Stress and burnout in nursing home and égida workers during COVID-19.

AIMS: Finding out whether there are differences in the levels of stress and burnout between workers providing care to dependent adults and those caring for independent older adults would provide comparative information about two different models of care. During the COVID-19 pandemic, workers caring for older adults were subjected to maladaptive situations that produced stress and burnout. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: A total of 900 nursing home and égidas workers were assessed for stress and burnout. Data were collected online from October 2020 to February 2021, when Puerto Rico was experiencing the peak of the third wave of COVID-19. MANOVAs were performed to study the interactions between the workplace and having had COVID, the workplace and the size of institution and the workplace and position held. DATA SOURCES: October 2020 to February 2021. RESULTS: All interactions were significant. Nursing homes showed higher levels of stress and burnout when workers had undergone COVID, when the size of the institution was larger and for technical staff other services; in égidas, having undergone COVID did not influence stress or burnout, which increased when the institution was smaller and for executive staff. CONCLUSIONS: This study showed that the effects of the COVID-19 pandemic affected nursing home workers more significantly than those working in other types of residential models with independent older adults. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Applying preventive interventions aimed at reducing stress and burnout would facilitate the adaptation of workers caring for older adults and help to improve the quality of care. IMPACT: This study analysed the impact of COVID-19 on the stress and burnout of workers providing services to older adults. Nursing home workers who have had COVID-19 have higher stress and burnout. The size of the institution has a different effect depending on whether older adults are dependent or independent. Workers in institutions dedicated to the care of the older adults. REPORTING METHOD: This study has adhered to the relevant EQUATOR guidelines: STROBE. PATIENT OR PUBLIC CONTRIBUTION: During the different waves of the COVID-19 pandemic, it was difficult to establish direct contact with workers providing care to older adults; this reason made it necessary to apply online systems to obtain information. The workers appreciated the fact that the implications for stress and burnout of the situation experienced during this difficult process were investigated.

Psychological Dimensions That Explain Integrity in Older Adults: Examination of a Structural Model.

OBJECTIVES: The aim of this research was to confirm whether internal coping strengths, depressive symptomatology and gratitude disposition are significant predictors of integrity in older adults. METHODS: Participated 394 Ecuadorian older adults with ages between 60 and 91 years old. Self-report were applied to assess the different variables under study. Specifically, integrity, coping, resilience, self-efficacy, mood and gratitude were assessed. RESULTS: A confirmatory model was estimated to predict ego-integrity. A personal adjustment factor composed of problem-focused coping strategies, resilience and self-efficacy, and gratitude showed positive and significant relationships with ego-integrity, whereas negative mood negatively predicted integrity. CONCLUSIONS: Integrity is a key variable to strengthen a coherent view of one's life history and highly relevant during ageing. Having personal strengths and dispositions that facilitate adaptation to ageing and maintaining a positive mood predicts the attainment of integrity. CLINICAL IMPLICATIONS: Integrity is an adjustment factor that facilitates adaptation to the stressors of ageing and to major life changes and loss of control indifferent areas of life.

Emotional intelligence predicting ego integrity in healthy older adults.

OBJECTIVES: A characteristic task in aging is the process of reevaluating and reflecting on one's life in order to give it meaning. The successful resolution of this task is defined as ego-integrity, and it is related to various psychological phenomena that foster the person's adaptation to change. The objective was to adapt an ego-integrity scale in a sample of older adults and study the relationships between emotional intelligence, coping strategies, and mood to find out whether they are predictors of ego-integrity. METHODS: The sample included 401 healthy older adults (241 women; ages 65-95, M = 73.69, SD = 6.83). Statistical analyses included structural equation models. Northwestern Ego-integrity Scale 9-item was tested showing that a structure with two unrelated factors fitted the data well. The internal consistency was satisfactory (.82 integrity and .72 despair). RESULTS: Emotional intelligence positively predicted problem-focused adaptive coping strategies (problem solving and positive reassessment) and negatively predicted state of mind (depression and hopelessness), whereas adaptive coping positively predicted integrity, and mood predicted it negatively. CONCLUSION: Emotional intelligence skills, adaptive coping strategies, and mood largely determine the successful resolution of the ego integrity conflict and are relevant resources in successful aging.

Emotional intelligence intervention in older adults to improve adaptation and reduce negative mood.

OBJECTIVES: Emotional intelligence (EI) is a strong predictor of negative mood. Applying emotional skills correctly can help to increase positive emotional states and reduce negative ones. This study aims to implement EI intervention designed to improve clarity, repair EI dimensions and coping strategies, and reduce negative mood in older adults. DESIGN: Participants were randomly assigned to the treatment or control group. SETTING: Participants were evaluated individually before and after the intervention. PARTICIPANTS: Participants included 111 healthy older adults; 51 in the treatment group and 60 in the control group. INTERVENTION: An EI program was implemented. The program was administered over 10 sessions lasting 90 min each. MEASUREMENTS: EI dimension (attention, clarity, and repair), coping strategies, hopelessness, and mood were assessed. RESULTS: Analysis of variance for repeated measures was applied. In the treatment group, scores on clarity and emotional repair increased and attention to emotions decreased; problem-focused coping (problem-solving, positive reappraisal, and seeking social support) showed significant increases, whereas emotion-focused coping (negative self-focused and overt emotional expression) obtained significant decreases; scores on negative mood measures declined significantly. CONCLUSIONS: An intervention based on EI is effective in older adults. After the EI intervention, the participants showed significant increases in their levels of clarity and emotional repair and intermediate levels of attention. In addition, the intervention was found to influence adaptation results, increasing the use of adaptive coping strategies and decreasing the use of maladaptive strategies, as well as reducing hopelessness and depressive symptoms.

Effects of a simple reminiscence intervention program on the reminiscence functions in older adults.

OBJECTIVES: Reminiscence promotes the acceptance of oneself and others, a sense of meaning, and the integration of the present and the past. The currently accepted classification contains eight reminiscence functions grouped in three broader functions: self-positive functions (identity, problem-solving, and death preparation); self-negative functions (bitterness revival, boredom reduction, and intimacy maintenance); and prosocial functions (conversation and teach-inform). The main objective of this study was to investigate how the eight dimensions change over time in a sample of healthy older adults after an intervention based on simple reminiscence and subsequent follow-up. DESIGN: Participants were randomly assigned to the treatment or control group. SETTING: Participants were evaluated individually before, immediately after, and 3 months after the intervention. PARTICIPANTS: Participants included 139 healthy older adults (71 intervention group and 68 control group). INTERVENTION: Ten weekly sessions lasting 2 hours each were administered, based on a simple reminiscence program. MEASUREMENTS: Participants were assessed with the Reminiscence Functions Scale. RESULTS: After the intervention, in the treatment group, there was a significant increase in the self-positive functions of problem-solving and death preparation, and these effects were maintained even at the follow-up; there was a significant reduction in the self-negative functions of bitterness revival and intimacy maintenance; and there was a significant increase in the prosocial function of conversation. CONCLUSIONS: When applying an intervention based on reminiscence, it is important to evaluate how it influences these functions because this information can help us to modify the objectives of the intervention and increase its effectiveness.

Phonological false recognition produced by bottom-up automatic activation in young and older people.

Two experiments explored a new procedure to implicitly induce phonological false memories in young and older people. On the study tasks, half of the words were formed from half of the letters in the alphabet, whereas the remaining words were formed from all the letters in the alphabet. On the recognition tests, there were three types of non-studied new words: critical lures formed from the same half of the letters as the studied words; distractors formed from the other half of the letters not used, and distractors formed from all the letters in the alphabet. In both experiments, the results showed that, in both young and older people, critical lures produced more false recognitions than distractors composed of all the letters in the alphabet, which, in turn, produced more false alarms than distractors composed of the letters not used during the study. These results support the predictions of the activation/monitoring models, which assume that false memories are partly due to activation spreading from items (semantically or phonologically) related to the critical words.

Motivated forgetting reduces veridical memories but slightly increases false memories in both young and healthy older people.

The aim of the current study is to examine the effects of motivated forgetting and aging on true and false memory. Sixty young and 54 healthy older adults were instructed to study two lists of 18 words each. Each list was composed of three sets of six words associated with three non-presented critical words. After studying list 1, half of the participants received the instruction to forget List 1, whereas the other half received the instruction to remember List 1. Next, all the subjects studied list 2; finally, they were asked to remember the words studied in both lists. The results showed that when participants intended to forget the studied List 1, they were less likely to recall the studied words, but more likely to intrude the critical words. That is, we can intentionally forget something but this can also entail the intrusion of some related false memories.

An emotional Stroop task with faces and words. A comparison of young and older adults.

ANTECEDENTS: Given the contradictions of previous studies on the changes in attentional responses produced in aging a Stroop emotional task was proposed to compare young and older adults to words or faces with an emotional valence. METHOD: The words happy or sad were superimposed on faces that express the emotion of happiness or sadness. The emotion expressed by the word and the face could agree or not (cued and uncued trials, respectively). 85 young and 66 healthy older adults had to identify both faces and words separately, and the interference between the two types of stimuli was examined. RESULTS: An interference effect was observed for both types of stimuli in both groups. There was more interference on positive faces and words than on negative stimuli. CONCLUSIONS: Older adults had more difficulty than younger in focusing on positive uncued trials, whereas there was no difference across samples on negative uncued trials.

Transcranial Direct Current Stimulation Intervention in Alzheimer's Disease and Its Follow-Up.

BACKGROUND: Alzheimer's disease (AD) stands as the prevailing type of dementia, marked by gradual memory loss and cognitive decline. Transcranial direct current stimulation (tDCS) is a non-invasive method used to regulate cortical brain function and has been explored as a potential treatment for cognitive impairment. OBJECTIVE: This study aimed to compare the effects of daily home-based active or sham tDCS on cognitive function in patients with early-stage AD and its follow-up after one month. METHODS: The study involved a randomized, blinded, and controlled-placebo design, with 18 participants enrolled. The primary outcome measures were general cognitive function, immediate, and delayed recall, and executive function. Participants included in the study were randomly assigned to the anodal and sham tDCS groups. Participants were assessed before and after the intervention and one month after the end of treatment. The home-based intervention was applied for 5 consecutive days, daily. RESULTS: The results showed a significant interaction between the active and sham groups; in particular, improvements in MMSE scores, immediate memory and delayed recall were observed at one-month follow-up in the active group. CONCLUSIONS: The positive effects of tDCS on cognitive function in AD patients observed suggest that tDCS may induce long-term neuroplastic changes, leading to sustained improvements in cognitive abilities.

Cognitive Stimulation in Moderate Alzheimer's Disease.

Cognitive stimulation is one of the non-pharmacological therapies recommended for dementia intervention. The present study evaluated the efficacy of an intervention based on cognitive stimulation in people with moderate Alzheimer's disease. Fifty-nine subjects with moderate dementia were randomly assigned to the stimulation group (N = 36) and the control group (N = 35). The treatment group received 16 intervention sessions cognitive tasks. All participants were evaluated with a battery of neuropsychological tests at three time points (pre, post, and follow-up). The treatment group showed significant increases in the three domains studied (memory, attention, and executive functions), although some of these effects were not maintained at follow-up. The control group progressively worsened. Cognitive stimulation was found to be an effective intervention for people with moderate Alzheimer's disease because it helped to maintain memory function, executive functions, and attention. However, the effects were minimized at the 3-month follow-up.

Cognitive Stimulation Program Presented Through New Technologies in a Group of People with Moderate Cognitive Impairment.

BACKGROUND: Cognitive stimulation is one of the non-pharmacological therapies recommended for intervention in dementia, consisting of activities involving different cognitive domains and involving brain activation. New technologies can be very useful in this field, favoring intervention tasks. OBJECTIVE: The objective of this work is to test the effectiveness of a cognitive stimulation intervention mediated with new technologies on a group of people with moderate dementia. METHODS: This is a quantitative, quasi-experimental study with a control and treatment group, with three measurement times (pre, post, and follow-up months after the end of the intervention). Ninety-eight subjects with moderate dementia were randomly assigned to the treatment group (N = 50) and the control group (N = 48). The treatment group received 16 intervention sessions including attention, executive function, and memory tasks, which were presented using new technologies and the activity was conducted in a group setting. Control group remained on a waiting list. The evaluators did not know which group each subject belonged to. All participants were assessed with a battery of neuropsychological tests. RESULTS: The results show an improvement in post-intervention outcomes in the treatment group compared to the control group on cognitive variables. No differences were found in mood depression. These results fade overtime after a few months without intervention. CONCLUSION: This type of intervention is useful to maintain cognitive functioning using new technologies and in a group setting, which favors the intervention. The improvements of the intervention disappear at follow-up, which would indicate the need to maintain the intervention over time.

[Hopelessness as a predictor of loneliness in older adults]. / La desesperanza como predictora de la soledad en adultos mayores.

BACKGROUND AND OBJECTIVE: Hopelessness is characterized by a set of negative cognitive schemas about the future, conceptualized on the basis of three dimensions: affective, motivational and cognitive. This construct is linked to loneliness, the incidence of which in older adults is increasingly high. The aim of this research is to test whether hopelessness factors predict levels of loneliness in older adults. MATERIAL AND METHODS: 138 non-institutionalized persons from Valencia city between 65-90 years old participated, with a mean age of 73.67 (SD=4.8), and 59.4% were women. The Beck Hopelessness Scale (BHS) and University of California Los Angeles Loneliness Scale (UCLA) were administered to assess participants. RESULTS: The motivational and cognitive factors acted as statistically significant predictors of loneliness, while the affective factor was not presented as a significant factor. The final model obtained an R2adj=.442, F(3, 87)=23.97, p<.001. CONCLUSIONS: Loneliness is a phenomenon of great concern in the field of gerontology due to its high incidence and impact. The results indicate that hopelessness, specifically loss of motivation and negative expectations about the future, are critical issues for the development of feelings of loneliness in older adults. Thus, it is relevant to pay attention to these variables in order to apply loneliness prevention programs.

Enhancing Immediate Memory, Potential Learning, and Working Memory with Transcranial Direct Current Stimulation in Healthy Older Adults.

BACKGROUND: Transcranial direct current stimulation (tDCS) has emerged as a prevention method or minimizer of the normal cognitive deterioration that occurs during the aging process. tDCS can be used to enhance cognitive functions such as immediate memory, learning, or working memory in healthy subjects. The objective of this study was to analyze the effect of two 20-min sessions of anodal transcranial direct stimulation on immediate memory, learning potential, and working memory in healthy older adults. METHODS: A randomized, single-blind, repeated-measures, sham-controlled design was used. The sample is made up of 31 healthy older adults, of whom 16 were in the stimulation group and 15 were in the sham group. The anode was placed on position F7, coinciding with the left dorsolateral prefrontal cortex region, and the cathode was placed on Fp2, the right supraorbital area (rSO). RESULTS: When comparing the results of the treatment group and the sham group, differences were observed in working memory and learning potential; however, no differences in immediate memory were found. CONCLUSION: The results showed that tDCS is a non-invasive and safe tool to enhance cognitive processes in healthy older adults interested in maintaining some cognitive function.

Comparison of Emotion Recognition in Young People, Healthy Older Adults, and Patients with Mild Cognitive Impairment.

BACKGROUND: The basic discrete emotions, namely, happiness, disgust, anger, fear, surprise, and sadness, are present across different cultures and societies. Facial emotion recognition is crucial in social interactions, but normal and pathological aging seem to affect this ability. The present research aims to identify the differences in the capacity for recognition of the six basic discrete emotions between young and older healthy controls (HOC) and mildly cognitively impaired patients (MCI). METHOD: The sample (N = 107) consisted of 47 young adults, 27 healthy older adults, and 33 MCI patients. Several neuropsychological scales were administered to assess the cognitive state of the participants, followed by the emotional labeling task on the Ekman 60 Faces test. RESULTS: The MANOVA analysis was significant and revealed the presence of differences in the emotion recognition abilities of the groups. Compared to HOC, the MCI group obtained a significantly lower number of hits on fear, anger, disgust, sadness, and surprise. The happiness emotion recognition rate did not differ significantly among the three groups. Surprisingly, young people and HOC did not show significant differences. CONCLUSIONS: Our results demonstrated that MCI was associated with facial emotion recognition impairment, whereas normal aging did not seem to affect this ability.

Mindfulness-based Cognitive Therapy to Improve Sleep Quality in Older Adults with Insomnia.

There is a high prevalence of insomnia in older adults, which has negative consequences for their well-being and quality of life. The recommendation for first-line treatments is to administer non-pharmacological interventions. The objective of this research was to verify the effectiveness of Mindfulness-Based Cognitive Therapy in older adults with subclinical and moderate insomnia, studying its impact on sleep quality. One hundred and six older adults participated and were assigned to the subclinical insomnia (n = 50) or moderate insomnia (n = 56) groups; subsequently, they were randomly assigned to the control and intervention groups. Subjects were evaluated at two times with the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. Significant results were obtained on both scales, with a reduction in insomnia symptoms in the subclinical and moderate intervention groups. The administration of a treatment that combines mindfulness and cognitive therapy is effective for treating insomnia in older adults.

Existe una alta prevalencia de insomnio en los adultos mayores, lo que tiene consecuencias negativas para su bienestar y calidad de vida. La recomendación para los tratamientos de primera línea es administrar intervenciones no farmacológicas. El objetivo de esta investigación fue verificar la efectividad de la terapia cognitiva basada en mindfulness en adultos mayores con insomnio subclínico y moderado, estudiando su impacto en la calidad del sueño. Participaron 106 adultos mayores que fueron asignados a los grupos de insomnio subclínico (n = 50) o de insomnio moderado (n = 56); posteriormente, fueron asignados aleatoriamente a los grupos de control y de intervención. Los sujetos fueron evaluados antes y después de la intervención con el índice de gravedad del insomnio y el índice de calidad del sueño de Pittsburgh. Se obtuvieron resultados significativos en ambas escalas, con una reducción de los síntomas de insomnio en los grupos de intervención subclínica y moderada. La administración de un tratamiento que combina mindfulness y terapia cognitiva es eficaz para tratar el insomnio en adultos mayores.

Home-based transcranial direct current stimulation in mild neurocognitive disorder due to possible Alzheimer's disease. A randomised, single-blind, controlled-placebo study.

Introduction: Mild neurocognitive disorder (mNCD), a pre-dementia stage close to Mild Cognitive Impairment, shows a progressive and constant decline in the memory domain. Of the non-pharmacological therapeutic interventions that may help to decelerate the neurodegenerative progress, transcranial direct current stimulation (tDCS) shows beneficial effects on the learning curve, immediate recall, immediate verbal memory and executive functions. The purpose of this research was to study the effect of tDCS on general cognition, immediate and delayed memory and executive functions by comparing an active group with a placebo group of mNCD patients. Methods: Participants were 33 mNCD due to possible AD, randomly assigned to two groups: 17 active tDCS and 16 placebo tDCS. Ten sessions of tDCS were conducted over the left dorsolateral prefrontal cortex. Several neuropsychological scales were administered to assess the primary outcome measures of general cognitive function, immediate and delayed memory and learning ability, whereas the secondary outcome measures included executive function tests. All participants were evaluated at baseline and at the end of the intervention. Mixed ANOVAs were performed. Results: Significant effects were obtained on general cognitive function, immediate and delayed memory and learning ability, with increases in scores in the active tDCS group. However, there were no significant effects on executive function performance. Conclusion: The present study demonstrated the effectiveness of tDCS in an active tDCS group, compared to a placebo group, in improving general cognition and immediate and delayed memory, as previous studies found. Taken together, our data suggest that tDCS is a simple, painless, reproducible and easy technique that is useful for treating cognitive alterations found in neurodegenerative diseases.

Genistein effect on cognition in prodromal Alzheimer's disease patients. The GENIAL clinical trial.

BACKGROUND: Delaying the transition from minimal cognitive impairment to Alzheimer's dementia is a major concern in Alzheimer's disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet effective substances are recommended. There is a need to develop new drugs to delay Alzheimer's dementia. We have taken a nutritional supplement approach with genistein, a chemically defined polyphenol that acts by multimodal specific mechanisms. Our group previously showed that genistein supplementation is effective to treat the double transgenic (APP/PS1) AD animal model. METHODS: In this double-blind, placebo-controlled, bicentric clinical trial, we evaluated the effect of daily oral supplementation with 120 mg of genistein for 12 months on 24 prodromal Alzheimer's disease patients. The amyloid-beta deposition was analyzed using 18F-flutemetamol uptake. We used a battery of validated neurocognitive tests: Mini-Mental State Exam (MMSE), Memory Alteration Test (M@T), Clock Drawing Test, Complutense Verbal Learning Test (TAVEC), Barcelona Test-Revised (TBR), and Rey Complex Figure Test. RESULTS: We report that genistein treatment results in a significant improvement in two of the tests used (dichotomized direct TAVEC, p = 0.031; dichotomized delayed Centil REY copy p = 0.002 and a tendency to improve in all the rest of them. The amyloid-beta deposition analysis showed that genistein-treated patients did not increase their uptake in the anterior cingulate gyrus after treatment (p = 0.878), while placebo-treated did increase it (p = 0.036). We did not observe significant changes in other brain areas studied. CONCLUSIONS: This study shows that genistein may have a role in therapeutics to delay the onset of Alzheimer's dementia in patients with prodromal Alzheimer's disease. These encouraging results indicate that this should be followed up by a new study with more patients to further validate the conclusion that arises from this study. TRIAL REGISTRATION: NCT01982578, registered on November 13, 2013.

Coping and Life Satisfaction in Colombian Older Adults.

BACKGROUND: Effective coping strategies facilitate older adults' optimal adaptation and contribute to their well-being. Problem-focused strategies are associated with active styles and enhance well-being. This study analyzes the role of coping strategies in Colombian older adults' subjective well-being (SWB) using structural equation modelling. Additionally, Confirmatory Factor Analyses of the Life Satisfaction Scale and Coping Strategies Questionnaires are performed. METHOD: A cross-sectional study is conducted with 455 Colombian older adults, ranging from 65 to 92 years old. RESULTS: The results show that problem-focused coping has a positive effect on SWB, whereas emotion-focused coping has a negative effect on SWB. CONCLUSIONS: This article highlights the relationship between effective coping and life satisfaction by showing that problem-focused coping strategies are adaptative and enhance well-being during aging.

Effectiveness of tDCS at Improving Recognition and Reducing False Memories in Older Adults.

BACKGROUND: False memories tend to increase in healthy and pathological aging, and their reduction could be useful in improving cognitive functioning. The objective of this study was to use an active-placebo method to verify whether the application of transcranial direct current stimulation (tDCS) improved true recognition and reduced false memories in healthy older people. METHOD: Participants were 29 healthy older adults (65-78 years old) that were assigned to either an active or a placebo group; the active group received anodal stimulation at 2 mA for 20 min over F7. An experimental task was used to estimate true and false recognition. The procedure took place in two sessions on two consecutive days. RESULTS: True recognition showed a significant main effect of sessions (p < 0.01), indicating an increase from before treatment to after it. False recognition showed a significant main effect of sessions (p < 0.01), indicating a decrease from before treatment to after it and a significant session × group interaction (p < 0.0001). CONCLUSIONS: Overall, our results show that tDCS was an effective tool for increasing true recognition and reducing false recognition in healthy older people, and suggest that stimulation improved recall by increasing the number of items a participant could recall and reducing the number of memory errors.

A Longitudinal Study of Episodic and Semantic Autobiographical Memory in aMCI and Alzheimer's Disease Patients.

BACKGROUND: The main objective of this study was to analyze the evolution of autobiographical memory (both episodic and semantic) in patients with mild cognitive impairment, patients with Alzheimer's disease, and a healthy control group. We compared these groups at two time points: first, at baseline, and in a follow-up after 18 months. METHOD: Twenty-six healthy older adults, 17 patients with mild amnestic cognitive impairment, and 16 patients with Alzheimer's disease, matched on age and educational level, were evaluated at both time points with the Autobiographical Memory Interview. RESULTS: The results showed significant longitudinal deterioration in episodic and semantic autobiographical memory in patients with mild cognitive impairment and in patients with Alzheimer's disease, but not in healthy older adults. CONCLUSIONS: The deterioration of episodic and semantic autobiographical memory in AD is confirmed; however, although the episodic was impaired in aMCI, a pattern that evolved toward deterioration over a period of eighteen months was observed for the semantic autobiographical memory.