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Objectives: Whether and how patients should be told their dementia diagnosis, has been an area of much debate. While there is now recognition that early diagnosis is important for dementia care little research has looked at how dementia-related diagnostic information is actually verbally communicated. The limited previous research suggests that the absence of explicit terminology (e.g., use of the term Alzheimer's) is problematic. This paper interrogates this assumption through a conversation analysis of British naturalistic memory clinic interaction.\ud \ud Method: This paper is based on video-recordings of communication within a UK memory clinic. Appointments with 29 patients and accompanying persons were recorded, and the corpus was repeatedly listened to, in conjunction with the transcripts in order to identify the segments of talk where there was an action hearable as diagnostic delivery, that is where the clinician is evaluating the patient's condition.\ud \ud Results: Using a conversation analytic approach this analysis suggests that diagnostic communication, which is sensitive and responsive to the patient and their carers, is not predicated on the presence or absence of particular lexical choices. There is inherent complexity regarding dementia diagnosis, especially in the ‘early stages’, which is produced through and reflected in diagnostic talk in clinical encounters.\ud \ud Conclusion: In the context of continuity of dementia care, diagnostic information is communicated in a way that conforms to intersubjective norms of minimizing catastrophic reactions in medical communication, and is sensitive to problems associated with ‘insight’ in terms of delivery and receipt or non-receipt of diagnosis.

Objectives: Mental health for older people has become a major social concern. Literature has shown that older people, especially when they become empty nesters—when a parent lives alone or lives with his/her spouse after the youngest child leaves home—may start to develop various mental health problems due to reduced contacts with their children. Methods: Using fixed-effects, multivariate regression with a difference-in-differences approach and propensity score matching, this paper examines the relationship between being an empty nester and mental health among older people in China, and the moderating effects of social contact and contact with one’s children in terms of mental health. Our data come from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015 and 2018. Results: We found that, in the short term, the mental health of older people may not be affected after they became empty nesters. But in the longer term, if they did not have regular contact with their children, their mental health would deteriorate with time. Social contact, especially cognitive activities, was beneficial to the mental health of the older empty nesters. We also found that for older empty nesters with disabilities, frequent social contact and contact with their children were more important. Conclusion: We urge the government to promote community-based social activities for older people, especially for those with functional limitations.

OBJECTIVES: This paper sought to examine the role of region and race/ethnicity in alcohol consumption among older adults. METHODS: Data were obtained from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Participants aged 60 and older were included (n=185, 190). Analyses of covariance (ANCOVAs) were conducted to examine the effects of region and race/ethnicity on alcohol consumption among older adults. RESULTS: Results indicate that region and race/ethnicity are significantly related to the alcohol consumption of older adults. More specifically, results suggest that White older adults consume significantly more alcohol than other racial/ethnic groups among older adults. Regarding regional effects, results suggest that older adults in the West consume significantly more alcohol than older adults in the Midwest and South. Additionally, results suggest regional variation in alcohol consumption patterns by race/ethnicity. CONCLUSION: Results provide additional insight into how and where alcohol is being used among older adults in the United States. Further, results highlight the importance of taking race/ethnicity and geography into consideration when investigating the health behaviors of older adults.

Objectives: With rates of diagnosed dementia increasing, and the state becoming increasingly reliant on informal carers, caregiver burden can lead to increased stress, depression and health difficulties for caregivers and care-recipients. This systematic review aimed to examine the published evidence, for interventions designed to reduce levels of carer burden, in those caring for a person with dementia. Methods: Three databases were searched (Medline, PsycINFO and CINAHL) for studies reporting on randomised controlled trials of non-pharmacological interventions for dementia-related caregiver burden (limiting to publications since 1999 to build upon a previous review by Acton & Kang [2001]). Data quality checks were completed for included papers and meta-analysis was performed to estimate the efficacy of individual interventions and different categories of non-pharmacological intervention. Results: Thirty studies were included in the analysis. Seven studies found a significant reduction in carer burden and a pooled effect found that intervening was more effective than treatment as usual (SMD = -0.18, CI = -0.30, -0.05). This result was small, but significant (p = 0.005). Multi-component interventions are more effective than other categories. High heterogeneity means that results should be interpreted with caution. Conclusions: Interventions that significantly reduced levels of burden should be replicated on a larger scale. The relative effectiveness of interventions targeting cognitive appraisals and coping styles suggests that future interventions might be informed by models theorising the role of these processes in carer burden.

OBJECTIVES: Late-onset stress symptomatology (LOSS) is a phenomenon observed in older combat veterans who experience increased combat-related thoughts, feelings, and reminiscences corresponding with the changes and challenges of aging. Previously, we developed and validated the LOSS Scale as a tool to assess LOSS. This paper describes the development and validation of a LOSS Scale short form (LOSS-SF) for use in various settings to screen veterans who may be actively re-examining their past wartime experiences. METHOD: Three studies examined the reliability (Study 1) and the concurrent (Study 2), convergent/divergent (Study 3) validity of the LOSS-SF in separate samples of male combat veterans age 55 and older (total N = 346). Veterans were administered measures via telephone and mail survey. Correlation and regression analyses examined the reliability and validity of the LOSS-SF. RESULTS: Across the three studies, the LOSS-SF exhibited strong internal consistency (alpha = .93), test-retest reliability (2 week interval on average; r = .88), and good concurrent validity with the LOSS Scale (r = .81). Convergent and divergent validity were supported by the pattern of correlations between the LOSS-SF and other construct measures. CONCLUSION: The LOSS-SF is a reliable and valid measure to quickly assess thoughts, feelings, and reminiscences about past combat experiences in older veterans and identify those veterans who may benefit from psychological interventions to effectively resolve related issues.

Objectives: This paper examines factors associated with happiness and to estimate happy life expectancy for older people in South Africa. Methods: The study uses data from the first wave of the Study on Ageing and Adult Health (SAGE) survey, which is a nationally representative population-based survey with a sample of 3,840 individuals aged 50 years and above. The Sullivan method and multivariate linear regression analysis were used in the analysis. Results: The prevalence of happiness was the same for men (55.5%) and women (55.4%) at the youngest of the age groups (50–59). However, this prevalence was higher in men than women across older ages. Women demonstrated longer life expectancy and happy life expectancy, but also unhappy life expectancy, compared to men, across all the ages. However, men had greater proportions of happy life expectancies compared to women. In multivariate analysis, wealth status, health, activity limitation, race and age were significantly associated with happiness among men and women. Conclusions: Gender disparities in happiness are demonstrated in this study. It is important to understand the factors that promote happiness in older people as this may point to areas that need intervention for improving overall quality of life

We undertook a cluster-randomised controlled trial exploring the effect of a therapeutic companion robot (PARO) compared to a look-alike plush toy and usual care on dementia symptoms of long-term care residents. Complementing the reported quantitative outcomes , this paper provides critical reflection and commentary on individual participant responses to PARO, observed through video recordings , with a view to informing clinical practice and research. A descriptive, qualitative design with five participants selected from the PARO intervention arm of the trial. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). The five participants and their responses to PARO are presented in terms of three issues: i.) Different pre-intervention clinical presentations and different responses; ii.) Same individual, different response - the need for continual assessment and review; and iii.) The ethics of giving and retrieving PARO. Implications for clinical practice and future research are discussed in relation to each issue. The findings suggest that one approach does not fit all, and that there is considerable variation in responses to PARO. A number of recommendations are discussed to aid the delivery of psychosocial interventions with PARO in practice, as well as to guide future research.

OBJECTIVES. Current literature highlights several negative sequelae for caregivers of individuals with Mild Cognitive Impairment (MCI), but little is known regarding the effect that caring for an individual with MCI has on health-related quality of life (HRQOL). The primary purpose of this paper was to identify the most important aspects of HRQOL related to caring for an individual with MCI. METHODS. Six focus groups were conducted with caregivers of individuals with MCI (n=32). Focus group discussions were transcribed verbatim, and a qualitative frequency analysis approach was used to analyze the data. RESULTS. Qualitative frequency analysis revealed that caregivers of individuals with MCI most frequently discussed their social health, including changes in their social roles and an increased need for social support (51.2% of the total discussion). This was followed by mental health concerns (37.9%) centering on anger, frustration, and a need for patience in the caregiving role, as well as caregiver-specific anxiety. Other discussion topics included physical health (10.0%), and the impact that stress and burden have on medical heath, and caregivers’ cognitive health (0.9%) including memory problems in relation to caregiver strain, sleep disruption, and cognitive fatigue. CONCLUSIONS. Findings illustrate the multiple domains of HRQOL that are affected in individuals providing care for someone with MCI. Moreover, findings highlight the need for extending support services to MCI caregivers, a group that is generally overlooked and are typically not offered support services due to the “less severe” nature of an MCI diagnosis.

Objective: Globally, depression is one of the most prevalent and burdensome conditions in older adults. However, there are few population-based studies of depression in older adults in developing countries. In this paper, we examine the prevalence of depressive symptoms and explore possible contributory risk factors in older adults living in Nepal. Methods: A cross-sectional study was conducted in two semi-urban communities in Kathmandu, Nepal. Depression was assessed using the 15-item Geriatric Depression Scale in 303 participants, aged 60 years and over. Multivariate logistic regression was then used to assess associations between potential risk factors and depression. Results: More than half of the participants (n = 175, 60.6%) had significant depressive symptomatology, with 27.7% having scores suggesting mild depression. Illiteracy (aOR = 2.01, 95% CI: 1.08–3.75), physical immobility (aOR = 5.62, 95% CI: 1.76–17.99), the presence of physical health problems (aOR = 1.97, 95% CI: 1.03–3.77), not having any time spent with family members (aOR = 3.55, 95% CI: 1.29–9.76) and not being considered in family decision-making (aOR = 4.02, 95% CI: 2.01–8.04) were significantly associated with depression in older adults. Conclusion: The prevalence of depression was significant in older adults. There are clear associations of depression with demographic, social support and physical well-being factors in this population. Strategies that increase awareness in the community along with the health and social care interventions are needed to address the likely drivers of depression in older adults.

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Objectives: This paper reports two related analyses of verbal material from seven Living Well with Dementia groups: the first examines changes in the verbal behaviours of participants across the course of the sessions in all seven groups; while the second contrasts therapist behaviour in two groups. Methods: In the first analysis, recordings of three sessions from each group were transcribed and participant descriptions of dementia were analysed using the Markers of Assimilation of Problematic Experiences of Dementia (MAPED) rating procedure. In the second analysis, therapist behaviour in weeks 2 and 8 from two groups (F and G) was analysed using the Hill Counsellor Verbal response rating scale. Inter-rater reliabilities for the two sets of ratings were ‘good’ and ‘very good’, respectively. Results: For the MAPED ratings, a five by four contingency table was analysed using chi-squared, which indicated a highly significant change in assimilation. There were significant higher levels of level 1 and 2 markers in the first two sessions and level 4 for sessions 5 and 6. Facilitators used significantly more direct guidance and information giving behaviour in the second session at Location F compared to Location G. Conclusions: The results suggest that important changes occurred in the way that dementia was described across the seven LivDem groups: this includes both reductions in the avoidance of direct references to dementia after the first two sessions, as well as an increase in ‘insight’ statements. Directive facilitator behaviour may be associated with poorer outcomes.

Objectives: Subjective memory complaints (SMC) are common in older people and previous research has shown an association with mood problems, such as depression and anxiety. SMC form part of the criteria for many definitions of mild cognitive impairment (MCI), but there is controversy over whether they should be included as they may be related more strongly to mood than to objective cognitive impairment. This study aims to clarify the relationship between mood and SMC in people with MCI. Method: This paper reports an analysis of data from the Medical Research Council Cognitive Function and Ageing study. Structured interviews were conducted with community-dwelling older people to assess a range of aspects of cognitive functioning and mood. Data from two time points approximately 24 months apart were used in this analysis. At baseline, participants without dementia or severe cognitive impairment were categorised into three groups according to cognitive status. Mood was investigated by assessing symptoms of anxiety and depression which were defined using a diagnostic algorithm. Associations were tested using logistic regression and chi square analyses. Results: A clear association was shown between SMC and mood, both cross-sectionally and over time. The relationship between our two competing definitions of MCI suggested that mood problems were more strongly related to the presence of SMC than objective cognitive impairment. Conclusion: SMC may be a function of anxiety and depression rather than being related to objective cognitive function. This questions whether SMC should be included in definitions of MCI.

Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer.PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer.The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms.Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.

This paper presents preliminary baseline data from a prospective study of nursing home adaptation that attempts to capture the complexity of residents' adaptive resources by examining psychological, social, and biological variables from a longitudinal conceptual framework. Our emphasis was on validating an index of allostasis.In a sample of 26 long-term care patients, we measured 6 hormone and protein biomarkers to capture the concept of allostasis as an index of physiological resilience, related to other baseline resources, including frailty, hope and optimism, social support, and mental health history, collected via interview with the resident and collaterals. We also examined the performance of self-report measures reflecting psychosocial and well-being constructs, given the prevalence of cognitive impairment in nursing homes.Our results supported both the psychometric stability of our self-report measures, and the preliminary validity of our index of allostasis. Each biomarker was associated with at least one other resilience resource, suggesting that our choice of biomarkers was appropriate. As a group, the biomarkers showed good correspondence with the majority of other resource variables, and our standardized summation score was also associated with physical, social, and psychological resilience resources, including those reflecting physical and mental health vulnerability as well as positive resources of social support, optimism, and hope.Although these results are based on a small sample, the effect sizes were large enough to confer some confidence in the value of pursuing further research relating biomarkers of allostasis to psychological and physical resources and well-being.

Loneliness and social isolation are two important health outcomes among older adults. Current assessment of these outcomes relies on self-report which is susceptible to bias. This paper reports on the relationship between loneliness and objective measures of isolation using a phone monitoring device.Phone monitors were installed in the homes of 26 independent elderly individuals from the ORCATECH Life Laboratory cohort (age 86 ± 4.5, 88% female) and used to monitor the daily phone usage for an average of 174 days. Loneliness was assessed using the 20-item University of California Los Angeles (UCLA) Loneliness scale. A mixed effects negative binomial regression was used to model the relationship between loneliness and social isolation, as assessed using the total number of calls, controlling for cognitive function, pain, age, gender, and weekday. A secondary analysis examined the differential effect of loneliness on incoming and outgoing calls.The average UCLA Loneliness score was 35.3 ± 7.6, and the median daily number of calls was 4. Loneliness was negatively associated with telephone use (IRR = 0.99, p0.05). Daily phone use was also associated with gender (IRR = 2.03, p0.001) and cognitive status (IRR = 1.51, p0.001). The secondary analysis revealed that loneliness was significantly related to incoming (IRR = 0.98, p0.01) but not outgoing calls.These results demonstrate the close relationship between loneliness and social isolation, showing that phone behaviour is associated with emotional state and cognitive function. Because phone behaviour can be monitored unobtrusively, it may be possible to sense loneliness levels in older adults using objective assessments of key aspects of behaviour.

© 2014 Taylor and Francis. Objectives: The aim of this paper is to report a pilot study in which participants who had recently received a diagnosis of dementia were randomised to either a 10-week group intervention or a waiting-list control.Method: Memory clinic staff with limited previous experience of group therapy were trained to lead a 10-week group therapy intervention called Living Well with Dementia. Fifty-eight participants, all of whom had received a diagnosis of Alzheimer's disease, vascular or Lewy body dementia within the previous 18 months, were randomised to receive either the intervention or treatment as usual (waiting-list control). Data collection occurred at baseline, within two weeks after the intervention finished and at 10-week follow-up.Results: The study met its recruitment targets, with a relatively low attrition rate for the intervention arm. The acceptability of the intervention and research methods was examined qualitatively and will be reported on elsewhere. For the primary outcome, measure of quality of life in Alzheimer's disease (QoL-AD), and secondary outcome, self-esteem, there was some evidence of improvement in the intervention group compared to the control group. There was, also, evidence of a reduction in cognitive functioning in the treatment group compared to the control. Such reported differences should be treated with caution because they are obtained from a pilot and not a definitive study.Conclusion: This pilot study succeeded in collecting data to inform a future definitive cost effectiveness clinical trial of Living Well with Dementia group therapy.

Rural and urban differences in the effects of care-giving are not well documented. This paper reports data on 122 carers for people with stroke or dementia living in rural and urban settings in Wales.Carers completed a postal questionnaire, including the SF-12v2 Health Survey. Definitions of rural and urban were based on the Urban/Rural Indicator from the Office of National Statistics (ONS) All Fields Postcode Directory 2004.Carers' mean Mental Component Summary (MCS) score (adjusted for age and sex) was one standard deviation below the population mean (-12.03). Male carers living in urban areas reported better mental health than male carers in rural areas (p0.05) and female carers in both settings (p0.05). A full model and a parsimonious model were developed, using MCS scores as outcome variables. In the full model sitting service provision in rural and urban locations was linked to better carer mental health, while support from friends and family was linked to better mental health for urban carers only.Our findings indicate the existence of both gender and location differences in carer experiences.