Some everyday life consequences of disability and bereavement for older adults.

The study analyzed daily event differences between groups experiencing the major stressors of conjugal bereavement and physical disability, and analyzed the association of everyday events with self-reports of mental health for different groups across a 3-month time span. Monthly interviews were conducted with 61 recently conjugally bereaved, 62 recently physically disabled, and 123 matched-comparison older adults between the ages of 60 and 80. The purpose of these interviews was to obtain a comprehensive assessment of the monthly frequencies of everyday life events. Self-reports of mental health were obtained from paper-and-pencil measures filled out after each interview. Causal models were used to analyze the best-fitting structure of event/mental health relationships for the first 3 monthly interviews. Undesirable events showed uniformly adverse effects on mental health. Desirable events benefited the psychological well-being of the disabled the most and had no positive effects on the mental health of the bereaved. The bereaved also evidenced less stability over time than other groups in the frequency of small undesirable events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of attachment bereavement and pre-event conditions on subsequent depressive symptoms in older adults.

A sample of 1,411 older adults (age 55+) who had been interviewed both prior to and after bereavement was studied, allowing for pre-event controls. Those who had lost a parent, spouse, or child had the strongest depressive reactions, as predicted by an attachment-bonding hypothesis; however, material losses were also related to depression. Although bereavement/loss events were clearly related to subsequent depression even after pre-event depression, resources, and events were controlled, certain pre-event characteristics were predictive of the bereavement/loss events, including prior undesirable events, age, and urban/rural residency. A further analysis of 1,007 persons with two post-event interviews (at 6-month to 1-year follow-up) revealed an initial depressive reaction to a bereavement/loss event, which then dissipated completely within 1 year's time. Generally, bereavement appeared to have limited etiologic importance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of mental health measures for older adults.

This article examines the factor structure of mental health self-reports among 246 older adults, ages 60 to 80 years, who were either recently physically disabled (n?=?62), recently bereaved (n?=?61), or matched control subjects (n?=?123). Confirmatory factor analyses were carried out on the Mental Health Inventory and the Psychiatric Epidemiology Research Interview (PERI) Demoralization Composite to test whether factor structures obtained in previous studies would fit the data for this older adult sample and whether those structures would be equivalent among groups that differ in degree of life stress. The structure of these two inventories was reorganized as a result of these analyses, resulting in 9 subscales that varied somewhat from the original subscale structure. The Bradburn Positive Affect Scale was added, and a second order confirmatory factor analysis was performed on these 10 scales. Two highly correlated superordinate factors emerged: Psychological Distress and Psychological Well-Being. Although the factor structure was generally similar across groups, there were some notable exceptions that could be attributed to between-groups differences in exposure to life stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health system and older adults in the 1990s.

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather, the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of memory training on the subjective memory functioning and mental health of older adults: A meta-analysis.

The effectiveness of memory training on the subjective memory functioning and mental health of older adults was examined in a meta-analysis. Effect sizes indicated that memory training led to improved subjective memory functioning (d++?=?.19), but the magnitude of the improvement was less than that obtained on objective memory measures (d++?=?.66) in the meta-analysis of P. Verhaeghen, A. Marcoen, and L. Goossens (1992). However, no differences in effectiveness were found among mnemonic training, expectancy modification, or placebo procedures such as unstructured practice. Improvement of subjective memory functioning was enhanced by including pretraining in skills such as the use of imagery and by including interventions to improve participants' attitudes toward the effects of aging on memory functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community mental health service use by older adults with dementia.

We considered the role of community-based public mental health services in providing care to older persons with Alzheimer's disease and other forms of dementia, and examined service outcomes within California's county-based public mental health system over a 3-year period. Treated prevalence rates, repeat service use rates, and service mix patterns were regressed onto individual, market, and contextual variables across 25 counties over 12 observation periods. The number of older adults with dementia who used community mental health services increased slightly over the observation periods, and service use was associated with age and Medicaid status. Service outcomes also were affected by complementary mental health and aging service systems within each county, as well as the poverty rate and location of the county. Future research is needed to clarify how administrative policies and service management practices contribute to increasing community mental health service use by persons with dementia. In the meantime, these findings can help program administrators and service providers understand the role of community-based mental health services in providing care to persons with dementia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neighborhood effects on physical and mental health: A study of Korean American older adults.

This study explored how the physical and mental health of Korean American older adults were influenced by neighborhood characteristics (i.e., proportion of individuals living below the poverty level, proportion of individuals 65 years of age and older, and proportion of racial/ethnic minorities in the census block groups where each respondent lived). Health perceptions (i.e., the subjective appraisal of one's own health) and depressive symptoms were used as indicators of physical and mental health. Multilevel analyses were performed with 567 individuals (at Level 1) nested within 233 census block groups (at Level 2). After controlling for individual demographic and health characteristics, we found that neighborhood poverty predicted health perceptions. The results add to the growing literature on the influence of the social environment and suggest that neighborhood characteristics should be taken into consideration in developing community-based policies for racially/ethnically diverse populations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65+) and younger (18-64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Providing mental health care to older adults: Unraveling the maze of Medicare and managed care.

This article reviews fundamental information about mental health benefits for older adults. Major systems, including Medicare, Medicaid, and managed care, are described. Regulations and policies that influence mental health care for older adults are distinct from those for the general population. In addition, Medicare has adopted managed-care options more recently than the private insurance industry. This relationship between Medicare and managed care is chronicled and future directions are postulated. Finally, we examine several empirical questions that have been raised due to the recent changes in the delivery of mental health care to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of specialty mental health organizations by older adults: U.S. national profile

Data from the four most recent biennial inventories of mental health organizations and general hospital mental health services conducted by the U.S. Department of Health and Human Services (1988 through 1994) were used to examine utilization of specialty mental health organizations by older adults. The data show steady inverse trends in utilization rates for inpatient and ambulatory care. The oldest clients (age 75 and older) had both the highest percentage decrease in use of inpatient services and the highest percentage increase in use of ambulatory services. The expected growth of the older adult population will challenge the ability of systems of care to maintain or increase the rate of ambulatory mental health care.     

Overcoming obstacles in providing mental health treatment to older adults: Getting in the door.

Older adults significantly underutilize mental health services relative to their numbers in the population. Barriers that impede their access include physical, financial, cognitive, emotional, and attitudinal issues. This article discuss strategies for overcoming these barriers including physical adaptations such as in-home psychotherapy and telephone sessions, use of support groups, strong community outreach, and liaisons with other professionals. Adaptations that help to increase older adults' use of mental health services are discussed, including education about treatment, nontraditional "pursuit" of clients, and use of alternative terminology. Informed consent is discussed as a special issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health and mental health in older adults: First steps in the study of a pedestrian complaint.

Investigated the relationship of self-reported foot problems to health, mental health, and functional mobility in 111 50–87 yr olds living in a multiethnic urban area. One-third of the respondents reported having problems with their feet. Analyses supported the prediction that foot complaints were significantly related to greater psychological distress and that for most individuals, this relationship was mediated by limited mobility. Specific psychological correlates were congruent with a picture of diminished sense of self-efficacy among those with foot problems. Results have implications for prevention and rehabilitation. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Local Medicare policies: A pathway for providing mental health services to older adults.

Inconsistent local Medicare service coverage policies constitute one of the most prominent barriers encountered by mental health professionals who provide services to older adults. In this study, the authors analyzed the scope and delineation of local Medicare policies for 19 types of psychiatric and psychological services in 2003 and again in 2006. Results indicated policies now exist for all Medicare services in all the states, and many of the local policies provide definitive statements to guide practice. However, some policies lacked delineation and variability persists from one region to the next. While researchers ascertain how local policies can impact service outcomes, providers should form issue networks and resolve current problems such as the inequities surrounding service documentation requirements and the lack of guidance in providing mental health care to older persons with dementia. Given that the Medicare administrative structure will undergo substantive changes in the next five years, there is an exceptional opportunity for providers to address these problems successfully and pave a pathway for providing specialty mental health services to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of psychological and physical health, stressful events, and social support on subsequent mental health help seeking among older adults.

Factors that influence mental health help seeking among adults 55+ yrs were examined prospectively. A discriminant analysis significantly differentiated between 120 older adults needing and seeking services and a comparison group of 120 older adults not needing services. Prior to having sought help, help seekers demonstrated poorer psychological well-being, reported more physical health problems, reported a higher level of unpleasant stressful events, and perceived greater deficits in the amount of social support available to them in time of need. The vast majority of these older help seekers sought help for their mental health problems from a medical doctor rather than from a mental health center or clinic or from a minister. Significantly more help seekers than nonseekers experienced stressful events involving bereavement, social and economic loss, and new physical illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of depressive symptoms on health behavior practices among older adults with vision loss.

Objective: The authors examined the interface between visual impairment and depressive symptoms on health behaviors, self-care, and social participation among adults ages 65 and older. Method: The authors analyzed data from the 1997–2004 National Health Interview Survey on visual impairment and depressive symptoms for 49,278 adults ages 65 and older, comparing visually impaired adults (n = 8,787) with and without depressive symptoms with a reference group of adults with neither condition (n = 3,136) for outcome measures: physical health, health behaviors, and difficulties with self-care and social participation. Results: Adults with visual impairment and severe depressive symptoms were more likely than adults with neither condition to smoke (14.9%, adjusted odds ratio [AOR] = 1.6), be obese (28.2%, AOR = 1.9), be physically inactive (80.5%, AOR = 3.0), have fair–poor health (76.0%, AOR = 26.5), and have difficulties with self-care (27.9%, AOR = 11.8) and social participation (52.1%, AOR = 10.9). Discussion and Conclusions: Older visually impaired adults with depressive symptoms are vulnerable to health decline and further disablement without timely interventions that target smoking cessation, healthy eating, and increased physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological health and problem-solving self-appraisal in older adults.

This study investigated relations between psychological health and problem-solving self-appraisal in 97 adults aged 65–96 years. Participants completed the Problem-Solving Inventory (P. P. Heppner, 1988) and two measures of psychological health encompassing both well-being and distress dimensions. Results of a canonical correlation analysis indicated that relations between problem-solving self-appraisal and psychological health were complex and sometimes contradictory. On the one hand, as problem-solving self-appraisal became more favorable (more confidence, more control, and increased approaching of problems), well-being increased and distress decreased. Conversely, perceptions of avoidant problem solving and decreased control were also associated with some increases in psychological health. Research and counseling implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age and sex differences in the mental health of older persons.

Administered the Trait Anxiety scale of the State-Trait Anxiety Inventory, a depression scale, and a general well-being scale to 2,051 respondents (aged 55+ yrs) to explore the age and sex relationships in the scales and the effects of age and sex when other correlated variables are considered. Results show that mental health was curvilinearly related to age with high symptom scores obtained in both 55–59 and 85–89 yr olds and lowest in 60–69 yr olds. Sex interacted with marital status, with higher symptoms among males in the never-married category and in females among the widowed and the married categories. When data were adjusted for correlations among these and other variables, the relationships between mental health with age and sex changed. In males, symptoms were unrelated to age, and in females, symptoms decreased with age down to the 80–84 yr old group. In the adjusted data, married females had lower symptoms than males. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of campus tensions on mental health.

Investigated the effects of campus tension at several institutions disrupted by student protests. Contrary to the American Council on Education (1970) finding that universities were not affected by protests, individual members of the university community were affected. Individuals showed evidence of increased anxiety, fears for safety, depression, difficulty in coping, and physical illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Private health insurance coverage and disability among older Americans

OBJECTIVES: This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and older. METHODS: Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. RESULTS: Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. DISCUSSION: The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.     

Social support, life events, and stress as modifiers of adjustment to bereavement by older adults.

As part of a larger panel study, interviews were obtained from 3 samples of older adults: 45 persons who had recently lost a spouse, 40 who had lost a parent or child, and 45 who were not bereaved. Assessments were conducted before and after the deaths. In the widowed sample, health remained quite stable, but depression increased sharply, then remained elevated. Changes were minimal in the sample who had lost a parent or child and in the nonbereaved sample. Multiple regression procedures were used to identify factors that contribute to depression and health 9 months after the spouse's death. Postbereavement depression was associated with higher prebereavement depression, higher financial pressures, higher global stress, fewer new interests, and lower social support. Health was a function of prebereavement health, new interests, financial pressures, and global stress. In general, life events and resources had stronger effects in the widowed sample than in the comparison samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)