Guest Editorial
The shifting conceptualization of elder abuse in the United States: from social services, to criminal justice, and beyond
- Shelly L. Jackson
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- Published online by Cambridge University Press:
- 18 August 2015, pp. 1-8
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A variety of forces have shifted the conceptualization of elder abuse over time to where it is almost unrecognizable when compared to its original conceptualization. The field has adopted or embraced whatever social problem is in vogue in an attempt to elevate elder abuse to a recognizable social problem that to date has eluded the field. This paper traces the various influences on the shifting conceptualizations of elder abuse and how those conceptualizations have shaped society's response. The paper concludes by suggesting that multiple conceptualizations can and must co-exist, a framework which is consistent with the multidisciplinary team approach becoming prevalent in the field.
Commentary paper of the month
Natural disaster, older adults, and mental health–a dangerous combination
- Meaghan L. O'donnell, David Forbes
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- 03 December 2015, pp. 9-10
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Natural disasters by their very nature occur suddenly and have the potential to cause great harm at an individual, family, community, and societal level. They occur frequently, and with the escalation in extreme events related to climate change, the frequency, and severity of natural disasters will only increase (Intergovernmental Panel on Climate Change (IPCC), 2014). Globally, a growing number of people are being exposed to natural disaster; however, the vulnerability to exposure is not equally shared. Those who are socially, physically, economically, culturally, politically, institutionally, or otherwise disadvantaged are especially vulnerable to experiencing natural disaster.
Review Article
Mental health implications for older adults after natural disasters – a systematic review and meta-analysis
- Georgina Parker, David Lie, Dan J. Siskind, Melinda Martin-Khan, Beverly Raphael, David Crompton, Steve Kisely
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- 27 July 2015, pp. 11-20
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Background:
Natural disasters affect the health and well-being of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared with younger adults. To date, no systematic review has evaluated this. We aimed to synthesize the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults.
Design:A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, adjustment disorder, and psychological distress.
Results:We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms and 1.73 more likely to develop adjustment disorder when exposed to natural disasters when compared with younger adults.
Conclusions:Given the global rise in the number of older adults affected by natural disasters, mental health services need to be prepared to meet their needs following natural disasters, particularly around the early detection and management of PTSD.
Corrigendum
Mental health implications for older adults after natural disasters – a systematic review and meta-analysis - CORRIGENDUM
- Georgina Parker, David Lie, Dan J. Siskind, Melinda Martin-Khan, Beverly Raphael, David Crompton, Steve Kisely
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- Published online by Cambridge University Press:
- 09 September 2015, p. 21
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In the above mentioned article by Parker et al., on the seventh page, in the final paragraph of column two, the following three sentences should have been removed:
“DSM-IV criteria specify a minimum six-month delay between the traumatic event and a diagnosis of PTSD (APA, 2000). Any diagnosis prior to this time would be an acute stress reaction. Based on these diagnostic criteria, it is possible that at least two studies were reporting acute stress reaction rather than PTSD.”
This error does not change the results or conclusions of the study.
Review Article
Falls in older adults with major depressive disorder (MDD): a systematic review and exploratory meta-analysis of prospective studies
- Brendon Stubbs, Jean Stubbs, Solomon Donald Gnanaraj, Andrew Soundy
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- 03 August 2015, pp. 23-29
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Background:
Depressive symptomology is now widely recognized as a key risk factor for falls. The evidence regarding the impact of major depressive disorder (MDD) on falls is unclear. A systematic review and exploratory meta-analysis was undertaken to explore the relationship between MDD and falls.
Methods:Major electronic database were searched from inception till April 2015. Studies that defined MDD and measured falls prospectively in older adults (≥60 years) were included. Studies relying on depressive symptomology alone were excluded. The methodological quality of included articles was assessed and study findings were synthesized using an exploratory meta-analysis.
Results:From a potential of 415 articles, only three studies met the inclusion criteria. This included 976 unique older adults with a range of mean age from ≥65 to 83 years. The methodological quality of included studies was satisfactory. None of the included studies’ primary aim was to investigate the relationship between MDD and falls. The exploratory meta-analysis demonstrated older adults with MDD are at increased risk of falling compared to non-depressed older adults (odds ratio (OR) 4.0, 95% CI 2.0–8.1, I2 = 60%, n = 976).
Conclusion:There is a paucity of research considering falls in older adults with MDD. Our results demonstrate that the odds of falling appear to be greater among people with MDD (OR 4.0) than in previous meta-analyses that have only considered subthreshold depressive symptoms. Given the distinct nature and challenges with MDD, more research is required to better understand the falls risk in this group.
Research Article
Relationship between dual task walking, cognition, and depression in oldest old people
- Juliana Hotta Ansai, Thais Rabiatti Aurichio, José Rubens Rebelatto
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- 01 July 2015, pp. 31-38
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Background:
The purpose of the study was to investigate the relationship between dual task walking, cognition, and depression in oldest old people living in the community.
Methods:We conducted an observational cross-sectional study at Federal University of São Carlos (Brazil). We assessed 67 community-dwelling older adults aged 80 years and over, who were able to walk alone and did not present with a risk of dementia (assessed by Mini-Mental State Examination, MMSE). The assessment consisted of anamnesis, dual task using the Timed Up and Go test associated with a motor task (TUGT-motor) and a cognitive task (TUGT-cognitive); cognitive measures using MMSE, Montreal Cognitive Assessment (MoCA), Clock Drawing test (CDT) and verbal fluency, and depressive measures by the Geriatric Depression Scale (GDS).
Results:There was a correlation with higher magnitude between cognitive tests and TUGT-cognitive, compared to TUGT-motor. For TUGT-motor, the highest correlations with cognitive tests were found between time and MMSE, MoCA (total score), and MoCA visuospatial/executive domain. For TUGT-cognitive, the highest correlations with cognitive tests were between number of steps and MMSE and between time and MMSE. GDS showed a significant weak correlation with number of steps taken in TUGT-motor, wrong words, and correct/time of TUGT-cognitive.
Conclusions:Dual task performances are associated with cognition in oldest old. Furthermore, dual task tests have less influence of educational level, are functional, fast, and easily applicable in clinical practice. Future studies are needed to confirm if dual task test is useful for cognitive screening in oldest old.
The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults
- Kimberly J. Stoeckel, Howard Litwin
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- 06 May 2015, pp. 39-47
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Background:
To examine the role of meaningful relationship characteristics, defined here as social network type, in relation to the association between functional impairment and depressive symptoms.
Methods:The sample included respondents aged 65 years and older (n = 26,401) from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Respondents were classified into one of seven relationship network types (Distal Children (living at a distance), Proximal Family (living nearby), Spouse, Other Family, Friend, Other, and No Network) according to the predominant characteristics of their most meaningful relationships. A two-stage regression analysis was performed in which the number of depressive symptoms was first regressed on the extent of functional impairment and network type, controlling for sociodemographic characteristics, cognition, health, and country. In the second stage, variables representing the interactions between functional impairment and network type were considered.
Results:The compositional characteristics of respondents’ relationships in later life, as defined by social network type, were associated with depressive symptoms. In particular, when experiencing functional impairment, those without any meaningful relationships were found to have more depressive symptoms when compared to all other network types. The findings underscore the importance of meaningful relationships for the mental health of older adults experiencing functional impairment as well as the risk of experiencing depression among those who maintain no personal social network.
Conclusions:The study shows that differing constellations of meaningful relationships in later life yield different associations with mental health, especially when taking functional limitations into account.
Structural and functional social network attributes moderate the association of self-rated health with mental health in midlife and older adults
- Tim D. Windsor, Pilar Rioseco, Katherine L. Fiori, Rachel G. Curtis, Heather Booth
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- 24 July 2015, pp. 49-61
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Background:
Social relationships are multifaceted, and different social network components can operate via different processes to influence well-being. This study examined associations of social network structure and relationship quality (positive and negative social exchanges) with mental health in midlife and older adults. The focus was on both direct associations of network structure and relationship quality with mental health, and whether these social network attributes moderated the association of self-rated health (SRH) with mental health.
Methods:Analyses were based on survey data provided by 2001 (Mean age = 65, SD = 8.07) midlife and older adults. We used Latent Class Analysis (LCA) to classify participants into network types based on network structure (partner status, network size, contact frequency, and activity engagement), and used continuous measures of positive and negative social exchanges to operationalize relationship quality. Regression analysis was used to test moderation.
Results:LCA revealed network types generally consistent with those reported in previous studies. Participants in more diverse networks reported better mental health than those categorized into a restricted network type after adjustment for age, sex, education, and employment status. Analysis of moderation indicated that those with poorer SRH were less likely to report poorer mental health if they were classified into more diverse networks. A similar moderation effect was also evident for positive exchanges.
Conclusions:The findings suggest that both quantity and quality of social relationships can play a role in buffering against the negative implications of physical health decline for mental health.
Leisure activities and depressive symptoms in older adults with cognitive complaints
- Gina Poelke, Maria I. Ventura, Amy L. Byers, Kristine Yaffe, Rebecca Sudore, Deborah E. Barnes
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- 24 August 2015, pp. 63-69
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Background:
Depressive symptoms are common in older adults and associated with increased risk of cognitive impairment. Leisure activities are often promoted for individuals with mood symptoms but few studies compare the effects of different types of leisure activities on reducing depressive symptoms.
Methods:Data were analyzed from participants enrolled from 2008–2009 in the Mental Activity and eXercise (MAX) Trial, which examined the effects of physical plus mental activity over 12 weeks in inactive older adults with cognitive complaints. There were no significant differences between intervention groups on the primary outcome of cognitive function or the secondary outcome of depressive symptoms; therefore, all participants were combined for the current analyses in which we examined changes in leisure activity engagement (Community Healthy Activities Model Program for Seniors (CHAMPS)), and changes in depressive symptoms (Geriatric Depression Scale (GDS)) as a function of changes in leisure activity engagement from baseline to post-intervention.
Results:Participants’ mean age was 73.0 years, 61.6% were female, and 63.6% were non-Hispanic white. There was a significant change in total hours per week engaged in leisure activities from baseline (36.7 hours, SD = 12.7) to post-intervention (40.4 hours, SD = 15.7; paired t-test p = 0.02), and mean change in depressive symptoms was significantly inversely correlated with change in leisure activity hours such that increases in total leisure activity were associated with decreases in depressive symptoms (r = −0.21, p = 0.04).
Conclusions:Increasing the total amount of leisure activity levels may help lower depressive symptoms in inactive older adults with cognitive complaints.
Six-month trajectories of self-reported depressive symptoms in long-term care
- Jane McCusker, Martin G. Cole, Philippe Voyer, Johanne Monette, Nathalie Champoux, Antonio Ciampi, Minh Vu, Eric Belzile, Chun Bai
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- 10 August 2015, pp. 71-81
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Background:
Depression is a common problem in long-term care (LTC) settings. We sought to characterize depression symptom trajectories over six months among older residents, and to identify resident characteristics at baseline that predict symptom trajectory.
Methods:This study was a secondary analysis of data from a six-month prospective, observational, and multi-site study. Severity of depressive symptoms was assessed with the 15-item Geriatric Depression Scale (GDS) at baseline and with up to six monthly follow-up assessments. Participants were 130 residents with a Mini-Mental State Examination score of 15 or more at baseline and of at least two of the six monthly follow-up assessments. Individual resident GDS trajectories were grouped using hierarchical clustering. The baseline predictors of a more severe trajectory were identified using the Proportional Odds Model.
Results:Three clusters of depression symptom trajectory were found that described “lower,” “intermediate,” and “higher” levels of depressive symptoms over time (mean GDS scores for three clusters at baseline were 2.2, 4.9, and 9.0 respectively). The GDS scores in all groups were generally stable over time. Baseline predictors of a more severe trajectory were as follows: Initial GDS score of 7 or more, female sex, LTC residence for less than 12 months, and corrected visual impairment.
Conclusions:The six-month course of depressive symptoms in LTC is generally stable. Most residents who experience a more severe symptom trajectory can be identified at baseline.
Quality of life of institutionalized older adults by dementia severity
- Emilia Castro-Monteiro, Mohammed Alhayek-Aí, Alicia Diaz-Redondo, Alba Ayala, Carmen Rodriguez-Blazquez, Fermina Rojo-Perez, Pablo Martinez-Martin, Maria João Forjaz
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- 28 May 2015, pp. 83-92
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Background:
The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity.
Methods:Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia.
Results:Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia.
Conclusions:QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia.
The applicability of the cognitive abilities screening instrument–short (CASI-S) in primary care in Brazil
- Glaucia Martins de Oliveira, Juliana Emy Yokomizo, Laís dos Santos Vinholi e Silva, Laura Ferreira Saran, Cássio M. C. Bottino, Mônica Sanches Yassuda
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- 29 April 2015, pp. 93-99
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Background:
The Cognitive Abilities Screening Instrument – Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care.
Objectives:To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy.
Methods:In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients’ health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status.
Results:The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = −0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%.
Conclusions:The CASI-S can be useful for dementia screening in primary care in Brazil.
The KICA Carer: informant information to enhance the Kimberley Indigenous Cognitive Assessment
- K. Smith, L. Flicker, D. Atkinson, A. Dwyer, N.T. Lautenschlager, J. Thomas, O.P. Almeida, D. LoGiudice
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- 14 August 2015, pp. 101-107
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Background:
A quality dementia-screening tool is required for older remote Aboriginal Australians who have high rates of dementia and limited access to appropriate medical equipment and clinicians. The Kimberley Indigenous Cognitive Assessment (KICA Cog) is a valid cognitive test for dementia in Aboriginal and Torres Strait Islander peoples. The KICA cognitive informant questionnaire (KICA Carer) had yet to be analyzed to determine validity alone or in combination with the KICA Cog.
Methods:The KICA Carer was completed by nominated informants of 349 remote-living Aboriginal Australians in the Kimberley region, Western Australia. Validity was assessed by comparing KICA Carer with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-10) consensus diagnoses based on a blinded specialist review. KICA Carer and KICA Cog were then compared to determine joint validity.
Results:A KICA Carer score of ≥3/16 gave optimum sensitivity (76.2%) and specificity (81.4%), area under curve (AUC) 0.89 (95% CI = 0.85, 0.94) with positive predictive value (PPV) of 35.8%, and negative predictive value (NPV) of 96.2%. A KICA Cog score of ≤33/39 gave a sensitivity of 92.9% and specificity of 89.9%, AUC 0.96 (95% CI = 0.94, 0.98), with PPV of 55.6% and NPV of 98.9%. Cut-off scores of KICA Cog ≤ 33/39 and KICA Carer ≥ 2/16 in series indicate possible dementia, with sensitivity of 90.5% and specificity of 93.5%. In this setting, PPV was 66.5% and NPV was 98.6%.
Conclusions:The KICA Carer is an important tool to accurately screen dementia in remote Aboriginal Australians when the KICA Cog is unable to be used for a patient. It is readily accepted by caregivers.
Key points:• For the best practice in the cognitive assessment of an Aboriginal Australian aged over 45 years, KICA Cog should be utilized.
• In cases where Aboriginal patients are not assessed directly, KICA Carer should be conducted with an informant. A cut-off score of ≥3/16 should be used (these tools can be downloaded from www.wacha.org.au/kica.html).
“The biggest problem we’ve ever had to face”: how families manage driving cessation with people with dementia
- Jacki Liddle, Amelia Tan, Phyllis Liang, Sally Bennett, Shelley Allen, David C. Lie, Nancy A. Pachana
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- 14 September 2015, pp. 109-122
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Background:
It is recognized that people with dementia are likely to need to stop driving at some point following diagnosis. Driving cessation can lead to negative outcomes for people with dementia and their family caregivers (FC), who often experience family conflict and tension throughout the process. Family experiences surrounding driving cessation have begun to be explored but warrant further examination.
Methods:Using a descriptive phenomenological approach, semi-structured interviews were undertaken with key stakeholders, including 5 retired drivers with dementia, 12 FC, and 15 health professionals (HP). Data were analyzed inductively to explore the needs and experiences of people with dementia and FC.
Results:The data revealed a range of possible interactions between people with dementia and FC. These were organized into a continuum of family dynamics according to levels of collaboration and conflict: in it together, behind the scenes, active negotiations, and at odds. At the in it together end of the continuum, people with dementia and FC demonstrated collaborative approaches and minimal conflict in managing driving cessation. At the at odds end, they experienced open conflict and significant tension in their interactions. Contextual factors influencing family dynamics were identified, along with the need for individualized approaches to support.
Conclusions:The continuum of family dynamics experienced during driving cessation may help clinicians better understand and respond to complex family needs. Interventions should be tailored to families’ distinctive needs with consideration of their unique contextual factors influencing dynamics, to provide sensitive and responsive support for families managing driving cessation.
Is there a preference for PET or SPECT brain imaging in diagnosing dementia? The views of people with dementia, carers, and healthy controls
- Claire Bamford, Kirsty Olsen, Chris Davison, Nicky Barnett, Jim Lloyd, David Williams, Michael Firbank, Helen Mason, Cam Donaldson, John O’Brien
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- 15 July 2015, pp. 123-131
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Background:
Positron emission tomography (PET) and single photon emission computed tomography (SPECT) brain imaging are widely used as diagnostic tools for suspected dementia but no studies have directly compared participant views of the two procedures. We used a range of methods to explore preferences for PET and SPECT.
Methods:Patients and controls (and accompanying carers) completed questionnaires immediately after undergoing PET and SPECT brain scans. Pulse rate data were collected during each scan. Scan attributes were prioritized using a card sorting exercise; carers and controls additionally answered willingness to pay (WTP) questions.
Results:Few differences were found either between the scans or groups of participants, although carers marginally preferred SPECT. Diagnostic accuracy was prioritized over other scan characteristics. Mean heart rate during both scans was lower than baseline heart rate measured at home (p < 0.001).
Conclusion:Most participants viewed PET and SPECT scans as roughly equivalent and did not have a preference for either scan. Carer preference for SPECT is likely to reflect their desire to be with the patient (routine practice for SPECT but not for PET), suggesting that they should be able to accompany vulnerable patients throughout imaging procedures wherever possible. Pulse rate data indicated that brain imaging was no more stressful than a home visit (HV) from a researcher. The data do not support the anecdotal view that PET is a more burdensome procedure and the use of PET or SPECT scans in dementia should be based on diagnostic accuracy of the technique.
Achieving consensus and controversy around applicability of palliative care to dementia
- Jenny T. van der Steen, Lukas Radbruch, Marike E. de Boer, Saskia Jünger, Julian C. Hughes, Phil Larkin, Dianne Gove, Anneke L. Francke, Raymond T.C.M. Koopmans, Pam Firth, Ladislav Volicer, Cees M.P.M. Hertogh
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- 10 June 2015, pp. 133-145
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Background:
People with dementia may benefit from palliative care which specifically addresses the needs of patients and families affected by this life-limiting disease. On behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study to define domains for palliative care in dementia and to provide recommendations for optimal care. An international panel of experts in palliative care, dementia care or both, achieved consensus on almost all domains and recommendations, but the domain concerning the applicability of palliative care to dementia required revision.
Methods:To examine in detail, the opinions of the international panel of 64 experts around the applicability of palliative care, we explored feedback they provided in the Delphi process. To examine which experts found it less important or less applicable, ordinal regression analyses related characteristics of the panelists to ratings of overall importance of the applicability domain, and to agreement with the domain's four recommendations.
Results:Some experts expressed concerns about bringing up end-of-life issues prematurely and about relabeling dementia care as palliative care. Multivariable analyses with the two outcomes of importance and agreement with applicability indicated that younger or less experienced experts and those whose expertise was predominantly in dementia care found palliative care in dementia less important and less applicable.
Conclusions:Benefits of palliative care in dementia are acknowledged by experts worldwide, but there is some controversy around its early introduction. Further studies should weigh concerns expressed around care receiving a “palliative” label versus the benefits of applying palliative care early.
Decreased hemoglobin levels, cerebral small-vessel disease, and cortical atrophy: among cognitively normal elderly women and men
- Sang Eon Park, Hojeong Kim, Jeongmin Lee, Na Kyung Lee, Jung Won Hwang, Jin-ju Yang, Byoung Seok Ye, Hanna Cho, Hee Jin Kim, Yeo Jin Kim, Na-Yeon Jung, Tae Ok Son, Eun Bin Cho, Hyemin Jang, Eun Young Jang, Chang Hyung Hong, Jong-Min Lee, Mira Kang, Hee-Young Shin, Duk L. Na, Sang Won Seo
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- 20 May 2015, pp. 147-156
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Background:
Decreased hemoglobin levels increase the risk of developing dementia among the elderly. However, the underlying mechanisms that link decreased hemoglobin levels to incident dementia still remain unclear, possibly due to the fact that few studies have reported on the relationship between low hemoglobin levels and neuroimaging markers. We, therefore, investigated the relationships between decreased hemoglobin levels, cerebral small-vessel disease (CSVD), and cortical atrophy in cognitively healthy women and men.
Methods:Cognitively normal women (n = 1,022) and men (n = 1,018) who underwent medical check-ups and magnetic resonance imaging (MRI) were enrolled at a health promotion center. We measured hemoglobin levels, white matter hyperintensities (WMH) scales, lacunes, and microbleeds. Cortical thickness was automatically measured using surface based methods. Multivariate regression analyses were performed after controlling for possible confounders.
Results:Decreased hemoglobin levels were not associated with the presence of WMH, lacunes, or microbleeds in women and men. Among women, decreased hemoglobin levels were associated with decreased cortical thickness in the frontal (Estimates, 95% confidence interval, −0.007, (−0.013, −0.001)), temporal (−0.010, (−0.018, −0.002)), parietal (−0.009, (−0.015, −0.003)), and occipital regions (−0.011, (−0.019, −0.003)). Among men, however, no associations were observed between hemoglobin levels and cortical thickness.
Conclusion:Our findings suggested that decreased hemoglobin levels affected cortical atrophy, but not increased CSVD, among women, although the association is modest. Given the paucity of modifiable risk factors for age-related cognitive decline, our results have important public health implications.
Head circumference as a useful surrogate for intracranial volume in older adults
- Tammy T. Hshieh, Meaghan L. Fox, Cyrus M. Kosar, Michele Cavallari, Charles R. G. Guttmann, David Alsop, Edward R. Marcantonio, Eva M. Schmitt, Richard N. Jones, Sharon K. Inouye
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- 02 April 2015, pp. 157-162
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Background:
Intracranial volume (ICV) has been proposed as a measure of maximum lifetime brain size. Accurate ICV measures require neuroimaging which is not always feasible for epidemiologic investigations. We examined head circumference as a useful surrogate for ICV in older adults.
Methods:99 older adults underwent Magnetic Resonance Imaging (MRI). ICV was measured by Statistical Parametric Mapping 8 (SPM8) software or Functional MRI of the Brain Software Library (FSL) extraction with manual editing, typically considered the gold standard. Head circumferences were determined using standardized tape measurement. We examined estimated correlation coefficients between head circumference and the two MRI-based ICV measurements.
Results:Head circumference and ICV by SPM8 were moderately correlated (overall r = 0.73, men r = 0.67, women r = 0.63). Head circumference and ICV by FSL were also moderately correlated (overall r = 0.69, men r = 0.63, women r = 0.49).
Conclusions:Head circumference measurement was strongly correlated with MRI-derived ICV. Our study presents a simple method to approximate ICV among older patients, which may prove useful as a surrogate for cognitive reserve in large scale epidemiologic studies of cognitive outcomes. This study also suggests the stability of head circumference correlation with ICV throughout the lifespan.
Influences on the perception of elder financial abuse among older adults in Southern California
- Bob G. Knight, Seungyoun Kim, Sarah Rastegar, Scott Jones, Victoria Jump, Serena Wong
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- 04 May 2015, pp. 163-169
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Background:
Under-reporting of elder financial abuse is partly due to failure of those around the victim to perceive the financial mistreatment as abuse. This study explored the effect of victim and perceiver factors on perception of elder financial abuse in the context of Routine Activity Theory (RAT).
Methods:488 older adults in Ventura County (CA) were surveyed about financial abuse using vignette method. In the study's Vignette 1, the amount of money taken, the type of frailty, and the relationship of perpetrator and victim were manipulated. In Vignette 2, the victim's age and relationship of perpetrator and victim were manipulated. Respondents’ demographics (age, gender, education, and ethnicity) were collected.
Results:Logistic regression analyses revealed that children of the victim were least likely to be seen as committing abuse in both vignettes. In Vignette 1, there was an interaction of gender of respondent and the amount of money taken. In Vignette 2, non-Whites were less likely to perceive the signing over of the house as financial abuse. Respondents endorsed the concept of a special court with expertize in elder abuse as a way to increase the likelihood that they would report.
Conclusions:Even though most financial abuse is perpetrated by family members, older adults are less likely to perceive a financial situation as abuse when it involves a child of the victim, thus making reporting and prevention less likely. The support for a specialty Elder Abuse Court (EAC) suggests that some reluctance to report is based on misgivings about punishing the perpetrator.
Letter
The role of psychological well-being in obese and overweight older adults
- Cinzia Giuli, Roberta Papa, Fiorella Marcellini, Marco Boscaro, Emanuela Faloia, Fabrizia Lattanzio, Giacomo Tirabassi, Roberta Bevilacqua
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- Published online by Cambridge University Press:
- 24 August 2015, pp. 171-172
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Being obese or overweight is often associated with impaired quality of life and psychological well-being (PWB) in comparison with normal-weight people (Giuli et al., 2014), both in developed and developing countries. PWB is considered a very important correlate of subjective well-being in people with excess weight. The concept of PWB is based on Ryff's multidimensional model (Ryff, 2014), which considers well-being as eudaemonic concept, and includes six dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Few studies have analyzed the role of specific correlates of perceived well-being in the obese and overweight Italian older population. The purpose of this study was to evaluate the role of perceived well-being in obese and overweight older adults. Our study included 124 overweight and obese older participants, aged 60 years or more, selected from patients attending the Division of Endocrinology, Department of Clinical and Molecular Sciences of Polytechnic University of Marche (Italy). As previously described (Giuli et al., 2014), the participants were recruited on the basis of specific inclusion/exclusion criteria, in a period of three years (January 2010–December 2012).