Quality of life in older adults with mood states associated with bipolar disorder: A secondary analysis of the English longitudinal study of ageing data.

OBJECTIVES: To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder. METHODS: The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure. RESULTS: The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group. CONCLUSIONS: Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes.

The Changing Care of Older Adults With Bipolar Disorder: A Narrative Analysis.

Older adults with bipolar disorder experience distinct challenges compared to younger age groups with bipolar disorder. They potentially require adaptations to the care they receive. This study aimed to explore experiences of care and changing care needs in older adults with bipolar disorder. People with bipolar disorder (aged ≥60) were recruited through three NHS Trusts in the North West of England, charity organisations, a confidential university participant database, and social media. Participants completed single time-point biographical narrative interviews, which were analysed using narrative analysis. Sixteen participants' accounts led to the creation of four themes: (1) 'Navigating the disruption caused by diagnosis'; (2) 'The removal of services that provided hope'; (3) 'Later life: We are on our own now'; and (4) 'Changing care needs in later life: We still need support'. The care needs of older adults with bipolar disorder appear to change over time, and services often fail to offer adequate, tailored care for this group at present. Current support requires adaptation to be effective and appropriate and to enable this group to age well in later life.

Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study.

BACKGROUND: Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic. OBJECTIVE: This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT. METHODS: A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes. RESULTS: Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed. CONCLUSIONS: The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs.

Understanding the Value of a Proactive Telecare System in Supporting Older Adults' Independence at Home: Qualitative Interview Study Among Key Interest Groups.

BACKGROUND: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare. OBJECTIVE: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are. METHODS: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis. RESULTS: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service. CONCLUSIONS: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources.

Changes in theta and alpha oscillatory signatures of attentional control in older and middle age.

BACKGROUND: Recent behavioural research has reported age-related changes in the costs of refocusing attention from a temporal (rapid serial visual presentation) to a spatial (visual search) task. Using magnetoencephalography, we have now compared the neural signatures of attention refocusing between three age groups (19-30, 40-49 and 60+ years) and found differences in task-related modulation and cortical localisation of alpha and theta oscillations. Efficient, faster refocusing in the youngest group compared to both middle age and older groups was reflected in parietal theta effects that were significantly reduced in the older groups. Residual parietal theta activity in older individuals was beneficial to attentional refocusing and could reflect preserved attention mechanisms. Slowed refocusing of attention, especially when a target required consolidation, in the older and middle-aged adults was accompanied by a posterior theta deficit and increased recruitment of frontal (middle-aged and older groups) and temporal (older group only) areas, demonstrating a posterior to anterior processing shift. Theta but not alpha modulation correlated with task performance, suggesting that older adults' stronger and more widely distributed alpha power modulation could reflect decreased neural precision or dedifferentiation but requires further investigation. Our results demonstrate that older adults present with different alpha and theta oscillatory signatures during attentional control, reflecting cognitive decline and, potentially, also different cognitive strategies in an attempt to compensate for decline.

Sources of Cognitive Conflict and Their Relevance to Theory-of-Mind Proficiency in Healthy Aging: A Preregistered Study.

Age-related decline in theory of mind (ToM) may be due to waning executive control, which is necessary for resolving conflict when reasoning about other individuals' mental states. We assessed how older (n = 50) and younger (n = 50) adults were affected by three theoretically relevant sources of conflict within ToM: competing self-other perspectives, competing cued locations, and outcome knowledge. We examined which best accounted for age-related difficulty with ToM. Our data show unexpected similarity between age groups when people are representing a belief incongruent with their own. Individual differences in attention and response speed best explained the degree of conflict experienced through incompatible self-other perspectives. However, older adults were disproportionately affected by managing conflict between cued locations. Age and spatial working memory were most relevant for predicting the magnitude of conflict elicited by conflicting cued locations. We suggest that previous studies may have underestimated older adults' ToM proficiency by including unnecessary conflict in ToM tasks.

The pros and cons of the implementation of a chronic care model in European rural primary care: the points of view of European rural general practitioners.

INTRODUCTION: This article describes the views of European rural general practitioners regarding the strengths, weaknesses, opportunities and threats (SWOT) of the implementation of a chronic care model (CCM) in European rural primary care. METHODS: This was a mixed-methods online survey. Data were collected from 227 general practitioners between May and December 2017. Categorical data were analysed using descriptive methods while free-text responses were analysed using qualitative methods. The setting was rural primary care in nine European countries (including Central and Eastern Europe). Main outcomes measures were respondents' evaluations of a chronic care model in their rural healthcare settings in terms of SWOT. RESULTS: The SWOT analysis showed that the expertise of healthcare professionals and the strength of relationships and communications between professionals, caregivers and patients are positive components of the CCM system. However, ensuring adequate staffing levels and staff competency are issues that would need to be addressed. Opportunities included the need to enable patients to participate in decision making by ensuring adequate health literacy. CONCLUSION: The CCM could certainly have benefits for health care in rural settings but staffing levels and staff competency would need to be addressed before implementation of CCM in such settings. Improving health literacy among patients and their carers will be essential to ensure their full participation in the implementation of a successful CCM.

Age-friendliness of living environments from the older person's viewpoint: development of the Age-Friendly Environment Assessment Tool.

BACKGROUND: according to the World Health Organisation, the role of the environment for older adults is to maintain and facilitate independence and promote quality of life. However, measures that examine the environment in terms of its potential impact on older people are either oriented towards specific aspects of the environment, specifically designed for community-level assessment rather than individually oriented, or are unwieldy for everyday use. OBJECTIVES: this article describes the development and validation of the Age-Friendly Environment Assessment Tool (AFEAT), assessing whether individual function and frailty impact on perceptions of environmental age-friendliness. The extent to which such perceptions may have moderate impacts of frailty on outcomes such as need for care support, quality of life and loneliness is examined. METHODS: a total of 132 participants aged 58-96 were recruited from retirement villages and local communities in the Midlands of the UK. Participants completed the AFEAT, and a series of measures designed to assess frailty and assessments of quality of life, loneliness and perceptions of functional limitations. RESULTS: internal reliability assessment indicated that the AFEAT possesses a Cronbach's Alpha score of 0.745. The AFEAT significantly predicted quality of life and loneliness, accounting for 17.1% and 5.8% of variance respectively, indicating high concurrent and predictive validity. Furthermore, the AFEAT moderated the predictive strength of frailty in predicting the amount of formal care an individual receives, but not quality of life or loneliness. DISCUSSION: the AFEAT is a valid and reliable tool, and analyses highlight the need for an individual-oriented Age-Friendly environment tool.

Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines.

BACKGROUND: Age-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described. MAIN TEXT: The guidelines were framed into four questions - one general and three on specific groups of interventions - all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders' values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions. CONCLUSIONS: We provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders' inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.

The use of technology in the context of frailty screening and management interventions: a study of stakeholders' perspectives.

BACKGROUND: Health and social care interventions show promise as a way of managing the progression of frailty in older adults. Information technology could improve the availability of interventions and services for older adults. The views of stakeholders on the acceptability of technological solutions for frailty screening and management have not been explored. METHODS: Focus groups were used to gather data from healthy and frail/pre-frail older adults, health and social care providers, and caregivers in three European countries - Italy, Poland and UK. Data were analysed using framework analysis in terms of facilitators or determinants of older adults' adoption of technology. RESULTS: Our findings clustered around the perceived value; usability, affordability and accessibility; and emotional benefits of frailty screening and management technology to stakeholders. We also noted issues relating to social support, previous experience of technology and confidence of stakeholders. CONCLUSIONS: Professionals and caregivers understand the benefits of technology to facilitate frailty care pathways but these views are tempered by concerns around social isolation. Frail older adults raised legitimate concerns about the accessibility and usability of technology, specifically around the potential for their personal information to be compromised. Solutions must be developed within a framework that addresses social contexts and avoids stigma around frailty and ageing.

FMR1 premutation frequency in a large, ethnically diverse population referred for carrier testing.

Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and is caused by an expansion of cytosine-guanine-guanine (CGG) repeats in the FMR1 gene. Female premutation allele carriers (55-200 CGG repeats) are at risk to have an affected child. Currently, specific population-based carrier screening for FXS is not recommended. Previous studies exploring female premutation carrier frequency have been limited by size or ethnicity. This retrospective study provides a pan-ethnic estimate of the Fragile X premutation carrier frequency in a large, ethnically diverse population of women referred for routine carrier screening during a specified time period at Progenity, Inc. Patient ethnicity was self-reported and categorized as: African American, Ashkenazi Jewish, Asian, Caucasian, Hispanic, Native American, Other/Mixed/Unknown, or Sephardic Jewish. FXS test results were stratified by ethnicity and repeat allele category. Total premutation carrier frequency was calculated and compared against each ethnic group. A total of 134,933 samples were included. The pan-ethnic premutation carrier frequency was 1 in 201. Only the Asian group differed significantly from this frequency. Using the carrier frequency of 1 in 201, a conservative pan-ethnic risk estimate for a male fetus to have FXS can be calculated as 1 in 2,412. This risk is similar to the highest ethnic-based fetal risks for cystic fibrosis and spinal muscular atrophy, for which population-wide screening is currently recommended. This study adds to the literature and supports further evaluation into specific population-wide screening recommendations for FXS.

Clinical experience with multigene carrier panels in the reproductive setting.

OBJECTIVES: Expanded carrier testing is acknowledged as an acceptable strategy for carrier testing by the American College of Obstetrics and Gynecology. Limited studies have investigated positivity rates of expanded carrier panels. We describe our experience with 3 commercial laboratory panels varying in size from 3 to 218 disorders. METHODS: We reviewed outcomes for 3 multigene carrier screening panels: trio (3 diseases), standard (23 diseases), and global (218 diseases). All panels used targeted genotype analysis of preselected mutations via next-generation sequencing. We calculated positivity rates for each panel. RESULTS: Positivity rates were 7.2% for Preparent Trio, 13.2% for Preparent Standard, and 35.8% for Preparent Global. The most frequent positive results in the global panel were (in descending order): abnormal hemoglobin electrophoresis, familial Mediterranean fever, cystic fibrosis, fragile X, glucose-6-phosphate dehydrogenase deficiency, alpha-thalassemia, and nonsyndromic hearing loss. CONCLUSIONS: While genetic diseases are individually rare, they are cumulatively common. Our experience illustrates that, with a panel of 218 diseases, the likelihood of identifying a carrier can be as high as 36%. Understanding panel positivity rates is one important factor for providers when choosing the right test for their practice, setting appropriate expectations for patients, and planning for follow-up counseling.

Patient-centred access to health care: a framework analysis of the care interface for frail older adults.

BACKGROUND: The objective of this study was to explore the issues surrounding access to health and social care services for frail older adults with Polish stakeholders, including healthy and frail/pre-frail older adults, health care providers, social care providers, and caregivers, in order to determine their views and perspectives on the current system and to present suggestions for the future development of a more accessible and person-centred health and social care system. METHODS: Focus groups were used to gather qualitative data from stakeholders. Data were analysed using framework analysis according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability and appropriateness. RESULTS: Generally services were approachable and acceptable, but unavailable. Poor availability related to high staff turnover, staff shortages and a lack of trained personnel. There were problems of long waiting times for specialist care and rehabilitation services, and geographically remote clinics. Critically, there were shortages of long-term inpatient care places, social care workers and caregivers. The cost of treatments created barriers to care and inequities in the system. Participants described a lack of integration between health and social care systems with differing priorities and disconnected budgets. They described an acute medical system that was inappropriate for patients with complex needs, alongside a low functioning social care system, where bureaucratisation caused delays in providing services to the vulnerable. An integrated system with a care coordinator to improve connections between services and patients was suggested. CONCLUSIONS: There is an immediate need to improve access to health and social care systems for pre-frail and frail patients, as well as their caregivers. Health and social care services need to be integrated to reduce bureaucracy and increase the timeliness of treatment and care.

Memory flexibility training for autobiographical memory as an intervention for maintaining social and mental well-being in older adults.

Autobiographical memory specificity (AMS) reduces with increasing age and is associated with depression, social problem-solving and functional limitations. However, ability to switch between general and specific, as well as between positive and negative retrieval, may be more important for the strategic use of autobiographical information in everyday life. Ability to switch between retrieval modes is likely to rely on aspects of executive function. We propose that age-related deficits in cognitive flexibility impair AMS, but the "positivity effect" protects positively valenced memories from impaired specificity. A training programme to improve the ability to flexibly retrieve different types of memories in depressed adults (MemFlex) was examined in non-depressed older adults to determine effects on AMS, valence and the executive functions underlying cognitive flexibility. Thirty-nine participants aged 70+ (MemFlex, n = 20; control, n = 19) took part. AMS and the inhibition aspect of executive function improved in both groups, suggesting these abilities are amenable to change, although not differentially affected by this type of training. Lower baseline inhibition scores correlated with increased negative, but not positive AMS, suggesting that positive AMS is an automatic process in older adults. Changes in AMS correlated with changes in social problem-solving, emphasising the usefulness of AMs in a social environment.

Be SMART: examining the experience of implementing the NHS Health Check in UK primary care.

BACKGROUND: The NHS Health Check was designed by UK Department of Health to address increased prevalence of cardiovascular disease by identifying risk levels and facilitating behaviour change. It constituted biomedical testing, personalised advice and lifestyle support. The objective of the study was to explore Health Care Professionals' (HCPs) and patients' experiences of delivering and receiving the NHS Health Check in an inner-city region of England. METHODS: Patients and HCPs in primary care were interviewed using semi-structured schedules. Data were analysed using Thematic Analysis. RESULTS: Four themes were identified. Firstly, Health Check as a test of 'roadworthiness' for people. The roadworthiness metaphor resonated with some patients but it signified a passive stance toward illness. Some patients described the check as useful in the theme, Health check as revelatory. HCPs found visual aids demonstrating levels of salt/fat/sugar in everyday foods and a 'traffic light' tape measure helpful in communicating such 'revelations' with patients. Being SMART and following the protocolrevealed that few HCPs used SMART goals and few patients spoke of them. HCPs require training to understand their rationale compared with traditional advice-giving. The need for further follow-up revealed disparity in follow-ups and patients were not systematically monitored over time. CONCLUSIONS: HCPs' training needs to include the use and evidence of the effectiveness of SMART goals in changing health behaviours. The significance of fidelity to protocol needs to be communicated to HCPs and commissioners to ensure consistency. Monitoring and measurement of follow-up, e.g., tracking of referrals, need to be resourced to provide evidence of the success of the NHS Health Check in terms of healthier lifestyles and reduced CVD risk.

A Scoping Review on the Opportunities for Social Engagement and Cognitive Frailty in Older Adults.

Cognitive frailty (CF) is defined as the clinical syndrome of the combination of physical frailty and cognitive impairment, without dementia. Numerous risk factors for CF have been previously identified but this scoping review focusses on the critical need for social engagement and the association with cognition. The focus of this scoping review on the opportunity for social engagement rather than on perception or experience of loneliness. Based on the results of 55 studies were synthesised into four social engagement categories, namely participation, household, network, and habitat. Social engagement is associated with maintaining or improving cognition, particularly through active participation in social roles. Habitat (i.e., rural or urban settings) also influences cognition and the challenge is to enable social participation.

What does it mean to age well with bipolar disorder? A qualitative study using photo elicitation.

OBJECTIVES: The objective of this study is to explore what ageing well means to older adults with bipolar disorder. METHODS: Older adults with bipolar disorder took photographs of aspects of their lives that they felt represented ageing well. They then completed audio-recorded photo elicitation interviews to explore what it meant to age well with bipolar disorder in detail. Data were analysed using reflexive thematic analysis. RESULTS: Seventeen participants met the criteria for bipolar disorder I or II. The analysis resulted in four key themes to ageing well with bipolar disorder: (1) Lifelong learning - referring to how participants accumulated a wealth of knowledge about bipolar disorder and used this to maintain stability in later life; (2) Finding where you belong - relating to how participants prioritised finding new communities, utilised family support and refined their support networks over time to age well; (3) Recognising your value and worth - which involved participants using their strengths and experiences to support others; and (4) Continuity of support - older adults with bipolar disorder highlighted the benefits of continuous support that allowed them to be actively involved in their treatment. CONCLUSIONS: Participants ageing with bipolar disorder identified unique challenges indicating that services require adaptation to meet their needs and support them to age well. Findings suggested that services should provide continuous care that allows this group to actively engage with their treatment, build upon their strengths, and develop meaningful connections with professionals and peers. This approach may enhance support for older adults with bipolar disorder and reduce the inequalities they experience.

Understanding exogenous factors and biological mechanisms for cognitive frailty: A multidisciplinary scoping review.

Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty (by any measure), AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included "cognitive frailty" OR (("cognitive decline" OR "cognitive impairment") AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as "behavioural" or "cognitive decline" or "senescence", were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer's disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research.

The effects of singing interventions on quality of life, mood and levels of agitation in community-dwelling people living with dementia: A quantitative systematic review.

Background and Aims: Music-based interventions have been found to benefit people living with dementia and have positive impacts on cognition and well-being. Most people with dementia live in the community and compared to people with dementia in residential care often have less access to music-based interventions. There are many forms of music interventions and singing has shown particular promise; in the realm of music interventions. It is important to determine what aspects of music interventions yield the most benefits for people with dementia. This review aimed to synthesise evidence on the impacts of singing interventions on quality of life, mood and neuropsychiatric symptoms for community-dwelling people with dementia. Methods: We systematically searched three electronic databases (PsycINFO, MEDLINE and Web of Science) for studies reporting on singing interventions with community-dwelling people with dementia. Studies were eligible for inclusion if they reported on a singing intervention with people living with dementia that included an outcome measure of quality of life, mood or agitation. Fourteen publications were identified and included in this review, with a total of n = 361 people with dementia. Results: Despite some inconsistencies across the literature, evidence suggests that singing interventions led to an improvement in mood and a reduction in agitation levels in people living with dementia. There was no strong evidence to suggest that singing interventions led to significant improvements in quality of life. Conclusions: This review highlights the potential of singing interventions as an effective psychosocial intervention for community-dwelling people with dementia. For key developments in this area, we urge that future studies include a control group where possible which will allow for more robust examinations of singing interventions and allow intervention effects to be distinguished from general deterioration in dementia symptoms over time.