandemic to reimagine long-term care, highlighting the value of socializing for care home residents.

Wisdom is a personality trait comprising seven components: self-reflection, pro-social behaviors, emotional regulation, acceptance of diverse perspectives, decisiveness, social advising, and spirituality. Wisdom, a potentially modifiable trait, is strongly associated with well-being. We have published a validated 28-item San Diego Wisdom Scale, the SD-WISE-28. Brief scales are necessary for use in large population-based studies and in clinical practice. The present study aimed to create an abbreviated 7-item version of the SD-WISE.

Participants included 2093 people, aged 20-82 years, recruited and surveyed through the online crowdsourcing platform Amazon Mechanical Turk. The participants’ mean age was 46 years, with 55% women. Participants completed the SD-WISE-28 as well as validation scales for various positive and negative constructs. Psychometric analyses (factor analysis and item response theory) were used to select one item from each of the seven SD-WISE-28 subscales.

We selected a combination of items that produced acceptable unidimensional model fit and good reliability (ω = 0.74). Item statistics suggested that all seven items were strong indicators of wisdom, although the association was weakest for spirituality. Analyses indicated that the 28-item and 7-item SD-WISE are both very highly correlated (r = 0.92) and produce a nearly identical pattern of correlations with demographic and validity variables.

The SD-WISE-7, and its derived Jeste-Thomas Wisdom Index (JTWI) score, balances reliability and brevity for research applications.

Rates of suicide in older adults may be higher than reported due to poor understandings of presentation of suicide ideation in this group. The objectives of this paper were to (i) review current measurement tools designed for older adults to detect suicide ideation and (ii) assess their psychometric properties.

We used a systematic review approach to identify measurement tools developed specifically for older adults without cognitive decline or impairment.

Ten articles that reported on a total of seven different measurement tools were identified. These included tools that focused on resiliency to suicide and those that measured risk of suicide behavior. There was wide variation across the articles: some were adaptations of existing scales to suit older populations, others were developed by authors; they varied in length from four to 69 items; a range of settings was used, and there was a mix of self-report and clinician-administered measures. Most displayed good psychometric properties, with both approaches showing similar quality. Limitations in terms of samples, settings, and measurement design are discussed.

The case for specific measures for older adults is clear from this review. There appear to be unique factors that should be considered in understanding suicide ideation and behavior among older adults that may not be directly assessed in non-specific measurements. However, there is a need to expand the diversity of individuals included in measurement development to ensure they are appropriate across gender, culture and minority status, and for the views of professionals to be considered.

To investigate the relationship between the P300 event-related potential, neuropsychological measures of memory, subjective memory complaints (SMCs), and indicators of psychosocial functioning.

In this cross-sectional study of 79 community-based older adults, aged 60–75 years, participants completed online surveys and in-person neuropsychological and electroencephalogram (EEG) assessments.

Measures included: the Change subscale of the Metamemory in Adulthood Questionnaire, NIH Toolbox Emotions battery (Perceived Stress and Psychological Well-Being), Geriatric Depression Scale, Geriatric Anxiety Scale, electrocortical measures (EEG), California Verbal Learning Test, 3rd Edition, and diagnostic ratings for mild and major neurocognitive disorders based on full neuropsychological battery, clinical interview, and two-clinician consensus.

P300 amplitude was associated with long-delay verbal memory recall and diagnostic rating. SMCs were not associated with objective memory or diagnostic rating. SMCs were associated with higher perceived stress, anxiety, and depression symptoms and lower psychological well-being.

Neural indicators such as the P300 may be useful for early detection of cognitive impairment. SMCs were not a reliable indicator of early memory impairment in relation to neuropsychological or neural indicators, but may be a useful indicator of unreported stress and mood symptoms in clinical settings.

We examined differences across three groups in Israel to test the double jeopardy versus the intersection escape hypotheses-which evaluate whether being older and belonging to an underrepresented group serves as a double burden, exposing older minorities to higher levels of perceived ageism or on the contrary, older age serves as a protective factor, especially for underrepresented groups.

A cross-sectional, nationally representative sample, consisting of three groups: Veteran Israelis, Israeli Arabs and immigrants from the Former Soviet Union. The latter two groups represent underrepresented (minority) populations in Israel.

Community-dwelling Israelis over the age of 50.

The sample was composed of 1570 participants.

To examine the double jeopardy versus the intersectional escape hypothesis, self-perceptions of aging (SPA) and perceived age-based discrimination in the healthcare system were examined as outcome variables.

Among Israeli Arabs, being older was related to better SPA, whereas among the immigrants being older was related to worse SPA. As immigrants became older, they were more likely to report ageist experiences. Israeli Arabs reported higher levels of ageist experiences, regardless of their age.

The findings point to certain groups that require education about ageism and the aging processes and might require further protection from the experiences of ageism. The findings also point to the relevance of different theoretical paradigms that advocate for the consideration of culture and group membership in the understanding of the experiences of ageism.