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Osborne, Hannah; Simpson, Jane; Stokes, Graham
doi: 10.1080/13607861003713208pmid: 20480417
It has been suggested that challenging behaviour in people with dementia reflects a person's pre-morbid personality traits and a number of studies have explored this hypothesis. However, inconsistencies in outcome between studies suggest a need to review the available evidence systematically. As a result, major bibliographic databases were searched for studies examining the relationship between pre-morbid personality and challenging behaviour in order to conduct a systematic review. We included all English language studies published in referenced journals that assessed pre-morbid personality via a valid comprehensive personality measure, and also explored a relationship with challenging behaviour in people with dementia. A total of 18 studies were identified that covered a wide range of challenging behaviours including ‘wandering’, affective states, aggression, anxiety and delusions/hallucinations. Studies were assessed for their methodological quality and statistical findings. Studies lacked representative samples, were affected by confounding variables and suffered from small sample sizes. However, 72% of the studies reported significant relationships between pre-morbid personality and behaviour. In terms of specific relationships, the strongest evidence was found for a positive relationship between pre-morbid neuroticism and mood, and aggression and overall behavioural acts, thus supporting the inclusion of personality as one factor in the formulation of behaviour (Ballard, C., O’Brien, J., James, I., & Swann, A. (2001). Dementia: Management of Behavioural and Psychological Symptoms. Oxford: Oxford University Press; Kitwood, T. (1993). Person and process in dementia: Editorial. International Journal of Geriatric Psychiatry, 1, 541–545).
Coudin, Geneviève; Alexopoulos, Theodore
doi: 10.1080/13607861003713182pmid: 20480414
Objectives: This study examined the effects of negative aging stereotypes on self-reported loneliness, risk-taking, subjective health, and help-seeking behavior in a French sample of older adults. The aim of this study was to show the detrimental effects of negative aging stereotypes on older adults’ self-evaluations and behaviors, therefore contributing to the explanations of the iatrogenic effect of social environments that increase dependency (e.g., health care institutions). Method: In the first experiment conducted on 57 older adults, we explored the effects of positive, neutral, or negative stereotype activation on the feeling of loneliness and risk taking decision. The second experiment (n = 60) examined the impact of stereotype activation on subjective health, self-reported extraversion as well as on a genuine help-seeking behavior, by allowing participants to ask for the experimenter's help while completing a task. Results: As predicted, negative stereotype activation resulted in lower levels of risk taking, subjective health and extraversion, and in higher feelings of loneliness and a more frequent help-seeking behavior. Conclusion: These findings suggest that the mere activation of negative stereotypes can have broad and deleterious effects on older individuals’ self-evaluation and functioning, which in turn may contribute to the often observed dependency among older people.
D’Hudson, Geoffrey; Saling, Lauren L.
doi: 10.1080/13607861003713141pmid: 20480419
Objectives: This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults. Method: A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour. Results: A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways. Conclusion: The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.
Kim, Giyeon; Jang, Yuri; Chiriboga, David A.; Ma, Grace X.; Schonfeld, Lawrence
doi: 10.1080/13607860903311758pmid: 20496182
Objectives: The purpose of this study was to examine factors associated with the mental health service use of Latino and Asian immigrant elders. Adapting Andersen's behavioral health model of health service utilization, predisposing, enabling, and mental health need factors were considered as potential predictors for use of mental health services. Method: Data were drawn from a nationally representative dataset, the National Latino and Asian American Survey (NLAAS). Hierarchical logistic regression analyses of mental health service use were conducted for Latino (N = 290) and Asian (N = 211) immigrant elders. Results: For both groups of immigrant elders, poor self-rated mental health was associated with significantly greater mental health service use, even after controlling for all other variables. For Latinos, use of mental health services was significantly associated with both predisposing factors (being younger and female) and mental health need factors (having any mood disorders and poor self-rated mental health). Among Asians, only mental health need factors (having any mood disorders and poor self-rated mental health) significantly affected mental health service use. In addition, poor self-rated mental health mediated the association between mood disorders and mental health service use only in Latino immigrant elders. Conclusion: Results highlight an important role of self-rated mental health as a potential barrier in the use of mental health services, and suggest intervention strategies to enhance service use.
Adamis, Dimitrios; Sharma, Naveen; Whelan, Paul J.P.; Macdonald, Alastair J.D.
doi: 10.1080/13607860903421011pmid: 20480420
Objectives: Delirium is a common neuropsychiatric condition with many adverse outcomes in elderly populations including death. Despite this, it is often misdiagnosed and mistreated. A number of scales can be used to detect delirium. We review scales that have been used in delirium studies and report their psychometric properties. Method: An extensive MEDLINE database search and subsequent examination of reference lists was conducted to identify the various delirium scales that have been designed, primarily for use in the elderly. Results: Twenty-four scales were identified. Delirium instruments differed according to the classification system they were based on, length of time to administer, the rater and whether they were screening scales or measured symptom severity. The psychometric properties of each scale is reported. Conclusion: A large number of scales exist, but not all are properly evaluated in terms of psychometric properties, and there is not unanimity about which scale is the best. However, a small number of scales may be considered already to be robust and useable: the CAM, the DRS, the MDAS and the NEECHAM.
MacIntosh, Randall C.; Strickland, Oriel J.
doi: 10.1080/13607860903421045pmid: 20480413
Objectives: This study examines the differential item functioning (DIF) on both the standard 20-item scale and 10-item and 12-item subsets of the Center for Epidemiological Studies Depression (CES-D) inventory. Method: Two elderly groups in the United States are compared: one composed of Hispanics and the other of non-Hispanic Whites. We also compare item use among the elderly Hispanics over time. Survey data was analyzed from participants (N = 4499) in the Established Populations for Epidemiologic Studies of the Elderly (EPESE) with complete data on the CES-D. Partial correlation analysis was applied to test hypotheses regarding the DIF on the basis of ethnic background and among the elderly Hispanics across time points. Results: Hispanics appear to express positive affect differently than non-Hispanic Whites. On the 20-item scale, Hispanics under responded to items measuring positive affect. Item bias was also found for one positive affect question in the 10-item subset. Among the Hispanic sub-population, we also observed item response bias for the positive affect items across time. A 12-item subset tested for DIF displays an acceptable amount of item bias across ethnic groups and across time for the Hispanic sample. Conclusions: Attempts to make substantive comparisons about the relative prevalence of depression symptoms in elderly Hispanic and non-Hispanic sub-populations appears to be limited by the lack of measurement invariance in the full CES-D. Comparisons across time for elderly Hispanics also appear problematic.
Conradsson, Mia; Littbrand, Håkan; Lindelöf, Nina; Gustafson, Yngve; Rosendahl, Erik
doi: 10.1080/13607860903483078pmid: 20496181
Objectives: To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living (ADL) and living in residential care facilities. Method: Cluster-randomized controlled study. Participants were 191 older people, aged 65–100, dependent in ADL and with Mini Mental State Examination scores between 10 and 30. One-hundred (52%) of the participants had a diagnosed dementia disorder. A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups. Sessions were held five times over each two week period for three months, a total of 29 times. The outcome measures, Geriatric Depression Scale (GDS-15) and Philadelphia Geriatric Center Morale Scale (PGCMS) were blindly assessed at baseline, three and six months. Results: At baseline, mean ± SD (range) for GDS was 4.4 ± 3.2 (0–14), and for PGCMS 11.0 ± 3.5 (2–17). There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample. Among people with dementia, there was a between-group difference at three months in PGCMS scores in favour of the exercise group. Conclusion: A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities. An individualized and multifactorial intervention may be needed in this group. However, an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia.
doi: 10.1080/13607860903483086pmid: 20480422
Objective: The present study investigated time perspective in old-old age as embodied in trajectories of life satisfaction ratings that individuals attribute to their past, present, and anticipated future. We hypothesized that these trajectories represent diverse strategies of coping with old age. Method: The sample was composed of 164 participants (mean age 91.9, SD = 4.3) who survived the third wave of a national longitudinal study in Israel. The findings indicated four groups; three with distinctive trajectories of life satisfaction – equilibrated, descending, and no-future, along with an unreported trajectory group. Results: The equilibrated trajectory group exhibited the highest functioning on central markers of adaptation (indicating depressive symptoms, self-rated health, and physical performance). The descending and the no-future trajectories were found to be moderately effective strategies. The unreported trajectory presented the lowest level of functioning. Conclusions: The findings revealed the adaptive roles of time-related perspective on life in old-old people. This perspective reflects a variety of rudimentary trajectories that constitute a time-based module of well-being along the continuum of one's life story. The study suggests that the diverse trajectories relate to essential domains of functioning. Practitioners and therapists may profit from assessing the time perspective of the old-old and directing it into more adaptive trajectories.
Sugawara, Norio; Yasui-Furukori, Norio; Umeda, Takashi; Sato, Yasushi; Kaneda, Ayako; Tsuchimine, Shoko; Saito, Manabu; Nakaji, Shigeyuki; Kaneko, Sunao
doi: 10.1080/13607860903586086pmid: 20614347
Objectives: The Clock Drawing Test (CDT) is commonly used for cognitive screening. The purpose of this study is to develop normative data for the CDT for the Japanese community-dwelling population, using the method of Freedman. This study also investigates the effect of demographic factors on the performance of the subjects in this task. Methods: We administered the CDT and the Mini-Mental State Examination (MMSE) to 873 volunteers. Using a multiple linear regression analysis, we found a gender difference in the free-drawn condition. Results: A detrimental effect of age was observed in the free-drawn and pre-drawn conditions. The years of education affected the CDT in the examiner 2 condition. Correlations of the MMSE with each of the five conditions of the CDT were significant, further validating this test. Conclusions: Our study provides preliminary normative data for the Japanese population stratified by the age and level of education. However, interpretation of our results was hampered by the large variability in the performance of the subjects and the possibility of a selection bias. Thus, additional studies will be necessary to further characterise the CDT scores for the Japanese community.
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