Mental Disorders In Later Life Research Articles

Construct validation of Urdu version of Pediatric Quality of Life Inventory: evidence from Pakistan

PurposeMental health problems during the initial years of life are precursors of mental disorders in later life, as well as poor quality of life. However, understanding and assessing the quality of life among children is very challenging and requires appropriate assessment measures. Against this backdrop, this study aims to establish the evidence for the construct and convergent validity of Urdu version of Pediatric Quality of Life Inventory (PedsQL) in Pakistani children.Design/methodology/approachThis study has a cross-sectional study design in which a sample of 291 primary school children (53.3% male children and 44.7% female children) were enrolled from 6 primary schools located in Rawalpindi District in 2021 through random sampling. Children’s ages ranged between 9 and 13 years (M = 10.51 years; SD = 0.73). Urdu translated version PedsQL, Rosenburg self-esteem scale (RSES), strengths and difficulties questionnaire (SDQ), difficulty subscale and socio-demographic form were administered in a group setting.FindingsConfirmatory factor analysis showed model provided a better fit similar to three factors: social/school functioning; psychological functioning; and physical functioning with good alpha reliability for full scale as well for subscales (r = 0.87, r = 0.75, r = 0.77 and r = 0.73), respectively. Pearson’s correlation of the translated version with SDQ_difficulties (r = −0.33; p < 0.01) and RSES (r = −016; p < 0.01) depicted solid discriminant validity (r = −0.33; p < 0.01) and RSES showed good convergent validity (r = −0.16; p < 0.01). Hence; PedsQL, Urdu proved to be a reliable, valid and efficient tool for the assessment of quality of life among Pakistani children, and its three-factor structure model suggested previously for Pakistani children was confirmed.Originality/valueThis study is original work by the researcher as part of their PhD project.

Association of Long-term Exposure to Air Pollution With Late-Life Depression in Older Adults in the US

Emerging evidence has suggested harmful associations of air pollutants with neurodegenerative diseases among older adults. However, little is known about outcomes regarding late-life mental disorders, such as geriatric depression. To investigate if long-term exposure to air pollution is associated with increased risk of late-life depression diagnosis among older adults in the US. This population-based longitudinal cohort study consisted of US Medicare enrollees older than 64 years. Data were obtained from the US Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The participants were continuously enrolled in the Fee-for-Service program and both Medicare Part A and Part B. After the 5-year washout period at entry, a total of 8 907 422 unique individuals were covered over the study period of 2005 to 2016, who contributed to 1 526 690 late-onset depression diagnoses. Data analyses were performed between March 2022 and November 2022. The exposures consisted of residential long-term exposure to fine particulate matter (PM2.5), measured in micrograms per cubic meter; nitrogen dioxide (NO2), measured in parts per billion; and ozone (O3), measured in parts per billion. Late-life depression diagnoses were identified via information from all available Medicare claims (ie, hospital inpatient, skilled nursing facility, home health agency, hospital outpatient, and physician visits). Date of the first occurrence was obtained. Hazard ratios and percentage change in risk were estimated via stratified Cox proportional hazards models accounting for climate coexposures, neighborhood greenness, socioeconomic conditions, health care access, and urbanicity level. A total of 8 907 422 Medicare enrollees were included in this study with 56.8% being female individuals and 90.2% being White individuals. The mean (SD) age at entry (after washout period) was 73.7 (4.8) years. Each 5-unit increase in long-term mean exposure to PM2.5, NO2, and O3 was associated with an adjusted percentage increase in depression risk of 0.91% (95% CI, 0.02%-1.81%), 0.61% (95% CI, 0.31%- 0.92%), and 2.13% (95% CI, 1.63%-2.64%), respectively, based on a tripollutant model. Effect size heterogeneity was found among subpopulations by comorbidity condition and neighborhood contextual backgrounds. In this cohort study among US Medicare enrollees, harmful associations were observed between long-term exposure to air pollution and increased risk of late-life depression diagnosis.

Corrigendum to “Does Late-life Depression Accelerate Aging?” [Am J Geriatr Psychiatry 31 (2023) 10–13

The editor regrets that the printed version of the above editorial commentary in the January, 2023 edition of AJGP) contained several errors. The correct and final version of the editorial commentary appears here. It offers a clear and robust discussion of the interface between geroscience and geriatric mental health and of the importance and innovation of the finding presented in the original research article. Does Late-Life Depression Accelerate Aging?The American Journal of Geriatric PsychiatryVol. 31Issue 1PreviewDepression in older adults occurs in the context of biological aging that contributes to the clinical symptoms, biomarkers, and the course of the disease.1 Neurobiology of aging and late-life mental disorders share features of increased cellular senescence, inflammation, and reduced mitochondrial function. In addition, serious mental disorders (SMDs), including major depression, are associated with an increased risk of medical illnesses and premature mortality from natural causes, with lifespans up to 25 years shorter than the general population, even after controlling for suicide. Full-Text PDF

Mental health care for older adults: recent advances and new directions in clinical practice and research.

The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.

Mental Health Screening and Digital Intervention for Thai Seniors Citizen in Primary Care

IntroductionAvoidable disability associated with depression, anxiety, and impaired cognition among older adults is pervasive. Incentives for the detection of mental disorders in late life include increased reimbursement, reduced cost, and less burden for patients and families.ObjectivesMental health problems in the elderly are major public health issues around the world. Thai older adults who experience mental illness rarely seek care from mental health specialists; rather, they tend to seek help from a general physician. Primary health care is, therefore, an important setting for the detection of mental health symptoms and subsequent treatment. We describe the design and implementation of a mental health care model in the Thai primary care system. Initial results of screening for behavioral and emotional problems are reported.MethodsThis work is intended to explore mental health conditions in Thai elderly people to provide of identifying and non-pharmacological treating psychiatric conditions in the Primary care unit. The instruments used in the survey, which consists of twelve symptoms found in the elderly, developed into an online program to suit pandemic conditions.ResultsIn an effort to document mental health problems in the primary care system, 4,854 veterans (mean age 68) from 46 provinces across Thailand were screened for multiple mental health symptoms. The sample divided into 1,701 males (35%) and 3,153 females (65%).ConclusionsWhile screening for depressed mood is now common in primary care, we found it useful to screen for specific symptoms of depression in older persons (including insomnia, change in eating habits, facial expression, and anxiety) in a primary setting.DisclosureNo significant relationships.

Association Between Pregnancy Loss and Common Mental Disorders in Later Life: A Large Prospective Cohort Study

Association Between Pregnancy Loss and Common Mental Disorders in Later Life: A Large Prospective Cohort Study

Factors associated with psychiatric disorders and treatment seeking behaviour among older adults in India

Since untreated or undertreated late-life mental disorders is associated with grave consequences including poor quality of life and increased mortality rates, this study investigates the associated factors of psychiatric disorders and its treatment seeking among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India (LASI) conducted during 2017–2018. The effective sample size was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were used to present the preliminary results. Chi-square test was used to find the significance level for bivariate association. Additionally, the Heckprobit selection model was employed to fulfil the objectives. It was revealed that about 2.8% of older adults had psychiatric disorder and of those who were suffering from psychiatric disorder, 41.3% (out of 2.8%) sought medical treatment. It was found that older adults who ever worked but currently not working, who had low level of life satisfaction, had poor self-rated health, had difficulty in activities of daily living (ADL) and instrumental ADL and had symptoms of psychological distress had higher probability of suffering from psychiatric disorder in reference to their counterparts. Older adults from oldest-old age group, who were females, from poorest wealth quintile, from Scheduled Tribe and from eastern region had lower probability of seeking treatment for psychiatric disorder in reference to their counterparts. The findings of the present study urge that greater attention be devoted at detecting and preventing late-life psychiatric disorder particularly among those who are at greater risk vis., male gender, working status as “ever worked but currently not working”, having low life satisfaction, poor SRH, ADL and IADL difficulties, higher psychological distress, belonging to higher wealth quintile and rural place of residence.

Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment

Anxiety disorders are among the most frequently diagnosed mental disorders in late life. As older adults comprise a growing segment of the population, evidence-based treatments for anxiety disorders in late life have come into sharper focus. Cognitive-behavioral therapy (CBT) for anxiety disorders in late life has received less empirical attention and widespread dissemination relative to other age groups. Increasing older adults’ access to timely assessment and effective treatment can help reduce the personal and societal costs of anxiety disorders. The purpose of this review paper is to discuss important considerations for the assessment of anxiety disorders in older adults and offer adaptations to CBT treatment for this population. As part of assessment considerations, we discuss how physical health conditions, cognitive impairment, and functional limitations can impact anxiety disorder diagnoses with older adults. We also outline validated self-report measures of anxiety disorder symptoms for older adults and highlight the importance of assessing older adults’ suitability for CBT. Several recommendations for adapting CBT protocols for older adults with anxiety disorders are described, such as extending psychoeducation, altered treatment pacing, use of content aids, and medical contraindications for interoceptive exposure. A case study is included that illustrates helpful assessment and treatment adaptions for an older woman with panic disorder. We highlight the pressing need to increase research and dissemination of CBT for anxiety disorders for older adults to meet the needs of an increasing segment of the population worldwide.

Grief and loss in old age: Exploration of the association between grief and depression.

BackgroundThe proportion of older adults is increasing due to demographic changes. Depression belongs to the most common mental disorders in late life. The loss of an emotionally significant person is a risk factor for the development of depression. The aim of this study is to analyze the association between depression and grief burden resulting from loss. Based on prior evidence, we examined loneliness as a possible mediator and social support as possible moderator of this association. MethodsThe cross-sectional analyses are based on a sample (N = 863) of study participants aged 75+ (M = 81.4 years, SD = 4.4, 62.2% female) with loss experience deriving from the multicenter prospective German cohort study AgeMooDe. Regression analyses (moderated mediation) were performed. ResultsWith increasing age (β = 0.10, p = .005) and grief burden (β = 0.33, p <. 001) depression severity increased. There was an indirect mediating effect of loneliness on the correlation of grief burden and depression (b = 0.04, CI [0.03, 0.05]), but no moderating effect of social support on the correlation of grief burden and loneliness. People living alone had a significantly higher risk of depression, increased loneliness and lack of social support. LimitationsAssessments were based on self-reporting and recorded dimensionally. The cross-sectional design limits conclusions about directions and causality of associations. Sampling bias cannot be completely excluded. ConclusionThe study provides empirical evidence and a better understanding of the association between grief and depression among the very old and the mediating role of loneliness.

PSYCHOLOGICAL TECHNOLOGIES OF WORKING WITH MILITARY SERVANTS DURING DECOMPRESSION

The article considers psychological technologies used by military psychologists when working with servicemen at the decompression stage. Today, this issue is especially relevant in the context of a long war, when there is a constant need to involve servicemen in active action. Trainings, various types of psychotherapy, which are conducted by military psychologists, are aimed at solving a set of psychological problems that have arisen in the military as a result of a long stay in the combat zone. Decompression measures are aimed at restoring the psychological state of the military, which is accompanied by a set of psychophysiological actions. During a stay on the territory of hostilities, a serviceman may face a significant number of risks that can lead to mental disorders in later life. As a result of the presence of servicemen in the area of the joint force operation, when entering a peaceful environment there is a probable threat of manifestations of perception of the environment through the “military prism of reality”, introversion, anxiety about changing family attitudes to it, fear of their own family so that the family does not learn about the horrors of war. Decompression aims to help the military deal with stress, deal with negative experiences, teach self-help techniques and balance the psycho-emotional state. Military psychologists with the help of art therapy work with subconscious traumatic events, help to survive the effects of war. The main attention is paid to psychological methods, techniques, techniques used to work with servicemen in order to restore the body and gradually readapt to normal living conditions, preventing the development of psychological trauma in them. The obtained results can be the basis for the creation of a psychological program of decompression for active servicemen of the Armed Forces of Ukraine, who are periodically in the combat zone and need a quick recovery to maintain constant combat readiness.

The National Institute of Mental Health: Research Agenda and Priorities in Geriatrics and Aging

The Geriatrics and Aging Processes Research Branch of the National Institute of Mental Health (NIMH) supports research on the etiology, pathophysiology, and trajectory of late life mental disorders. The branch encourages research using neuroscience, cognitive and affective science, and social and behavioral science to translate basic and preclinical research to clinical research. The branch prioritizes research that investigates neuropsychiatric disorders of aging, how they interact with neurodevelopment/neurodegeneration, and how to assess, treat, and prevent them. Of particular interest is research on social isolation and suicide. Suicide prevention research is an urgent priority: NIMH’s portfolio includes projects aimed at identifying those at risk for suicide, understanding causes of suicide risk, developing suicide prevention interventions, and testing the effectiveness of these interventions and services in real-world settings. In this talk, a NIMH program official will discuss the NIMH research agenda in the domain of late-life mental illness, social isolation, and suicide.

Play Mode Effect of Exergames on Subthreshold Depression Older Adults: A Randomized Pilot Trial.

BackgroundSubthreshold depression is a common mental disorder in late life. Increasing studies have supported the positive effects of exergames to subthreshold depression. The current study aims to investigate how play mode potentially affects exergames’ effects on subthreshold depression among older adults.MethodA between-group experiment was carried out to compare the effect of exergames with different play modes. Fifty-two Singaporean older adults with subthreshold depression were randomly assigned into two conditions, and performed either single-player or multiple-player Nintendo Wii Tennis exergames for 6 weeks, while the key variables of depression, social support and loneliness were measured at both pre- and post-study period.ResultsFindings from path analysis suggested that older adults in multiple-player exergames experienced lower levels of loneliness, and further more reduction on subthreshold depression, when compared to those in single-player exergames. Although social support was not affected by play mode, the significant relationship among social support, loneliness, and depression was found in the context of exergaming.ConclusionThis study not only provides additional insight into a possible causal association lining play mode and health outcomes of exergames, but also opens the discussion of how to optimize antidepressive effect of exergames for older adults.

Effects of Mind-Body Interventions Involving Meditative Movements on Quality of Life, Depressive Symptoms, Fear of Falling and Sleep Quality in Older Adults: A Systematic Review with Meta-Analysis.

Background: The aim of the present systematic meta-analytical review was to quantify the effects of different mind–body interventions (MBI) involving meditative movements on relevant psychological health outcomes (i.e., quality of life (QoL), depressive symptoms, fear of falling (FoF) and sleep quality) in older adults without mental disorders. Methods: A structured literature search was conducted in five databases (Ovid, PsycINFO, PubMed, SPORTDiscus, Web of Science). Inclusion criteria were: (i) the study was a (cluster) randomized controlled trial, (ii) the subjects were aged ≥59 years without mental illnesses, (iii) an intervention arm performing MBI compared to a non-exercise control group (e.g., wait-list or usual care), (iv) psychological health outcomes related to QoL, depressive symptoms, FoF or sleep quality were assessed and (v) a PEDro score of ≥5. The interventions of the included studies were sub-grouped into Tai Chi/Qigong (TCQ) and Yoga/Pilates (YP). Statistical analyses were conducted using a random-effects inverse-variance model. Results: Thirty-seven randomized controlled trials (RCTs) (comprising 3224 participants) were included. Small to moderate-but-significant overall effect sizes favoring experimental groups (Hedges’ g: 0.25 to 0.71) compared to non-exercise control groups were observed in all outcomes (all p values ≤ 0.007), apart from one subdomain of quality of life (i.e., social functioning, p = 0.15). Interestingly, a significant larger effect on QoL and depressive symptoms with increasing training frequency was found for TCQ (p = 0.03; p = 0.004). Conclusions: MBI involving meditative movements may serve as a promising opportunity to improve psychological health domains such as QoL, depressive symptoms, FoF and sleep quality in older adults. Hence, these forms of exercise may represent potential preventive measures regarding the increase of late-life mental disorders, which need to be further confirmed by future research.

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

Role of Perceived Social Support on the Association between Physical Disability and Symptoms of Depression in Senior Citizens of Pakistan.

An emerging body of literature has implied that perceived social support is known as an upstream element of cognitive health. Various dimensions of perceived social support may have divergent influence on physical and cognitive health in later life. The present study aimed to investigate the mediating role of perceived social support on the relationship between physical disability and symptoms of depression in senior citizens of Pakistan. The data were collected from three metropolitan cities (Lahore, Faisalabad, Multan) in the Punjab province of Pakistan and 100 participants were approached from each city with a total sample size of 300. The results demonstrated that family support, friends’ support, and significant others’ support mediated the association between physical disability and symptoms of depression, with an indirect effect of 0.024, 0.058, and 0.034, respectively. The total direct and indirect effect was 0.493. Physical disability was directly associated with symptoms of depression and greater physical disability predicted a higher level of symptoms of depression. Perceived social support, including family support, friends’ support, and significant others’ support, showed an indirect association with symptoms of depression. Furthermore, family support and friends’ support were more significantly associated with symptoms of depression as compared to significant others’ support. The research discoveries have better implications for health care professionals, hospice care workers, and policy makers. A holistic approach is required to prevent senior citizens from late-life mental disorders.

The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study.

ObjectivesDepression and anxiety are common mental disorders in later life. Few population‐based studies have investigated their potential impacts on mortality in low‐ and middle‐income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity, and mortality in later life using a population‐based cohort study across eight LMICs.MethodsThis analysis was based on the 10/66 cohort study including 15 991 people aged 65 years or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru, Puerto Rico, China, and India, with an average follow‐up time of 3.9 years. Subthreshold and clinical levels of depression were determined using EURO‐D and ICD‐10 criteria, and anxiety was based on Geriatric Mental State (GMS)–Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Cox proportional hazard modelling was used to estimate how having depression, anxiety, or both was associated with mortality adjusting for sociodemographic and health factors.ResultsParticipants with clinical depression (hazard ratio [HR]: 1.45; 95% CI, 1.24‐1.70) and subthreshold anxiety (HR: 1.26; 95% CI, 1.15‐1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors and health conditions. Comorbidity of depression and anxiety was associated with a 30% increased risk of mortality but the effect sizes varied across countries (Higgins I2 = 58.8%), with the strongest association in India (HR: 1.99; 95% CI, 1.21‐3.27).ConclusionsDepression and anxiety appear to be associated with mortality in older people living in LMICs. Variation in effect sizes may indicate different barriers to health service access across countries. Future studies may investigate underlying mechanisms and identify potential interventions to reduce the impact of common mental disorders.

Successful Aging in Individuals From Less Advantaged, Marginalized, and Stigmatized Backgrounds

Health and well-being in later life are heavily influenced by behaviors across the life course, which in turn are influenced by a variety of wider contextual, social, economic, and organizational factors. There is considerable potential for inequalities in health-promoting behaviors and health outcomes, arising from poverty, social, and environmental factors. This suggests that individuals from disadvantaged backgrounds and circumstances may have more exposure to (chronic) stressors, coupled with reduced access to resources, and increased susceptibility to risk factors for ill-health and mental disorders in later life. This drastically decreases the likelihood for successful aging in individuals from less advantaged backgrounds. Nevertheless, despite these adverse circumstances, some high-risk, disadvantaged individuals have been shown to achieve and maintain good health and well-being into later life. This scientific update provides an overview of recently published research with samples that, against expectations, demonstrate successful aging. Favorable personality traits, cognitive strategies, and a high-level of intrinsic motivation, paired with a supportive social environment, have been found to build a prosperous basis for successful aging and positive health outcomes in later life for individuals living in aversive environmental circumstances. For clinical psychologists, the movement towards the investigation of underlying mechanisms of successful aging from a psychological perspective, particularly in disadvantaged individuals, may be a critical step towards understanding the vast heterogeneity in aging. Successful aging is possible in disadvantaged individuals. Psychological and social resilience resources may compensate for the impact of disadvantage. The application of multi-level resilience models can aid future research on successful aging. Successful aging is possible in disadvantaged individuals. Psychological and social resilience resources may compensate for the impact of disadvantage. The application of multi-level resilience models can aid future research on successful aging.

Study design of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) project; a cohort study of older patients with affective disorders referred for specialised geriatric mental health care

BackgroundAffective disorders, encompassing depressive-, anxiety-, and somatic symptom disorders, are the most prevalent mental disorders in later life. Treatment protocols and guidelines largely rely on evidence from RCTs conducted in younger age samples and ignore comorbidity between these disorders. Moreover, studies in geriatric psychiatry are often limited to the “younger old” and rarely include the most frail. Therefore, the effectiveness of treatment in routine clinical care for older patients and impact of ageing characteristics is largely unknown.ObjectiveThe primary aim of the Routine Outcome Monitoring for Geriatric Psychiatry & Science (ROM-GPS) – project is to examine the impact of ageing characteristics on the effectiveness of treatment for affective disorders in specialised geriatric mental health care.MethodsROM-GPS is a two-stage, multicentre project. In stage one, all patients aged ≥60 years referred to participating outpatient clinics for specialised geriatric mental health care will be routinely screened with a semi-structured psychiatric interview, the Mini International Neuropsychiatric Interview and self-report symptom severity scales assessing depression, generalized anxiety, hypochondria, and alcohol use. Patients with a unipolar depressive, anxiety or somatic symptom disorder will be asked informed consent to participate in a second (research) stage to be extensively phenotyped at baseline and closely monitored during their first year of treatment with remission at one-year follow-up as the primary outcome parameter. In addition to a large test battery of potential confounders, specific attention is paid to cognitive functioning (including computerized tests with the Cogstate test battery as well as paper and pencil tests) and physical functioning (including multimorbidity, polypharmacy, and different frailty indicators). The study is designed as an ongoing project, enabling minor adaptations once a year (change of instruments).DiscussionAlthough effectiveness studies using observational data can easily be biased, potential selection bias can be quantified and potentially corrected (e.g. by propensity scoring). Knowledge of age-related determinants of treatment effectiveness, may stimulate the development of new interventions. Moreover, studying late-life depressive, anxiety and somatic symptom disorders jointly enables data-driven studies for more optimal classification of these disorders in later life.Trial registrationDutch Trial Register: NL6704 (www.trialregister.nl). Retrospectively registered on 2017-12-05.

Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review.

Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia.MethodA systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017.ResultsThe search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis.Clinical implicationsThe most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.

Bilateral Repetitive Transcranial Magnetic Stimulation in Older Adults with Depression

Depression is the most common, treatable, mental disorder in late life, making it a major public health concern: 2 to 4 % of persons over the age of 65 suffer from major depression. Current pharmacological treatments for LLD, however, provide modest efficacy. Rates of treatment resistance in randomized controlled trials (RCT) in LLD range from 55-81% using first line antidepressants. The failure of first line treatment to induce remission in patients leads to impaired psychosocial function and diminished quality of life. Depression in older adults, and non-response to antidepressants, is associated with low connectivity in the cognitive control network. Cognition, in particular executive function and processing speed, are often impaired in LLD. It is an important predictor of acute antidepressant treatment outcome. In a 2010 report from the National Institutes of Health (NIH), depression was identified as one of six potentially modifiable risks for cognitive decline, AD, or both. Successful interventions targeting depression could reduce the prevalence of AD by up to 15% in North America, making depression the second most promising target for prevention studies after physical inactivity. Data from three randomized sham controlled trials that have included older adults show converging evidence for the efficacy of bilateral repetitive transcranial magnetic stimulation in this population. Emerging data suggests that intermittent theta burst stimulation (TBS) is similar in effectiveness to high frequency rTMS. An ongoing study is exploring the effectiveness of bilateral (low frequency right then high frequency left) dorsolateral prefontal rTMS compared to continuous TBS right and intermittent TBS left in older adults with depression while also examining the effects on cognition. The design and interim results of this trial will be presented.