Mental Health In Later Life Research Articles

Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study

BackgroundIn recent years, there have been increasing calls for integrating late-life mental health services into primary care in China, but data on the epidemiology of depressive disorders in older adults receiving primary care are very limited. This study examined prevalence, correlates and recognition of depressive disorders among Chinese older adults receiving primary care. MethodsA total of 752 older patients (65+ years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. ResultsOne–fifth (20.3%) of the older adults met DSM-IV criteria for depressive disorders during the month prior to the interview: 10.2% had major depression, 4.8% had dysthymia, and 5.3% had minor depressive disorder. The recognition rate of older patients with depressive disorders was 1.3% only. In multiple logistic regression analysis, factors significantly associated with depressive disorders included female gender (OR = 1.61), an education of primary school and below (OR = 1.69), poor financial status (OR = 2.44), poor or fair family relationship (OR = 1.66), loneliness (OR = 1.77), hypertension (OR = 1.91), heart disease (OR = 2.02), chronic gastric ulcer (OR = 6.01), and arthritis (OR = 3.55). LimitationsOlder adults from primary care clinics of economically underdeveloped regions of China were not included. ConclusionsDepressive disorders are prevalent but poorly recognized in Chinese older adults receiving treatment in primary care clinics. In order to improve the emotional well-being and health of older adults, it is time to integrate the management of common mental disorders into primary healthcare in China.

Understanding the complex relationship between early-life adversity and later-life mental health.

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Impact of combat exposure on mental health trajectories in later life: Longitudinal findings from the VA Normative Aging Study.

Cross-sectional studies have shown contradictory results concerning the impact of combat exposure on mental health in later life. We examined whether combat exposure influences trajectories of mental health symptoms in older male veterans using longitudinal data collected from 1985 to 1991 in the Veterans Affairs Normative Aging Study (N = 1,105, age range = 40-86 years in 1985). Noncombat veterans showed little systematic change in depressive and anxiety symptoms with age, whereas combat veterans showed U-shaped nonlinear changes, with higher levels in midlife decreasing until the mid-60s and then increasing again in the 70s and 80s. These findings support the notion that military service, and especially combat exposure, is a hidden variable in aging research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exercise, Fitness and the Aging Brain: A Review of Functional Connectivity in Aging

Aging is associated with changes in brain structure and function with some brain regions showing more age-related deterioration than others. There is evidence that regional changes in brain structure and function may affect the functioning of other, less- age-sensitive brain regions and lead to more global changes in brain efficiency and cognitive functioning. Fortunately, emerging evidence from health neuroscience suggests that age-related brain changes and associated cognitive declines may not be inevitable. In fact, they may even be reversible. Exercise is a particularly promising health behavior known to induce changes in regional brain structure and function in older adults. However, much less is known about how exercise affects the organization of brain networks in late life. The purpose of this review is to summarize what is known to date regarding the relationships between functional connectivity, exercise, fitness, and physical activity in aging. A critical summary of this literature may reveal novel mechanisms by which physical activity influences brain health, which in turn may be leveraged to improve other aspects of functioning, including physical, cognitive, and mental health in late life.

Accumulated lifecourse adversities and depressive symptoms in later life among older men and women in England: a longitudinal study

AbstractThis paper investigates the association between accumulated major lifecourse adversities and later-life depressive symptoms among older people in England, both at a single point in time (prevalence) and the onset over time during later life (incidence), using data from the English Longitudinal Study of Ageing. Using retrospective data on the experience of major life adversities from childhood onwards, five latent classes were identified: no/few lifecourse adversities (58.6%), lost relationship (27.0%), chained adversities (2.4%), childhood adversities (6.3%) and war-related adversities (5.7%). Older people who had experienced ‘chained adversities’, ‘childhood adversities’ and ‘a lost relationship’ had higher odds of presenting current depressive symptoms in 2006, even after controlling for socio-demographic characteristics, health-risk behaviours and social resources. Longitudinal analysis indicated that amongst respondents who were clear of depression in 2006, those older people who had experienced childhood adversities, a lost relationship and war-related adversities experienced a higher risk of having a new case of depressive symptoms. Results further indicate that women's mental health in later life is more sensitive to earlier life adversities than men's. The study shows that intervention earlier in the lifecourse may have benefits for the individual both contemporaneously and over the longer term.

Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0–18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0–15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = −0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = −0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults’ social networks, and these moderating effects vary between rural and urban China.

Job Characteristics, Job Preferences, and Physical and Mental Health in Later Life.

Existing research linking SES with work primarily focuses on the precursors (educational attainment) and outcomes (income) of work, rather than asking how diverse facets of work influence health. Using four waves of data from the Wisconsin Longitudinal Study, we evaluate whether multiple measures of respondent job characteristics, respondent preferences for those characteristics, and their interaction substantially improve the fit of sociological models of men's and women's physical and mental health at midlife and old age compared to traditional models using educational attainment, parental SES, and income. We find that non-wage job characteristics predict men's and women's physical and mental health over the lifecourse, although we find little evidence that the degree to which one's job accords with one's job preferences matters for health. These findings expand what we know about how work matters for health, demonstrating how the manner and condition under which one works has lasting impacts on wellbeing.

Marital Transitions and Depressive Symptoms among Older Adults: Examining Educational Differences

Background: Later decades of the life course have undergone rapid transformations due to demographic changes in ageing societies, such as more frequent occurrences of later-life marital transitions. Adaption to these transitions, even when welcomed, brings novel chances and challenges in negotiating new social roles in old age, which could reinforce preexisting disparities in the acquisition and mastery of resources, social ties, and coping strategies. Objectives: Because the ability to weather later-life marital transitions may depend on the long arm of education acquired earlier in the life course, the present study aims to identify and track trends in the prevalence of marriage, divorce/separation, and widowhood among sociodemographic subgroups; link the occurrence of those transitions with mental health; and test the influence of educational attainment on these associations. Methods: We employ an intraindividual, within-person approach to quantify the occurrence of marital transitions and their impact using data from the Health and Retirement Study (n = 22,013; 1992–2010). Measures of transition occurrence, depressive symptoms, and educational attainment were available across up to 10 biennial assessments. Results: Individuals with less than a high school diploma displayed the highest likelihood of losing their significant other through divorce/separation or death. Marital loss was associated with increasing, and marital gain with decreasing, depressive symptoms. Compared to those with less than a high school diploma, individuals with a high school or general equivalency diploma exhibited larger increases in depressive symptoms associated with widowhood, even though their average levels of depressive symptoms were lower in the absence of this transition. Conclusions: Our findings revealed a predictable educational gradient for the occurrence of marital transitions and later-life mental health. Yet higher, formalized education did not protect the participants from increased depression in the presence of a loss-related transition, which could suggest that the strains of spousal loss may to some degree function as a leveler of the preexisting social inequalities of stratified life courses. We conclude that the benefits conferred by education are not necessarily ubiquitous, and its impact on the adaptation to spousal loss may be more complex and nuanced depending on the range of prior experiences and available coping strategies.

Early-life adversity, later-life mental health, and resilience resources: a longitudinal population-based birth cohort analysis.

Participant data came from the Medical Research Council National Survey of Health and Development, a nationally-representative birth cohort study. The General Health Questionnaire-28 (GHQ-28) captured mental distress at ages 53, 60-64, and 68-69. An eight-item cumulative psychosocial adversity score was created (0, 1, 2, ≥3 adversities). Individual (i.e., education, occupational status, physical activity) and social (i.e., social support, neighborhood cohesion) resources were examined as mediators and moderators of CPA and GHQ-28 in longitudinal multilevel models. Greater adversity was associated with an average GHQ-28 score increase of 0.017, per unit adversity (β = 0·017, p < 0·001, 95% CI 0·011, 0·022). Lower mental distress was associated with higher levels of physical activity, occupational status, education, social support, and neighborhood cohesion. There was no evidence that resources moderated the relationship between GHQ-28 and adversity. All resources, save for physical activity and occupational status, partly mediated this relationship. Individual and social resources were associated with lower mental distress. They did not modify, but partly mediated the association between childhood adversity and adult mental distress. Social support was the most important mediator, suggesting that interventions to promote greater social support may offset psychosocial adversities experienced in childhood to foster better mental health in older adults.

‘He just gave up’: an exploratory study into the perspectives of paid carers on supporting older people living in care homes with depression, self-harm, and suicide ideation and behaviours

AbstractThis study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson's concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context.

Depression in Later Life: The Role of Adult Children's College Education for Older Parents' Mental Health in the United States.

Research on the socioeconomic gradient in mental health links disadvantaged family background with subsequent symptoms of depression, demonstrating the "downstream" effect of parental resources on children's mental health. This study takes a different approach by evaluating the "upstream" influence of adult children's educational attainment on parents' depressive symptoms. Using longitudinal data from the U.S. Health and Retirement Study (N = 106,517 person-years), we examine whether children's college attainment influences their parents' mental health in later life and whether this association increases with parental age. We also assess whether the link between children's college completion and parents' depression differs by parents' own education. Parents with children who completed college have significantly lower levels of depressive symptoms than parents without college-educated children, although the gap between parents narrows with age. In addition, at baseline, parents with less than a high school education were more positively affected by their children's college completion than parents who themselves had a college education, a finding which lends support to theories of resource substitution. Offspring education is an overlooked resource that can contribute to mental health disparities among older adults in a country with unequal access to college educations.

CHILDHOOD EXPERIENCES OF RACIAL DISCRIMINATION AND PSYCHOLOGICAL DISTRESS AMONG AFRICAN AMERICAN ADULTS

Despite substantial evidence documenting the mental health consequences of discrimination, few studies examine how childhood discrimination shapes psychological well-being later in life. This study examined this linkage among African American adults in the Nashville Stress and Health Study (N= 622). Findings showed a significant association between childhood racial discrimination and adult psychological distress. Discrimination in early childhood (ages 0–12) and adolescence (age 13–18) was associated with greater levels of adult psychological distress. However, these effects were explained by adulthood discrimination experiences. Results also indicated a conditional relationship between childhood discrimination and adult mental health, such that those with no or some early childhood discrimination experienced amplified adult distress levels; those who experienced discrimination as adolescents had diminished mental health risk as adults. These findings suggest childhood discrimination influences adult mental health by shaping adult discrimination exposure. In some cases, childhood discrimination experiences are protective for mental health in later life.

How Theatre Encourages Well-being – and Can Engage a Wider Audience

A recent study of single-ticket buyers and subscribers at a major regional theatre – Actors Theatre of Louisville, Kentucky – focused on measuring quantitatively the psychological benefits of engaging with theatre and gathering qualitatively observations by focus groups. Both confirmed the hypothesis that regular attendance promotes flourishing and meaningful social interaction, psychological stimulation, and positive emotions. The study also affirms that attending theatre contributes to a shared sense of community, this at a time when such community appears starkly diminished in the United States. In addition, focus groups wished that audiences better reflected the demographic diversity outside the auditorium. Evident disparities include urban vs. rural, prosperous vs. not, more education vs. less, black vs. white – reflecting those that splinter national politics. One microcosm of one theatre's audience provokes suggestions to foster a more democratic audience and plural istic culture that endeavours to cross rather than ignore the divides. Russell Vandenbroucke is Professor of Theatre at the University of Louisville and Director of its Peace, Justice &amp; Con flict Transformation programme. He was previously Artistic Director of Chicago's Northlight Theatre. Suzanne Meeks is Professor and Chair of the Psychological and Brain Sciences Department, University of Louisville. Her research focuses on mental health in later life.

Helping Older Adults With the Ageless Challenge of Substance Abuse

Helping Older Adults With the Ageless Challenge of Substance Abuse

Health and Aging Policy Fellows: Dementia and Mental Health Policy to Improve Lives of Older Adults.

The Health and Aging Policy Fellows (HAPF) Program has, since its inception in 2008, provided health policy training and mentorship for 113 gerontological professionals across a wide range of disciplines and stages of careers. The fellows' shared passion is the effective engagement of policy levers to improve the lives of older adults. This article briefly describes the HAPF Program and provides a sample of policies with which fellows have been engaged related to dementia and late-life mental health. Approximately 20% of the fellows have specifically addressed one of these areas during their fellowship year. This would be expected, given that 14% of older adults aged 71 and older have a diagnosis of dementia, and although new mental health diagnoses decline as adults age, mental health conditions remain prevalent. Thus, we conclude by describing opportunities for future advocacy and policy efforts in dementia and mental health in the areas of funding, translating science to practice, interprofessional education and innovative models of care for persons with these conditions.

Indicators of mental health in later life: A major public health issue

Indicators of mental health in later life: A major public health issue

Advances and Barriers for Clinical Neuroimaging in Late-Life Mood and Anxiety Disorders.

Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders. In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through "personalized pharmacotherapy" or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation. This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.

Family relations, sense of coherence, happiness and perceived health in retired Taiwanese: Analysis of a conceptual model.

A growing awareness of the rapidly increasing aged population in the world has led to growing attention to mental health in late life. Happiness has been emphasized as an important indicator of physical health and is predicted by a sense of coherence. However, the mechanism of influence of family relations on sense of coherence, happiness and perceived health is unknown. The present study aimed to analyze a conceptual model of the relationships among family relations, sense of coherence, happiness and perceived health in retired persons. A total of 142 retired participants were recruited from social service centers in Taipei, Taiwan. A structured questionnaire measuring the relationships among family relations, sense of coherence, happiness and perceived health was filled in by each respondent. Data were analyzed using structural equation modeling. The results showed that family relations is positively correlated with happiness, sense of coherence and perceived health. The results also showed that good family relations and a sense of coherence predict greater happiness. The results from structure equation modeling showed that the relationship between family relations and perceived health is completely mediated by happiness and a sense of coherence, but only the indirect effect of happiness is significant. The results also showed that family relations is partially mediated by the sense of coherence to happiness. In caring for retired older people, medical professionals need to increase their family relations and sense of coherence simultaneously, and then promote happiness in their interventions. Geriatr Gerontol Int 2018; 18: 154-160.

AGING AND MENTAL HEALTH: THE U.S. PERSPECTIVE

AbstractBy 2040 21% of those living in the U.S. will be 65 years of age and older. U.S. citizens come from different cultures and bring with them varying views of aging. However, the U.S. has long been a country with a primary focus on youth. Even though the U.S. population is rapidly becoming older, ageism persists. It is estimated that 20% of the older population experience mental health problems, including dementias, depression, anxiety and substance misuse. However, ageism and mental health stigma create barriers to adequate attention being focused on later-life mental health issues. National health insurance programs reimburse for mental health services for older adults, and recent federal policies have increased insurance compensation for metal health disorders. However, application of the federal policies vary by state, and service gaps still exit. Cultural and political factors impacting older adult mental health services will be considered.

Micro-scale environment and mental health in later life: Results from the Cognitive Function and Ageing Study II (CFAS II)

BackgroundPoor micro-scale environmental features, such as graffiti and broken windows, have been associated with crime and signs of social disorder with a potential impact on mental health. The aim of this study is to investigate the association between micro-scale environment and mental health problems in later life, including cognitive (cognitive impairment and dementia) and common mental disorders (depressive and anxiety symptoms). MethodsThe method of visual image audits was used to collect micro-scale environmental data for 3590 participants in the Cognitive Function and Ageing Study II, a population-based multicentre cohort of people aged 65 or above in England. Multilevel logistic regression was used to examine the associations between the quality of micro-scale environment and mental health problems taking into account urban/rural difference. ResultsPoor quality of micro-scale environment was associated with nearly 20% increased odds of depressive (OR: 1.19; 95% CI: 0.99, 1.44) and anxiety symptoms (OR: 1.17; 95% CI: 0.99, 1.38) while the direction of association for cognitive disorders differed across urban and rural settings. Although higher odds of cognitive disorders were found in rural settings, living in a poor quality environment was associated with nearly twice higher odds of cognitive impairment (OR: 1.88; 95% CI: 1.18, 2.97) in urban conurbations but 20% lower odds in rural areas (OR: 0.80; 95% CI: 0.57, 1.11). LimitationsThe causal direction could not be fully determined due to the cross-sectional nature of the data. The visual nature of the environmental assessment tool means it likely does not fully capture features related to the availability of local support services, or opportunities for social participation and interaction. ConclusionsThe quality of micro-scale environment appears to be important to mental health in older people. Interventions may incorporate the environmental aspect to reduce cognitive and common mental disorders.