Mental Disorders In Later Life Research Articles

Prevalence of anxiety disorder among older adults in Spain: A meta-analysis.

Anxiety disorders are recognized as one of the most prevalent mental disorders in late-life. However, the prevalence of anxiety disorders in older Spanish people has not yet been determined. The aim was to review epidemiological studies systematically to calculate the overall prevalence of anxiety in Spanish older adults by using meta-analytic techniques. We searched relevant published studies in electronic databases up to January 2018 providing data on the prevalence of anxiety among people aged 65+ years in Spain. Overall anxiety prevalence estimates were calculated using random-effects models. Sources of heterogeneity were explored by means of univariate meta-regressions. A total of 9 studies were included in the meta-analysis (N = 12,577). Pooled overall prevalence of anxiety was 11% (95% confidence interval (CI): 6%-18%) representing 1958,471 people aged 65+ (95%CI: 1068,257-3204,771). Point, 12-month and lifetime prevalence of anxiety disorders were 12%, 6% and 19%, respectively. We detected a small publication bias effect for life-time prevalence of anxiety. The use of different diagnostic methods across the studies would have required separate analyzes. Some heterogeneity was found across studies, probably due to different methodological issues. Overall, the pooled prevalence of anxiety disorders in Spanish older adults was lower than that observed in other countries. Due to the negative consequences of anxiety disorders in older adults, detection and treatment should be a priority in this population.

Successful aging of mental disorders in late life

Successful aging of mental disorders in late life

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.

Elaborating Risk Society Theory: A Biosocial Approach

The paper elaborates risk society theory in terms of the hazards caused by environmental chemicals as well as the stress generated by individualization, utilizing recent findings provided by biosocial science, particularly epigenetic mechanisms in the developmental stage. Epigenetics explains that vital phenomena can be affected by environmental chemical contaminants and the psychosocial stresses of individualization that are transmitted to the next generation without any change in the base sequence. The paper tries to unify these two kinds of risk factors into an epigenetic system in which exposed fetuses and infants might have physical and mental disorders in later life. This biosocial perspective incorporates the reproductive mechanisms of risk over generations into risk society theory.

Association between childhood trauma and accelerated telomere erosion in adulthood: A meta-analytic study

BackgroundChildhood trauma has long-term sequelae on health status and contributes to numbers of somatic and mental disorders in later life. Findings from experimental studies in animals suggest that telomere erosion may be a mediator of this relationship. However, results from human studies are heterogeneous. To address these inconsistencies, we performed a meta-analysis regarding the association between childhood trauma and telomere length in adulthood. MethodArticles were identified by systematically searching the Medline, EMBASE and Web of Science databases. Twenty four studies, which include twenty six sample sets and 30,919 participants, met the inclusion criteria for meta-analyses. ResultsThis meta-analyses revealed that individuals experienced childhood trauma have accelerated telomere erosion in adulthood, with a small effect size (r = −0.05, 95% CI = −0.08–0.03, p < 0.001). Subgroup analyses by type of childhood trauma revealed a trend in difference between groups (Q = 5.24, p = 0.07). Analyses for individual trauma types revealed a significant association between childhood separation and telomere erosion (r = −0.09, p < 0.001), but not for physical abuse, sexual abuse and loss of a parent. ConclusionThis meta-analysis demonstrated a significant association between childhood trauma and accelerated telomere erosion in adulthood, and further revealed that different trauma types have various impacts on telomere. Additional research on the mechanism that links the individual types of childhood trauma with telomere is needed in the future.

Mobile Health Technology in Late-Life Mental Illness: A Focused Literature Review

In an era of rising geriatric mental health care needs worldwide, technological advances can help address care needs in a cost-effective fashion. Our objective in this review was to assess whether mobile health technology, such as tablets and smartphones, are feasible to use in patients with late-life mental and cognitive disorders, as well as whether they were generally reliable modes of mental health/cognitive assessment. We performed a focused literature review of MEDLINE, PsychInfo, and Embase databases, including papers specifically assessing the implementation of mobile health technologies: electronic tablets (e.g., iPad), smartphones, and other mobile computerized equipment in older adults (age ≥65 years) diagnosed with or at risk of a mental and/or cognitive disorder. A total of 2,079 records were assessed, of which 7 papers were of direct relevance. Studies investigated a broad variety of mobile health technologies. Almost all examined samples with dementia/cognitive dysfunction or at risk for those disorders. All studies exclusively examined the use of mobile health technologies for the assessment of cognitive and or mental illness symptoms or disorders. None of the studies reported participants having any difficulties using the mobile health technology assessments and overall reliability was similar to paper-and-pencil modes of assessment. Overall, mobile health technologies were found to be feasible by patients and had promising reliability for the assessment of cognitive and mental illness domains in older adults. Future clinical trials will be necessary to assess whether portable communication interventions (e.g., symptom tracking) can improve geriatric mental health outcomes.

The psycho-geriatric patient in the Emergency Room (ER) of the Maggiore della Carità Hospital in Novara

IntroductionDue to population aging, the health system will face increasing challenges in the next years. Concerning mental disorders, they are major public health issues in late life, with mood and anxiety disorders being some of the most common mental disorder among the elderly. For this reason, increasing attention has to be paid to the evaluation of the elderly in psychiatry emergency settings.ObjectivesTo evaluate the socio-demographic and clinical features of over 65 patients referred to psychiatric consultations in the ER of “Maggiore della Carità” Hospital in Novara, in a 7 years period.AimsThe analysis of the characteristics of the study sample could be potentially useful in resource planning in order to better serve this important segment of the general population.MethodsDeterminants of ER visits for over 65 patients referred to psychiatric evaluation were studied retrospectively from 2008 to 2015.ResultsElderly patients made up 14,7% (n = 458) of all psychiatric evaluation in the ER (n = 3124). About two thirds (65,9%) were females and one third were males (34,1%). The mean age of patients recruited was 75.11 years. The majority of subjects (68.6%) presented without a diagnosis of Axis I according to DSM-IV. The other most frequent diagnosis was “cognitive disorders” (11.4%) and “mood disorders” (10.9%).ConclusionsThe large proportion of patients without a diagnosis of Axis I, could be related to the misunderstanding of the psychosocial aspects of aging. Preliminary results highlight the importance of research on this topic, considering population aging and the impact of mental disorders in late-life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric Diagnoses Among Older Recipients of Publicly Funded Mental Health Services.

To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county. Secondary analysis of county human services claims data and claims from an insured population in the same county. Inpatient and outpatient clinics in Allegheny County, PA. Adults aged 65 and older in the county who received treatment for a psychiatric diagnosis in 2012 (county base services, n = 1,457; Medicaid, n = 641; Health plan insurance, n = 5,595). Psychiatric diagnoses were classified using the International Classification of Diseases, 9th revision (ICD-9). Episodic mood disorders and schizophrenia were more common among county-funded and Medicaid recipients (50-54% vs 34%). Neurotic conditions were more common among older adults with health plan insurance (18% vs 8%). Nearly a quarter of older adults receiving county base services were classified as having "ill-defined and unknown causes of morbidity and mortality," compared <1% among insured and 6% among Medicaid recipients. The prevalence of psychiatric conditions among older adults varies by insurance coverage, suggesting a role for social and economic factors associated with safety net coverage as well as system-level differences in delivery of mental health services. Comparing the prevalence of psychiatric diagnoses across insurance types offers insight on social determinants of risk for mental disorders in late life.

Session 403 - Pharmacotherapy of Late-Life Mental Disorders: Is There Anything New Under the Sun?

Session 403 - Pharmacotherapy of Late-Life Mental Disorders: Is There Anything New Under the Sun?

Consequences of early adverse rearing experience(EARE) on development: insights from non-human primate studies.

Early rearing experiences are important in one's whole life, whereas early adverse rearing experience (EARE) is usually related to various physical and mental disorders in later life. Although there were many studies on human and animals, regarding the effect of EARE on brain development, neuroendocrine systems, as well as the consequential mental disorders and behavioral abnormalities, the underlying mechanisms remain unclear. Due to the close genetic relationship and similarity in social organizations with humans, non-human primate (NHP) studies were performed for over 60 years. Various EARE models were developed to disrupt the early normal interactions between infants and mothers or peers. Those studies provided important insights of EARE induced effects on the physiological and behavioral systems of NHPs across life span, such as social behaviors (including disturbance behavior, social deficiency, sexual behavior, etc), learning and memory ability, brain structural and functional developments (including influences on neurons and glia cells, neuroendocrine systems, e.g., hypothalamic-pituitary-adrenal (HPA) axis, etc). In this review, the effects of EARE and the underlying epigenetic mechanisms were comprehensively summarized and the possibility of rehabilitation was discussed.

The assessment of met and unmet care needs in the oldest old with and without depression using the Camberwell Assessment of Need for the Elderly (CANE): Results of the AgeMooDe study

BackgroundDepression belongs to the most common mental disorders in late life and will lead to a significant increase of treatment and health care needs in the future. The Camberwell Assessment of Need for the Elderly (CANE) evaluates met and unmet care needs in older individuals. Reports on needs of the elderly with depression are currently lacking. The aim of the present study was to identify met and unmet needs in older primary care patients with and without depression using the German-language version of the CANE. Furthermore, the association between unmet needs and depression ought to be explored. MethodsAs part of the study “Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)”, a sample of 1179 primary care patients aged 75 years and older was assessed. Descriptive and inferential statistics as well as logistic regression analyses were conducted. ResultsThis study, for the first time in Germany, provides data on the distribution of met and unmet needs in depressive and non-depressive older primary care patients. As a main result, unmet needs were significantly associated with depression; other risk factors identified were gender, institutionalization, care by relatives and impaired functional status. LimitationsThe conclusions about directions and causality of associations between the variables are limited due to the cross-sectional design. ConclusionsThe study results provide an important contribution to generate a solid base for an effective and good-quality health and social care as well as to an appropriate allocation of health care resources in the elderly population.

L’éclosion de la gérontopsychiatrie à l’Université de Montréal, une histoire à découvrir

Geriatric psychiatry became an official psychiatric subspecialty in Canada in 2009. The first board examinations from the Royal College of Physicians and Surgeons of Canada (RCPSC) took place in 2013. Geriatric Psychiatry focuses on the assessment, diagnosis, and treatment of complex mental disorders in late life, a time when the interface between physical and mental health issues often adds a new level of complexity.Little has been written on the history of geriatric psychiatry in Québec and in Canada. A lesser-known aspect is that from the 1970's onwards, the department of psychiatry at the Université de Montréal (UdeM) and its network of teaching hospitals have played a pioneering role in the development of geriatric psychiatry services and training. We seek to recount the history of geriatric psychiatry at UdeM, by tracing the milestones and identifying the main actors responsible for its development, from the inception of the department of psychiatry 50 years ago. This leads us to share reflections on some of the issues geriatric psychiatry is facing in Québec. We interviewed several key actors, past and present, of geriatric psychiatry at UdeM. We read through relevant sources such as articles and monographs on the local history of psychiatric services, information bulletins and annual reports from hospitals and from UdeM, as well as other documentation from personal archives. One of the very first geriatric psychiatry services in Canada was founded in 1978 at the Institut universitaire en santé mentale de Montréal, with a dedicated inpatient unit for new admissions of elderly psychiatric patients. A geriatric psychiatry outpatient clinic was inaugurated the same year at the Pavillon Albert-Prévost. Throughout the years, geriatric psychiatry services were also developed in the remaining hospital sites affiliated with the department of psychiatry at the UdeM (Hôpital Maisonneuve-Rosemont, Centre hospitalier de l'Université de Montréal, Institut universitaire de gériatrie de Montréal), driven by dedicated individuals, in accordance with their respective historical background and mission. Clinical training is provided in each of these sites for medical students, psychiatry residents and more recently, for future geriatric psychiatrists. In 2014, the geriatric psychiatry residency program at UdeM was the first to be accredited in Québec by the RCPSC, as well as the first French language geriatric psychiatry program in North America. Geriatric psychiatry in 2015 is a burgeoning field, in a challenging demographic context. Despite the clinical need, major obstacles remain, particularly in the absence of specific geriatric psychiatry positions. Furthermore, the Québec healthcare system is going through a major restructuration in 2015, adding to the uncertainty. The 50th anniversary of the department of psychiatry at UdeM is an opportunity to underline the contribution of UdeM to the development of geriatric psychiatry in Québec, and to emphasize the specific needs of the elderly in terms of mental health care and geriatric psychiatry services.

Associations of lifetime abstention and past and current alcohol use with late-life mental health: A propensity score analysis

BackgroundCompared to the extensive research on the effects of alcohol intake on physical health, little research has been done on the effects of alcohol use/nonuse patterns on mental disorders in late life. This study examined associations between mental disorders and alcohol use/nonuse patterns among individuals aged 65+ years. MethodsData came from the public use files of the 2008 to 2012 National Survey on Drug Use and Health. Alcohol use/nonuse groups were lifetime abstainers, ex-drinkers, bingers, and nonbingers. Mental health problems were lifetime major depressive episode (MDE) and anxiety disorder, past-year MDE and anxiety disorder, and past-year serious suicidal ideation. To minimize selection biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity score weights on covariates. Then we employed logistic regression models with mental health outcomes as the dependent variables. ResultsThe four alcohol use/nonuse groups did not differ in past-year MDE. However, odds ratios show that, relative to non-binge drinking, lifetime abstention decreased the odds of lifetime MDE by more than 60% (OR=0.39, 95% CI=0.23–0.68, p=.001) and the odds of lifetime anxiety disorder by almost half (OR=0.55, 95% CI=0.38–0.79, p=.002). Ex-drinkers were more likely than nonbingers to report past-year serious suicidal thoughts (OR=2.29, 95% CI=1.45–3.62, p<.001). ConclusionsWhile lifetime abstainers had significantly better lifetime mental health histories than nonbingers, ex-drinkers had worse past-year mental health status. Since lifetime abstainers and ex-drinkers have significantly different characteristics, researchers should distinguish between these groups.

Late-Life Mental Health Disorders. Data from a Population-Based Study

Although highly prevalent, so far mental disorder in late life has deserved little research interest, especially at the population level. Our study provides a reliable picture of the distribution of mental health disorders in a sample of 462 Italian older people aged 75+, women are 53.2%, from a population-based study, the Faenza Project. In our sample, one mental disorder is diagnosable in one out of 3 elderly. The most prevalent diagnosis was General Anxiety Disorder (20.7%) and Dementia (19.0%), with female significantly more affected than male. Also Cognitive Impairment No Dementia was highly prevalent with 13.9% of the sample showing these symptoms. The most frequent overlap was between GAD and Major Depressive Episode. The risk of suicide is very high among older, in our sample 7.3% had suicidal thoughts. In spite of that approximately 70% of older adults with mood and anxiety disorders did not use services. There is a need to improve awareness about mental disorders in late- life, both in the community and among health care professionals to find innovative strategies to promote a successful aging with the integration of geriatric psychiatry and primary care.

Geriatric Psychiatry: What's in a Name, and Five Concerns about DSM-5.

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A Systematic Approach to the Pharmacotherapy of Late-Life Mental Disorders

A Systematic Approach to the Pharmacotherapy of Late-Life Mental Disorders

Measurement equivalence of the CES-D 8 depression-scale among the ageing population in eleven European countries

Depression is one of the most prevalent mental disorders in later life. However, despite considerable research attention, great confusion remains regarding the association between ageing and depression. There is doubt as to whether a depression scale performs identically for different age groups and countries. Although measurement equivalence is a crucial prerequisite for valid comparisons across age groups and countries, it has not been established for the eight-item version of the Centre for Epidemiological Studies Depression Scale (CES-D8). Using multi-group confirmatory factor analysis, we assess configural, metric, and scalar measurement equivalence across two age groups (50–64years of age and 65 or older) in eleven European countries, employing data from the Survey of Health, Ageing, and Retirement (SHARE). Results indicate that the construct of depression is comparable across age and country groups, allowing the substantive interpretation of correlates and mean levels of depressive symptoms.

Neurobiological Processes of Risk and Resilience in Adolescence: Implications for Policy and Prevention Science

ABSTRACTThis article focuses on the concepts of risk and resilience and their potential to inform clinical interventions, school‐based prevention programs, and social policies. Research suggests that childhood adversity can trigger a cascade of psychological and neurobiological events that can lead to mental disorders in later life. Yet little is known about how these processes manifest in adolescence, a developmental window that is typically associated with an elevated risk for psychopathology and represents a period of neurological growth and reorganization that is second only to early childhood. A better understanding of adolescent brain development may provide an empirical grounding to improve the focus and timing of interventions, particularly those that target self‐regulation, meta‐cognition, and social supports. Finally, opportunities and challenges that emerge when bridging neuroscience and prevention science are discussed.

Time Does Not Heal All Wounds: Older Adults Who Experienced Childhood Adversities Have Higher Odds of Mood, Anxiety, and Personality Disorders

We aimed to examine the prevalence of several types of childhood adversity across adult cohorts, whether age moderates the effect of childhood adversity on mental health, the relationship between childhood adversity and psychopathology among older adults, the dose-response relationship between number of types of childhood adversities and mental disorders in later life, and whether lifetime mental health treatment reduces the odds of psychopathology among older survivors of childhood adversity. In a population-based, cross-sectional study on a nationally representative U.S. sample, we studied 34,653 community-dwelling Americans 20 years and older, including 7,080 adults 65 years and older from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Trained lay interviewers assessed past-year mood and anxiety disorders and lifetime personality disorders. Participants self-reported childhood adversity based on questions from the Adverse Childhood Experiences Study. Childhood adversity was prevalent across five age cohorts. In our adjusted models, age did not moderate the effect of childhood adversity on mental disorders. Older adults who experienced childhood adversity had higher odds of having mood (odds ratio: 1.73; 95% confidence interval: 1.32-2.28), anxiety (odds ratio: 1.48; 95% confidence interval: 1.20-1.83), and personality disorders (odds ratio: 2.11; 95% confidence interval: 1.75-2.54) after adjusting for covariates. An increasing number of types of childhood adversities was associated with higher odds of personality disorders and somewhat higher odds of anxiety disorders. Treatment-seeking was associated with a reduced likelihood of anxiety and, especially, mood disorders in older adult childhood adversity survivors. These results emphasize the importance of preventing childhood adversity and intervening once it occurs to avoid the negative mental health effects that can last into old age.

Strategies to Improve Mental Health Treatment Adherence Among Older Adults

The mental disorders of late life constitute one of the most pressing global public health issues of the 21st Century. Poor adherence to treatment remains a significant impediment to improving care. The NIMH document “Research on adherence to interventions for mental disorders” noted that: clinical effectiveness of efficacious interventions for mental disorders is substantially limited by less than optimal adherence. Adherence is defined as the extent to which a person's behavior (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice.