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Suicidal behavior in late life differs in important ways from suicidal behavior that occurs earlier in the lifespan, suggesting the possibility of developmental differences in the etiology of suicidal behavior. This paper examines late life suicidal behavior within the context of lifespan developmental theory.This paper presents a conceptual framework for using lifespan developmental theory to better understand late life suicidal behavior.We argue that the motivational theory of lifespan development, which focuses on control, is particularly relevant to late life suicide. This theory posits that opportunities to exert control over important aspects of one's life diminish in late life as a result of declines in physical functioning and other factors, and that successful aging is associated with adaptive regulation of this developmental change. Although continued striving to meet goals is normative throughout the lifespan, most individuals also increase the use of compensatory strategies in old age or when faced with a decline in functioning. We propose that individuals who do not adapt to developmental changes by altering their strategies for exerting control will be at risk for suicidal behavior in late life. This paper reviews evidence that supports the importance of control with respect to suicidal outcomes in older adults, as well as findings regarding specific types of control strategies that may be related to suicide risk in older adults with health-related limitations.Although suicidal behavior is not a normal part of aging, the application of lifespan developmental theory may be useful in understanding and potentially preventing suicide among older adults.

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.

The paper describes recruitment results and characteristics of the UP-TECH clinical trial sample, including level of care services use, informal caregiver burden and its determinants.UP-TECH is designed to test innovative care solutions for community-dwelling patients with moderate stage Alzheimer's disease and their caregivers in Italy. Four hundred and fifty patient-caregiver dyads were randomized into three arms receiving different combinations of services, composed of case management interventions, nurse visits, assistive technology and educational brochures. The research nurses administered a questionnaire comprising an in-depth socio-demographic assessment and several clinical scales, such as Novak's Caregiver Burden Inventory. Analyses of baseline data were conducted using uni- and bi-variate statistics. Linear regressions were computed to identify de-confounded correlates of caregiver burden.Four hundred and thirty-eight patient-caregiver dyads were recruited and randomized. In our sample, patients are predominantly women (71.5%), with an average age of 81.5 years and a mean Mini-Mental State Examination score of 16.2. Caregivers are mostly women (66.2%) and offspring (55.7%), with a mean caregiver burden score of 27.6. They provide more than 50 hours of care per week, while receiving an almost negligible support from public services. Factors associated with caregiver burden are female gender, kinship and the patient's behavioral disturbances. The most important factor associated with lower burden is the employment of a live-in care worker.The paper provides a comprehensive description of moderate stage Alzheimer's disease patients and their caregivers, suggesting useful markers of caregiver burden. The well-balanced randomization assures the reliability of the study data-set for prospective evaluation of care strategies.

Western literature has repeatedly indicated a strong relationship between living alone and depression among the aged population, however, studies among the Chinese population are scarce. In this paper, we examine whether the association between living alone and depression is independent of health status, social support and financial strain among Chinese older adults, and subsequently assess whether such association persists after adjusting these variables. Cross-sectional data drawn from the Hong Kong Population Census consisting of 2,003 Chinese elderly people aged 60 or over were analyzed. Chi-square tests and logistic regression analyses revealed that living alone results in higher levels of depressive symptoms for older women but not for older men. This relationship remained significant even when socio-demographic variables, health indicators, social support, and financial strains were adjusted; yet, the impact of living alone with depression disappeared when all variables were controlled. In summary, this paper is the first to report that living alone is an independent risk factor contributing to depression among Chinese older women, as well as identifying certain significant factors including social support and health indicators that can affect and explain the link between living alone and depression. Preventive measures and related issues were discussed.

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.

Objective: Over the last decade, the literature relating to older Aboriginal and Torres Strait Islander people's preferences for social and emotional wellbeing services has grown. However, little evidence exists in relation to older Aboriginal and Torres Strait Islander people's experiences of services relating to social and emotional wellbeing. This paper highlights older Aboriginal and Torres Strait Islander people's experiences of social and emotional wellbeing services in Australia and then uses these key findings of the research, along with the literature, to develop a strength-based approach for service providers.Methods: Yarning was the preferred research method for the older Aboriginal community. In total, 16 older Aboriginal people, including eight women and eight men participated in the research yarning sessions. A modified version of an existing thematic analysis process supported yarning members to participate in each stage of the research, including data analysis.Results: The themes emerging from the voices of the yarning members are they couldn't give a damn about them, You've got to get the right one and ticking the box. The themes focus on negative, positive and preferred experiences of social and emotional wellbeing service provision.Conclusion: The key findings and related literature contribute to the development of a strength-based approach, which supports the implementation of responsive and effective services that address Elders, older peoples and their communities' social and emotional wellbeing issues and aspirations.

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.

Objective: The intent of this exploratory qualitative study was to examine African American Baptist clergy's pastoral care to older congregants with mental disorders. Critical Race Theory was the guiding framework in this study.Method: A purposive sample of 18 African American clergy participated in one-on-one interviews.Results: Collectively, all participants were active in the provision of mental health to older congregants with mental disorders. The primary emergent theme ‘shepherding the flock’ the central phenomenon uncovered in the data, was used to organize a model of pastoral care, which is presented in this paper. Findings from this study supported results from previous studies on the integral role of the Church and clergy in the African American community.Conclusion: Moreover, this study highlights the importance of internal ministries in the Church and the need for further study and potential partnership opportunity.

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.

The burden of informal caregivers might show itself in different ways in different cultures. Understanding these differences is important for developing culture-specific measures aimed at alleviating caregiver burden. Hitherto, no findings regarding such cultural differences between different European countries were available. In this paper, differences between English, Finnish and Greek informal caregivers of people with dementia are investigated.A secondary analysis was performed with data from 36 English, 42 Finnish and 46 Greek caregivers obtained with the short form of the Burden Scale for Family Caregivers (BSFC-s). The probabilities of endorsing the BSFC-s items were investigated by computing a logit model with items and countries as categorical factors. Statistically significant deviation of data from this model was taken as evidence for country-specific response patterns.The two-factorial logit model explains the responses to the items quite well (McFadden's pseudo-R-square: 0.77). There are, however, also statistically significant deviations (p0.05). English caregivers have a stronger tendency to endorse items addressing impairments in individual well-being; Finnish caregivers have a stronger tendency to endorse items addressing the conflict between the demands resulting from care and demands resulting from the remaining social life and Greek caregivers have a stronger tendency to endorse items addressing impairments in physical health.Caregiver burden shows itself differently in English, Finnish and Greek caregivers. Accordingly, measures for alleviating caregiver burden in these three countries should address different aspects of the caregivers' lives.

© 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.

This paper aimed to describe the burden experienced by informal caregivers supporting a person with dementia (PwD) who lives at home and utilizes a dementia care network (DCN), to investigate the factors that are associated with caregiver burden, and to identify possible differences in caregiver burden among different types of DCNs.This study was part of a multi-center, interdisciplinary evaluation of DCNs in Germany (DemNet-D). Cross-sectional data were collected in face-to-face interviews with people with dementia (PwDs) and their caregivers, and 13 DCNs were represented. Standardized questionnaires were used to assess caregiver burden, challenging PwD behaviors, functional competence and caregiver health status. Based on qualitative data, four DCN governance types were used in a multivariate analysis of burden categories.There were 560 PwD-caregiver dyads enrolled in the study. Informal caregivers (n = 536) reported a low-to-moderate burden associated with PwD characteristics (instrumental activities of daily living, challenging behaviors) and caregiver characteristics (gender) as well as the relationship between the caregivers and PwDs. Women felt more burdened but also showed higher levels of personal development. No differences were observed among the different DCN governance types.DCNs might contribute toward moderate to low caregiver burden. Indicators of positive caregiving aspects can be used by DCNs to advance support structures for informal caregivers drawing upon interventions already established for other community settings. Particular interest should be paid to female and spousal caregivers who might be in in need of greater and/or different kinds of support.

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.

Objective: Studies indicate a limited understanding of dementia and its associated symptoms, causes and consequences among South Asian older adults. As a consequence, fewer people from this ethnic group receive a diagnosis of dementia. The aim of this study was to adapt the previously designed Barts Explanatory Model Inventory Checklist (BEMI-C), a tool designed to elicit perceptions of mental illness from people with different cultural backgrounds, for use with people with dementia in the South Asian population. Method: Both a literature review and 25 qualitative interviews were conducted to find themes and perceptions that are relevant to the South Asian culture in recognising and dealing with symptoms of dementia. The emergent themes and perceptions were then added to the BEMI-C through synthesis of findings. Results: The initial four checklists of symptoms, causes, consequences and treatments from the BEMI-C were retained in the new BEMI-Dementia (BEMI-D) and expanded with six additional themes, including 123 new perceptions relevant to the understanding of dementia. All new themes emerged from the qualitative interviews, some of which were also found in the literature. Conclusion: Given the national priority of improving dementia awareness and timely diagnosis, the BEMI-D can serve as a useful tool, in research and perhaps practice, to assess the barriers to dementia service uptake in this population and their understandings of dementia. Based on the detailed methodological description of the adaptation of the BEMI-C, this paper further suggests how this tool can be adapted to suit other ethnic minority groups.

There is a growing recognition of dementia as a condition that affects both members of a couple individually while also influencing the relational bond between them. This is an area which potentially has important service implications. Accordingly, the aim of this review was to elaborate the experience of dementia on partner/spousal relationships through a synthesis of pertinent qualitative literature.A systematic literature search for qualitative research papers was undertaken in November 2013. Five databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES and PsycINFO) were searched using terms for dementia, partner and qualitative data analysis. Meta-synthesis was conducted on the data within the found papers.A line-of-argument synthesis of 10 studies yielded four overarching themes, which highlight couples' efforts to maintain their sense of togetherness; shifts in balance and power within their relationship which can impact upon both partners' sense of identity; the empathy and sensitive attunement between couples as they work to protect each other's sense of role and identity; and the resilience couples demonstrate in the face of great fear, uncertainty and hopelessness.Findings have important implications for both research and practice, particularly the need for services to support couples' efforts to enhance couplehood in spite of dementia. Ultimately, this review adds further weight to arguments to refocus dementia care on relationships in addition to individuals.

The association between exposure to stressful life events (SLEs) and late-life depression is well-documented. However, the role of resilience as a buffer against the adverse mental health effects of SLEs in late life has not been convincingly demonstrated. In this paper, the moderating effect of resilience in the relationship between SLEs and depressive symptomatology in older Chinese adults is investigated.A population sample of 385 community-dwelling older Chinese adults aged ≥60 years responded to questionnaires on resilience (Connor-Davidson resilience scale), depressive symptomatology (Geriatric Depression Scale, GDS-15) and SLEs.Increased numbers of SLEs (β = 0.343, p.001) and lower levels of resilience (β = -0.137, p0.001) were significantly associated with higher levels of depressive symptomatology. There was a significant interaction of resilience and number of SLEs on depressive symptomatology (p = 0.003). The sense of personal competence and optimism was the principal underlying resilience dimension moderating the relationship for both the young-old (aged 60-69) and the old-old (aged 70 and above).The finding of significant interaction supported the role of resilience in moderating the adverse effect of SLEs in terms of depressive symptoms among older Chinese adults.

Positive reappraisal is a meaning-based cognitive emotion regulation strategy that is frequently used by older adults to deal with stressors. The strategy involves finding personally relevant positive meaning from an experience in the face of its negative reality. As positive reappraisal has not been previously systematically examined and appears to be particularly relevant to older adults, this paper reviews the research on positive reappraisal in older adult populations.Database searches identified 302 studies, of which 22 addressed positive reappraisal in older adult samples. The findings were categorised into four core themes: use and value for older adults, effects on mental health, benefit for physical illness, and influence of cognitive functioning and gender.The literature indicates that positive reappraisal is an adaptive coping strategy for older adults with wide-ranging benefits. Specifically, positive reappraisal appears to be related to improved mental health for older adults, and particularly in the context of physical illness.Helping older adults find meaning in their negative experiences appears to be a worthwhile research area to pursue. Questions for future research on positive reappraisal in older adulthood are proposed.

© 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.

This paper examines the mediating effect of child-grandparent conflict on the relationship between child trauma exposure and grandparenting stress.Data was collected from a sample of custodial grandparents who participated in kinship care or relative caregiving programs (n = 251). Grandparenting stress was measured with Parenting Stress Scale (BerryJones, 1995 ) modified for grandparents. A series of regression models and structural equation models (SEM) were used to test the relationship between the number of different types of child trauma exposures and grandparenting stress, and to examine the mediating effect of child-grandparent conflicts on the relationship.Almost three-fourths (72%) of children had experienced at least one type of traumatic exposure. The SEM model shows that child's trauma exposure indirectly affected grandparenting stress, mediated by child-grandparenting conflicts though no direct path between the child's trauma exposure variable and grandparenting stress was found. A higher level of child-grandparent conflicts was also associated with a lower level of emotional well-being among custodial grandparents.Based on these findings, recommendations are made about how to tailor a trauma-informed approach to the needs of custodial grandparents.

Objectives: Reminiscence is a popular intervention for seniors, but, with mixed evidence supporting its efficacy, questions have been raised about the mechanisms underlying improvement. The present paper addresses this question by investigating the degree to which health effects depend on the development of a shared sense of group identification. This is examined in the context of traditional story-based reminiscence as well as novel forms of song-based reminiscence.Method: As the focus of a manualized intervention, 40 participants were randomly assigned to secular song (n = 13), religious song (n = 13), or standard story reminiscence (n = 14) groups. These were run over six weeks with cognitive performance, anxiety, and life satisfaction measured before and after the intervention. Measures of group fit were included to examine whether social identification contributed to outcomes.Results: No evidence of change emerged over time as a function of intervention form alone, but analysis of identification data revealed significant interactions with the type of reminiscence group. Specifically, initial fit with the story reminiscence group was associated with enhanced cognitive outcomes and greater life satisfaction, while fit with the religious song reminiscence group was associated with greater life satisfaction and less anxiety.Conclusion: These findings show that group identification is a key moderator through which reminiscence promotes health outcomes. Implications for theory and practice highlight an inherent limitation in randomized controlled trials insofar as they may compromise participants group identification.

Elder abuse and neglect is an increasing concern that adversely affects the health and well-being of older people in most societies. The purpose of this paper is to describe the psycho-social impact of elder mistreatment on the health and well-being of older Korean people living in New Zealand.Data were collected from in-depth interviews. The lived experiences of elder abuse and neglect were studied with 10 older people who were, or who had been, mistreated in their family context. To analyse the data collected, a combined analysis approach was employed using traditional code-based techniques and a concept-mapping method.The findings of the study show that the effects of elder mistreatment were complex and multidimensional. The older persons who were mistreated in family settings experienced a range of emotional, psychological distress and physical symptoms. Many of them identified 'Hwa-byung' (literally anger disease) as a health issue associated with suppressed emotions of anger, demoralisation, heat sensation and other somatised symptoms.Elder abuse and neglect is a traumatic life event that has considerable psycho-social impacts on older people experiencing the problem. It is important to recognise the power of multidimensional challenges caused by elder mistreatment in health and well-being.

Objectives: The term metamemory refers to the knowledge one has about the development and use of memory in general, and one’s own memory processes in particular. The current theoretical perspective on memory processes is best described by the memory systems framework which represents a useful tool in specifying different ‘kinds’ of memory. We present here the Self-evaluation of Memory Systems Questionnaire (SMSQ), which assesses the multidimensional construct of metamemory based on memory systems framework. Method: SMSQ has been developed on a large and heterogeneous sample (N=3088) via both, web-based and paper-and-pencil form. With the aim of increasing its general utility, we used items referring to situations or materials which are highly likely for everyone to have encountered during their everyday life. Results: Analyses revealed good content validity, factorial validity, internal consistency reliability, and construct validity in terms of expected theoretical group differences. SMSQ is represented by 6 distinct factors: subjective evaluation, episodic memory, semantic memory, memory for numbers, visuospatial memory, and reminder and aids. Age differences found on SMSQ between young and old adults confirm the well- established empirical findings on the memory and aging. Conslusion: SMSQ is a brief, easily administrable, multidimensional metamemory questionnaire, marked with the sound background from the findings on memory systems and cognitive aging.

In this paper, subjective well-being as an indicator for successful aging is investigated from a salutogenic perspective that states that the sense of coherence plays a key role for psychological adaptation. It should be demonstrated that the sense of coherence mediates the relationship between generalized resistance resources and subjective well-being. One-hundred-and-seventy psychophysically active elderly persons (37 men) filled out a questionnaire assessing the sense of coherence, subjective well-being and resistance resources (such as age, education, physical health, activity level, social support and personality variables). It was found that resources co-varied with the sense of coherence and subjective well-being, accounting for 52 and 48% of the variance, respectively. The most important predictors were self-efficacy, self-esteem and education. After controlling for resources, the sense of coherence accounted for an additional 6% of the variance in well-being. The sense of coherence clearly mediated the relationship between resources and well-being. The findings corroborate the salutogenic idea that the sense of coherence creates, or maintains, a form of psychological integrity as represented by subjective well-being. The promotion of a strong sense of coherence should be a major aim of gerontological interventions.

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.

Dementia Care Mapping (DCM) is increasingly being promoted world-wide as a useful approach in assisting staff to improve the well-being of residents with dementia. While DCM is employed as an outcome measure of well-being and as a process to assist staff improve quality of care, it has not been subject to the rigorous scrutiny of a controlled trial to establish its efficacy as an outcome measure, or as an intervention. In 2005 the authors were awarded an Australian Health Minister's Grant to conduct a randomised control trial of DCM in 15 residential dementia care units across the city of Sydney, Australia. This paper reports on a pilot study conducted with 35 dementia care residents in three secure residential care units in the state of New South Wales, Australia, prior to the controlled trial. The main aims of the pilot were to determine the sensitivity of DCM against the validated baseline and outcome measures selected for the trial and to evaluate the utility of the research plan. The utility of the research plan was established. Whilst a significant improvement was shown in staff interactions with residents over time, there was no evidence that DCM improved the residents' quality of life and well-being in relation to physical and cognitive functioning, although there was a reduction in the residents' levels of agitation and depression. While as a research tool DCM needs further refinement to match the strength of validated outcome measures that more accurately assess the residents' well-being, DCM procedures improved staff's attention to monitoring and attending to the residents' well-being.

Dementia Care Mapping (DCM) is an observational tool that provides rich data about the quality of life and quality of care of persons with dementia in group care settings. The method is time-consuming and thus costly to implement in practice. This paper presents an attempt to 'streamline' DCM for the sake of simplifying it and reducing the financial resources required to implement it. Data were collected for 166 persons with dementia in three types of care settings. Seven streamlined time-sampling models were tested against the original DCM model. In general, results support the use of certain models for specific purposes. The strengths and limitations of these streamlined models are discussed and recommendations are made.

Although one in four seniors currently lives in a rural area, little is known about the capacity of rural nursing homes to provide specialized dementia services. The physical and social environments are increasingly recognized as important factors in the quality of life and functional ability of persons with dementia. This study compared eight rural nursing homes (those located in centres with populationsor =15,000) that had created dementia Special Care Units (SCUs) to eight same-sized rural nursing homes that did not have SCUs. Outcomes were assessed in relation to residents, staff, family members, and the environment. In this paper we describe the overall study design and findings from the environmental assessment. Analysis of variance (ANOVA) was used to compare the SCU versus non-SCU environments on the nine dimensions of the Physical Environmental Assessment Protocol (PEAP), which was used to assess the physical environment. The SCUs were more supportive on six dimensions: maximizing awareness and orientation, maximizing safety and security, regulation of stimulation, quality of stimulation, opportunities for personal control, and continuity of the self. Analysis of variance was also used to compare the groups on the six subscales of the Nursing Unit Rating Scale (NURS), which assesses the social environment of dementia care settings. The SCUs were more supportive on the Separation and Stimulation subscales, indicating that SCUs had greater separation of residents with dementia from other residents for activities of daily living and programming, and better control of non-meaningful stimulation.

This paper examines the psychometric properties of a three-part (participant, informant, and performance) Measure for assessing Awareness of Financial Skills (MAFS). The MAFS was administered to 10 seniors with dementia and 25 well-functioning seniors, and their informants. Measures of cognitive functioning, social desirability, neuroticism, and perceived control were administered to each participant to allow for an assessment of validity. Internal consistency estimates for the participant and informant questionnaires were found to be 0.92 and 0.97, respectively. Convergent validity analysis indicated that performance on this measure was related to level of cognitive functioning, with higher level of unawareness associated with decreased cognitive ability. Discriminant validity analysis showed that performance on this measure was not related to social desirability or neuroticism. This study provides evidence that the MAFS is a reliable and valid tool for assessing awareness of financial skills in older adults.

Details of service receipt by 132 people diagnosed with dementia and their carers were collected in South London (boroughs of Lewisham, Camberwell, Southwark and Croydon), a geographical area served by several health and social care providers. The data collected included the Caregiver Activity Survey, which details the informal care given. This paper reports the formal and informal services received by the people with dementia at entry to the study. The amount of time spent on specific caring tasks by all informal carers of people with dementia averaged seven hours per week, but was significantly higher for co-resident carers, even when controlling for the level of dependency of the person cared-for. The odds ratios of receipt of formal services are given, according to where people were living: in the community or residential care, with co-resident carers or alone.

Researchers in the aging field are paying increasing attention to the importance of perceived self-efficacy in understanding experiences and health-related outcomes of family caregivers. This paper details the strategy we used to measure family caregiver self-efficacy for managing dementia, and reports on observed associations between the resulting self-efficacy measures, caregiver depressive symptoms, and caregiver physical health symptoms. Family caregivers (n = 197) were interviewed after calling a local Alzheimer's Association chapter in the mid-western USA. Nine items inquiring about caregivers' certainty that they could carry out specific behaviors related to dementia care clustered into two distinct self-efficacy factors: symptom management self-efficacy (4 items) and community support service use self-efficacy (5 items). Internal consistency reliability for both factors was high (Cronbach's alpha = 0.77 and 0.78, respectively). Symptom management self-efficacy demonstrated a much stronger correlation with a published global caregiver competence measure than did service use self-efficacy (r = 0.49 and 0.27, respectively). In a multivariate regression model predicting caregiver depression symptoms, higher symptom management self-efficacy scores were associated with fewer depressive symptoms (beta = -0.17, p < 0.05). In a separate model, higher service use self-efficacy scores (beta = -0.20, p < 0.01) and higher symptom management self-efficacy scores (beta = -0.16, p < 0.05) were associated with fewer physical health symptoms. These new measures of dementia management self-efficacy hold promise for use in future studies.

This paper compares employed and non-employed caregivers of cognitively impaired elderly family members. Using two competing positions derived from role theory, role conflict and role expansion, we explored whether holding the positions of both caregiver and worker led to greater role overload and psychological role conflict, or provided an outlet that helps caregivers better manage the demands placed on them. We found no differences between employed and non-employed caregivers on measures of role overload, worry and strain, and depression. For working caregivers, however, greater conflict on the job was associated with higher role overload and worry and strain while beneficial work experiences were only weakly associated with lower role overload and worry and strain. There was an interaction effect between positive work experiences and role overload when predicting depressive symptoms. These results provide some support for role conflict, but also suggest that caregivers may vary considerably in how they adapt to multiple roles.