The mental health effects of the COVID-19 pandemic on older adults are examined. Early results suggest a greater resilience to these effects among community-dwelling older adults. This resilience ...could be due to interactions among internal and external factors.
Abstract
Objectives
Old age is characterized by many physical and social losses that adversely affect subjective well-being (SWB). Yet, past studies have shown that wisdom tends to be positively ...related to SWB in old age, particularly under adverse circumstances. We tested whether three-dimensional wisdom, measured as a combination of cognitive, reflective, and compassionate (affective) personality qualities, moderated the inverse association between adverse life events and well-being.
Method
A sample of 994 adults aged 51–99 years (M = 77) from the Successful AGing Evaluation (SAGE) study and structural equation models with well-being as a latent variable were used to test the hypothesis.
Results
Greater wisdom, in particular the reflective wisdom dimension, was positively associated with SWB and buffered the inverse relation between the experience of adverse life events during the previous year and current well-being.
Discussion
Wisdom appears to strengthen older adults’ ability to cope with aging-related losses and, therefore, is a valuable psychological resource in old age.
Abstract Background With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and ...consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. Methods We searched PubMed (1980–Jan 2010) using the terms: subsyndromal depression , subthreshold depression , and minor depression in combination with elderly , geriatric , older adult , and late-life. Data were extracted from 181 studies of late-life subthreshold depression. Results In older adults subthreshold depression was generally at least 2–3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8–10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥ 1 year. Prominent risk factors included female gender, medical burden, disability, and low social support ; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. Limitations Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. Conclusions The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This study of loneliness across adult lifespan examined its associations with sociodemographics, mental health (positive and negative psychological states and traits), subjective cognitive ...complaints, and physical functioning.
Analysis of cross-sectional data.
340 community-dwelling adults in San Diego, California, mean age 62 (SD = 18) years, range 27-101 years, who participated in three community-based studies.
Loneliness measures included UCLA Loneliness Scale Version 3 (UCLA-3), 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Scale, and a single-item measure from the Center for Epidemiologic Studies Depression (CESD) scale. Other measures included the San Diego Wisdom Scale (SD-WISE) and Medical Outcomes Survey- Short form 36.
Seventy-six percent of subjects had moderate-high levels of loneliness on UCLA-3, using standardized cut-points. Loneliness was correlated with worse mental health and inversely with positive psychological states/traits. Even moderate severity of loneliness was associated with worse mental and physical functioning. Loneliness severity and age had a complex relationship, with increased loneliness in the late-20s, mid-50s, and late-80s. There were no sex differences in loneliness prevalence, severity, and age relationships. The best-fit multiple regression model accounted for 45% of the variance in UCLA-3 scores, and three factors emerged with small-medium effect sizes: wisdom, living alone and mental well-being.
The alarmingly high prevalence of loneliness and its association with worse health-related measures underscore major challenges for society. The non-linear age-loneliness severity relationship deserves further study. The strong negative association of wisdom with loneliness highlights the potentially critical role of wisdom as a target for psychosocial/behavioral interventions to reduce loneliness. Building a wiser society may help us develop a more connected, less lonely, and happier society.
Neuropsychiatric symptoms of dementia (NPS) are a group of noncognitive symptoms that occur in over 90% of individuals with dementia. NPS seem to result from a complex interaction among various ...biological, psychosocial, and environmental factors, and they are associated with greater morbidity and mortality, higher caregiver burden and burnout, high risk of nursing home placement, and increased cost of care for patients with dementia. Use of standardized assessment tools like the Neuropsychiatric Inventory can assist with qualifying and quantifying NPS. In this review, the authors evaluate the evidence for efficacy and safety of nonpharmacological and pharmacological interventions for treating NPS, mostly based on published meta-analyses. Commonly prescribed medications include atypical antipsychotics, acetylcholinesterase inhibitors, memantine, antidepressants, and mood stabilizers. There are also limited data on cannabinoids, repetitive transcranial magnetic stimulation, and ECT in individuals with NPS. Available evidence indicates that several nonpharmacological interventions are beneficial in the management of NPS and are recommended as first-line treatments. Pharmacotherapy should be reserved for the treatment of more severe or refractory NPS or where nonpharmacological management is not feasible. Atypical antipsychotics have shown mostly modest benefit in reducing NPS, and their use is limited by their adverse effect profiles. Recent investigations suggest potential strategies for preventing or at least reducing the risk of dementia and NPS. The authors conclude with brief guidelines for clinical practice as well as future research.
The systematic review and meta-analysis by Chinnappa-Quinn et al. (this issue) reports increased risk of cognitive decline following hospitalization for acute physical illnesses in older persons ...without pre-existing clinical evidence of a major neurocognitive disorder like dementia. ...there is a clear need for assessing, preventing, and managing frailty appropriately in older adults suffering from neuropsychiatric disorders. A majority of the study participants (53%) were Spanish speakers, indicating broader and pragmatic applicability of the easy-to-administer LASSI-L. ...this study has both biological and intervention implications for neurocognitive disorders.
Schizophrenia is associated with increased physical morbidity and early mortality, suggesting that the aging process may be accelerated in schizophrenia. However, the biological underpinnings of ...these alterations in aging in schizophrenia are unclear.
We conducted a detailed search of peer-reviewed empirical studies to evaluate evidence for accelerated biological aging in schizophrenia based on systemic, age-related biomarkers. We included studies that investigated differences between persons with schizophrenia and healthy comparison subjects in levels of biomarkers known to be associated with aging and examined the relationship of these biomarkers to age in the 2 groups.
Forty-two articles that met our selection criteria were reviewed. Nearly 75% reported abnormal biomarker levels among individuals with schizophrenia, including indices of inflammation, cytotoxicity, oxidative stress, metabolic health, gene expression, and receptor/synaptic function, with medium to large effect sizes reported in many studies. Twenty-nine percent of the studies observed differential age-related decline in schizophrenia. Markers of receptor/synaptic function and gene expression were most frequently differentially related to age in schizophrenia. Schizophrenia patients with greater disease severity and longer illness duration exhibited higher levels of inflammatory and oxidative stress biomarkers and shorter telomere length.
Most studies show biomarker abnormalities in schizophrenia, and there is some suggestion for accelerated aging. Although definitive interpretation is limited by cross-sectional design of the published reports, findings in the area of gene expression and synaptic function are promising and pave the way for future longitudinal studies needed to fully test this hypothesis.
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