An examination of the prevalence of mental disorders among the elderly in the community.

Administered the Older Americans Resources and Services multidimensional functional assessment questionnaire to a multistage statewide area probability sample of 2,146 noninstitutionalized Virginians 60 yrs of age and older. Findings indicate that the vast majority of Ss in the community possessed the cognitive capacity and psychological resources necessary to manage the tasks of living independently. Only a relatively small proportion experienced psychological dysfunction, and these rates closely approximated those suggested by literature reviews. Overall, health self-ratings, education, and income were positively correlated with psychological well-being for nearly all psychological status measures. Age, sex, race, and marital status were related only to certain psychological disorders. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of primary chest wall tuberculosis

The elderly are persons over age 65, now comprising 12% of our population. The normal elderly function normally both in their self care, and also in their social activities of daily living, which we tabulate. The current terms for the normally functioning elderly who show only mild psychological deficits are age-associated memory impairment and age-related cognitive decline, which we define, criticize and tabulate. The psychological deficits of the elderly consist of mild generalized slowing and inaccuracies compared to normal young persons. These deficits are measured by objective psychological tests which mimic real daily living situations--the name-face test, fire alarm test, two delayed recall tests, misplaced objects test, shopping list test, and digit symbol test, which we describe. A longer early formal education is preventive of mental dulling during normal aging. Treating using overlearning, by cognitive training, is significantly beneficial.     

Effect of valued activity disability, social comparisons, and satisfaction with ability on depressive symptoms in rheumatoid arthritis.

This longitudinal study identified a model through which function affects the psychological well-being of individuals with rheumatoid arthritis (RA). Results of hierarchical linear regression analyses (N = 436) demonstrated that greater physical impairment resulted in greater disability in valued activities and engagement in unfavorable social comparisons. All 3 factors--greater physical impairment, greater disability in valued activities, and unfavorable comparison evaluations--predicted low satisfaction with abilities. Low satisfaction with abilities was the most important predictor of higher depressive symptoms and mediated the impact of physical impairment, valued activity disability, and unfavorable comparisons on depressive symptoms. Results highlight the role of personal meaning attached to changes in functional status in predicting the long-term psychological well-being of individuals with chronic illnesses such as RA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The strengths model in long-term care: linking cost containment and consumer empowerment

In this study we examined the following: (1) frequencies of remarrying or becoming romantically involved for widows and widowers during the first 2 years of widowhood; (2) attitudes toward dating and remarriage among the recently widowed, and their evolution; (3) identifiable factors which predict the development of new romances, such as sex, age, income, and level of education; and (4) the psychological well-being of those widows and widowers involved in romances compared to those who were not. The San Diego Widowhood Project was a prospective study in which 249 widows and 101 widowers who were identified through San Diego County death certificates completed detailed questionnaires 2, 7, 13, 19, and 25 months after their spouses' deaths. The main outcome measures for this study were marital and romance status, attitudes toward romance at several time points, demographic predictors of romance status, and self-reported measures of psychological well-being. By 25 months after the spouse's death 61% of men and 19% of women were either remarried or involved in a new romance. Women expressed more negative feelings about forming new romantic relationships. Younger age was a predictor of becoming involved in a new romance for women, and higher monthly income and level of education were predictors for men. Greater psychological well-being was highly correlated with being remarried or in a new romance 25 months after the spouse's death. It may be helpful for family, friends, and therapists to know that dating and remarriage are common and appear to be highly adaptive behaviors among the recently bereaved.     

Cognitive decline from estimated premorbid status predicts neurodegeneration in Alzheimer's disease.

This study investigated the relationship between premorbid and current cognitive function with respect to the clinical features of patients with various types of neurodegeneration in the form of Alzheimer's disease (AD), mild cognitive impairment (MCI), and subjective cognitive impairment (SCI), as compared with a healthy control group (C). Clinical features (MMSE, cognitive and depressive symptoms), genetics (apolipoprotein E; APOE) and measures of neurodegeneration (Aβ42, t-tau, and p-tau) were examined, as well as present cognitive function. Various methods of assessing premorbid cognitive function were compared, including a Swedish NART-analogous test (Irregularly Spelled Words; ISW), a Swedish lexical decision test (SLDT), a Hold test (Information in WAIS-R), Best current performance test, and combined demographic characteristics. Results showed that cognitive decline (premorbid minus current cognitive function) based on SLDT and ISW was a significant predictor for MMSE and Aβ42, whereas corresponding associations for present cognitive function and decline measures based on other methods were less powerful. Results also showed that specific verbal abilities (e.g., SLDT and ISW) were insensitive to AD and that these abilities indicated premorbid cognitive function in retrospect. In conclusion, cognitive decline from premorbid status reflects the disease processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain assessment in children with cognitive impairment. An exploration of self-report skills

Prior to surgery, 47 children (ages 8 to 17) with borderline to profound cognitive impairment were administered tasks to evaluate their understanding of the concepts of magnitude and ordinal position and their abilities to use a 0 to 5 numerical scale to rate pain levels in schematic faces. Of the 111 children (ages 4 to 14) without cognitive impairment, were administered the same tasks. Nurses conducting preoperative evaluations predicted whether children would understand the numerical scale. Fifty percent (n = 3) of children with borderline and 35% (n = 7) of children with mild cognitive impairment (and all children 8 years and older nonimpaired) correctly used the scale. Half of the children with cognitive impairment demonstrated skills (magnitude and ordinal position) that may allow them to use simpler pain rating methods. Nurses overestimated the abilities of cognitively impaired children (and younger children without cognitive impairment) to use the rating scale.     

Serum uric acid and cognitive function in community-dwelling older adults.

Among possible markers of age-related cognitive decline, uric acid (UA) is controversial because it has antioxidant properties but is increased in diseases that often lead to cognitive impairment. In this study of 96 elderly adults, participants with mildly elevated (but normal) serum UA were 2.7 to 5.9 times more likely to score in the lowest quartile of the sample on measures of processing speed, verbal memory, and working memory. Even after controlling for age, sex, race, education, diabetes, hypertension, smoking, and alcohol abuse, the multivariate-adjusted odds of poor verbal memory and working memory remained significant (ps     

Loisirs et santé mentale: les relations entre la motivation pour la pratique des loisirs et le bien-être psychologique.

Studied interactions between motivations for leisure activities and psychological well-being to test the hypothesis that a high degree of motivational self-determination is associated with a high level of psychological functioning. 463 secondary school students (mean age 17 yrs) completed a questionnaire assessing their intrinsic and extrinsic motivation for different types of leisure activities. The types of motivation differed with regard to their levels of self-determination. Results were analyzed in relation to questionnaire data on psychological well-being. The Motivation for Leisure Scale (L. G. Pelletier et al, 1994) and the Index of Psychological Well-Being (Pelletier et al) were used. (English abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mild cognitive deficit in the elderly. Results of a gerontologic study

The term "mild cognitive impairment" refers to cognitive deficits which exceed normal physiological aging processes, but do not fulfill the criteria for dementia. The prevalence rates of four current concepts were compared in a sample of 202 healthy 60-64 year-old participants recruited from the interdisciplinary longitudinal study on adult development and aging (ILSE). Furthermore, the relationships between cognitive deficits and psychological and sociodemographic variables were examined. The following prevalence rates were determined: 13.5% for age-associated memory impairment, 6.5% for age-consistent memory impairment, 1.5% for late-life forgetfulness and 23.5% for aging-associated cognitive decline. Subjective cognitive complaints did not correlate with results obtained from neuropsychological tests. Significant correlations were however found between subjective cognitive complaints and higher scores on depression and neuroticism scales. Significant correlations were also found between a reduced test performance and a lower educational level and socioeconomic status. Longitudinal studies are warranted to further elucidate the predictive value of these diagnostic concepts.     

A prospective study on cortisol, dehydroepiandrosterone sulfate, and cognitive function in the elderly

The objective of this study was to investigate the relation between the peripheral concentrations of the adrenal steroid hormones cortisol and dehydroepiandrosterone sulfate (DHEAS) and cognitive impairment and decline. A prospective study design was used. The setting was a suburb of Rotterdam, The Netherlands. The study population consisted of a sample of 189 healthy participants from the population-based Rotterdam Study, aged 55-80 yr, who were invited for an additional examination. Follow-up examinations took place 1.9 yr after baseline, on the average. We determined fasting blood levels of DHEAS before dexamethasone administration and of cortisol and corticosteroid-binding globulin before and after the administration of 1 mg dexamethasone overnight. The 30-point Mini-Mental State Examination (MMSE) was used to assess cognition. The associations with cognitive impairment (MMSE score of <26; 6% of the sample) and cognitive decline (drop in MMSE score of >1 point/yr; 24%) were estimated using logistic regression, with adjustment for age, sex, education, and depressive symptoms. An increase of 1 SD in the estimate of free cortisol (SD = 30.3) was associated with cognitive impairment, although not significantly [odds ratio (OR) = 1.5; 95% confidence interval (CI), 0.9-2.4]. A 1 SD increase in the natural logarithm of cortisol after the administration of 1 mg dexamethasone (SD = 0.68) was associated with an OR for cognitive decline of 1.5 (95% CI, 1.0-2.3). A 1 SD increase in DHEAS (SD = 2.10 micromol/L) was inversely, but nonsignificantly, related to cognitive impairment (OR = 0.5; 95% CI, 0.2-1.1) and cognitive decline (OR = 0.6; 95% CI, 0.4-1.1). The ratio of free cortisol over DHEAS was significantly related to cognitive impairment (OR = 1.8; 95% CI, 1.0-3.2). This prospective study among healthy elderly subjects suggested that basal free cortisol levels were positively related to cognitive impairment, and cortisol levels after dexamethasone treatment were related to cognitive decline. There was an inverse, but nonsignificant, association between DHEAS and cognitive impairment and decline.     

Dementia, agitation, and care in the nursing home

OBJECTIVE: To examine the behavioral and functional problems of the cognitively impaired. DESIGN: A survey of a cohort of residents from six nursing homes. PARTICIPANTS: Subjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non-participants had similar demographics except for a higher incidence of mental illness in the non-participant group, which did not have a significant impact on agitation. SETTING: Six nursing homes in New York City, three voluntary non-profit and three proprietary. MEASUREMENT: The study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time-motion observations of staff-resident interactions. RESULTS: Residents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time-motion analysis. Regression analysis revealed that for non-demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0001). CONCLUSIONS: The care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.     

Psychosocial adjustment among cancer survivors: Findings from a national survey of health and well-being.

Objective: The current study examined whether cancer survivors showed impairment, resilience, or growth responses relative to a sociodemographically matched sample in four domains: mental health and mood, psychological well-being, social well-being, and spirituality. The impact of aging on psychosocial adjustment was also investigated. Design: Participants were 398 cancer survivors who were participants in the MIDUS survey (Midlife in the United States) and 796 matched respondents with no cancer history. Psychosocial assessments were completed in 1995–1996 and 2004–2006. Main Outcome Measures: Outcomes including self-report measures of mental health and mood, psychological well-being, social well-being, and spirituality. Results: Findings indicated that cancer survivors demonstrated impairment relative to the comparison group in mental health, mood, and some aspects of psychological well-being. Longitudinal analyses spanning pre- and postdiagnosis clarified that while mental health declined after a cancer diagnosis, poorer functioning in other domains existed prior to diagnosis. However, survivors exhibited resilient social well-being, spirituality, and personal growth. Moreover, age appeared to confer resiliency; older survivors were more likely than younger adults to show psychosocial functioning equivalent to their peers. Conclusion: While younger survivors may be at risk for disturbances in mental health and mood, cancer survivors show resilience in other important domains of psychosocial adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Within-Occasion Intraindividual Variability and Preclinical Diagnostic Status: Is Intraindividual Variability an Indicator of Mild Cognitive Impairment?

Intraindividual variability in cognitive test performance has the potential to be a good marker of preclinical Alzheimer's disease status (S. C. Li & U. Lindenberger, 1999). Using cross-sectional community data from 2,317 individuals aged 60-64 years, the authors of this study found that variability was greater in individuals who met criteria for mild cognitive impairment or aging-associated cognitive decline but not for age-associated memory impairment. Higher variability was associated with lower education and a non-English-speaking background. In contrast to previous findings, variability in this study did not contribute uniquely to meeting criteria for mild cognitive impairment. The reasons for the differences may reside in the authors' method of estimating mean independent variability, the use of an occasion-specific measure, or the relatively younger age of the participants. Follow-up of the cohort in 4 years will yield data on the prospective validity of variability as a risk factor for impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Me against myself: Motivational conflicts and emotional development in adulthood.

Two studies investigated adult age differences in the frequency and emotional consequences of motivational conflicts (i.e., feeling that one wants to or should do something else in a given situation). Study 1 compared younger and older adults. Study 2 included a more age-heterogeneous sample ranging from 20 to 70 years. Data were obtained using diary and experience-sampling methods. Multilevel regression showed that motivational conflict was associated with lower emotional well-being. With age, the frequency of motivational conflict decreased, while emotional well-being increased. Importantly, the age-related decrease in motivational conflicts partly accounted for the age-related increase in emotional well-being. Findings were consistent across studies and robust after the authors controlled for age differences in a number of control variables including time use. The authors conclude that an age-related decrease in motivational conflicts in daily life may be among the factors underlying the positive development of emotional well-being into older adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biological and Psychological Factors Associated With Memory Function in Fibromyalgia Syndrome.

Fibromyalgia is a stress-related disorder characterized by chronic pain, memory impairment, and neuroendocrine aberrations. With the hypothesis that biological and psychological symptoms may underlie the cognitive problems, the relative influences of neuroendocrine function and psychological factors on declarative memory were examined among 50 women with fibromyalgia. This within-group analysis controlled for age, education, pain, and relevant medications. Neuroendocrine function and depression had significant independent associations with memory function. Higher log-transformed mean salivary cortisol levels were associated with better performance on both immediate and delayed visual recall and with delayed verbal recall. Depressive symptoms were negatively associated with verbal recall. These findings suggest that a basic disorder of endocrine stress responses may contribute to the cognitive symptoms experienced by fibromyalgia patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contribution of psychosocial factors to socioeconomic differences in health

The National Survey of Mid-life Developments in the United States (MIDUS) is one of several studies that demonstrate socioeconomic gradients in mortality during midlife. When MIDUS findings on self-reported health, waist to hip ratio, and psychological well-being were analyzed for their possible roles in generating socioeconomic differences in health, they revealed clear educational gradients for women and men (i.e., higher education predicted better health). Certain potential mediating variables, like household income, parents' education, smoking behavior, and social relations contributed to an explanation of the socioeconomic gradient. In addition, two census-based measures, combined into an area poverty index, independently predicted ill health. The results suggest that a set of both early and current life circumstances cumulatively contribute toward explaining why people of lower socioeconomic status have worse health and lower psychological well-being.     

Subjective past, present, and future fit: Effects on anxiety, depression, and other indicators of well-being.

207 undergraduates preparing for annual academic examinations at an Indian university completed self-administered questionnaires measuring the effects of subjective current, retrospected, and anticipated person–environment fit on affective and somatic strain and well-being. A distinction was made between cognitive (e.g., meeting demands for intelligence, good memory) and motivational (e.g., being able to muster the effort) fit. Results show that poor cognitive fit had a greater effect on predicting high levels of strain across all time frames, but did best in the past and current frames. Poor motivational fit had its greatest effect on strain when fit dealt with anticipated or current fit. It is suggested that the more subjectively uncontrollable a dimension of fit, the more salient it is in the past time frame; the more subjectively controllable the dimension, the more salient it is in the future time frame. Scales to measure fit and strain and well-being are appended, as are their means, standard deviations, and reliabilities. (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What practitioners should know about working with older adults.

Clinicians need to know more about working with older age groups because the number and proportion of older adults in the U.S. population are increasing and more professional psychologists will be called upon to deliver psychological services to them. Any assessment of an older adult should include the client's current mental status, cognitive ability, social supports available, the client's medical status, and, if cognitive impairment is suspected, interviews with family members and friends. Assessments may have to be modified in the testing environment to assure optimal performance. Psychological interventions proven effective with younger adults are also effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cognitive reserve hypothesis: A longitudinal examination of age-associated declines in reasoning and processing speed.

The term cognitive reserve is frequently used to refer to the ubiquitous finding that, during later life, those higher in experiential resources (e.g., education, knowledge) exhibit higher levels of cognitive function. This observation may be the result of either experiential resources playing protective roles with respect to the cognitive declines associated with aging or the persistence of differences in functioning that have existed since earlier adulthood. These possibilities were examined by applying accelerated longitudinal structural equation (growth curve) models to 5-year reasoning and speed data from the no-contact control group (N = 690; age 65–89 years at baseline) of the Advanced Cognitive Training for Independent and Vital Elderly study. Vocabulary knowledge and years of education, as markers of cognitive reserve, were related to levels of cognitive functioning but unrelated to rates of cognitive change, both before and after the (negative) relations between levels and rates were controlled for. These results suggest that cognitive reserve reflects the persistence of earlier differences in cognitive functioning rather than differential rates of age-associated cognitive declines. (PsycINFO Database Record (c) 2010 APA, all rights reserved)