Engage! a pilot study of a brief behavioural activation program to promote engagement and well-being in older adults.

Previous research has indicated the suitability of behavioural activation (BA) as an intervention for reducing depression in older adults. However, little research has investigated the potential of BA to increase active engagement and well-being in older adults. The current pilot study sought to investigate the usefulness and acceptability of BA to promote well-being in a group of non-clinical older adults. Participants (N = 18) aged between 65 and 86 (M = 77.82, SD = 5.59) who were retired and living independently in the community were provided a 6-week BA program predominantly delivered online. Treatment retention, self-ratings, and participants' compliance to treatment principles indicate preliminary feasibility for the use of BA as an approach for increasing active engagement in older adult populations. Participants also provided feedback on their experiences with the program post-intervention via individual structured interviews. Thematic analysis of these data revealed that participants found the program to be beneficial in terms of increased self-awareness and social engagement, and provided several recommendations for improving acceptability of the program and workbook. The unexpected events relating to the first wave of the novel coronavirus (COVID-19) led to necessary adaptations to delivery modalities, and provided the researchers with an opportunity to investigate the use of a structured well-being program on a high-risk population during a pandemic. Our findings support the proposition that BA is a suitable intervention for increasing engagement and well-being in older adults, provide insight into adapting programs for older adults, and suggest next steps for testing intervention efficacy.

Deriving prevalence estimates of depressive symptoms throughout middle and old age in those living in the community.

BACKGROUND: There is considerable debate about the prevalence of depression in old age. Epidemiological surveys and clinical studies indicate mixed evidence for the association between depression and increasing age. We examined the prevalence of probable depression in the middle aged to the oldest old in a project designed specifically to investigate the aging process. METHODS: Community-living participants were drawn from several Australian longitudinal studies of aging that contributed to the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Different depression scales from the contributing studies were harmonized to create a binary variable that reflected "probable depression" based on existing cut-points for each harmonized scale. Weighted prevalence was benchmarked to the Australian population which could be compared with findings from the 1997 and 2007 National Surveys of Mental Health and Well-Being (NSMHWB). RESULTS: In the DYNOPTA project, females were more likely to report probable depression. This was consistent across age levels. Both NSMHWB surveys and DYNOPTA did not report a decline in the likelihood of reporting probable depression for the oldest old in comparison with mid-life. CONCLUSIONS: Inconsistency in the reports of late-life depression prevalence in previous epidemiological studies may be explained by either the exclusion and/or limited sampling of the oldest old. DYNOPTA addresses these limitations and the results indicated no change in the likelihood of reporting depression with increasing age. Further research should extend these findings to examine within-person change in a longitudinal context and control for health covariates.

Subjective well-being mediates the effects of resilience and mastery on depression and anxiety in a large community sample of young and middle-aged adults.

OBJECTIVE: The tripartite model of depression and anxiety hypothesizes that positive and negative affect is related to depression and anxiety. However, the specific role of cognitive or psychological well-being constructs like resilience and mastery within a tripartite context and throughout adulthood is unclear. METHOD: Data was drawn from two longitudinal population-based cohorts, aged 20-24 and 40-44 based in Canberra, Australia (N = 3989). We sought to determine the interrelatedness of two affective measures of subjective well-being, positive and negative affect, with two cognitive measures of psychological well-being, resilience and mastery. We then tested their independent effects on depression and anxiety, and hypothesized, following the tripartite model, that subjective well-being would mediate the effects of the psychological well-being variables on mental health and that the psychological well-being variables would be more strongly related to positive subjective well-being. RESULTS: Principal axis factoring delineated four affective and cognitive dimensions of well-being comprising positive and negative affect, resilience and mastery. Structural equation models identified the psychological well-being variables as significantly related to subjective well-being, which fully mediated the effects of resilience and partially mediated the effect of mastery on depression and anxiety. These findings were consistent throughout both young and middle adulthood. CONCLUSIONS: Psychological well-being components are significant predictors of subjective well-being affect states that increase vulnerability to depression and anxiety.

Psychological distress in non-drinkers: associations with previous heavy drinking and current social relationships.

AIMS: The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association. The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers. METHODS: A national cross-sectional survey yielded data from 2856 Australians aged 20-22, 30-32 and 40-42 years (response rate 15.9%). RESULTS: The sample was representative for many socio-demographic factors but under-represented people not in the labour force and over-represented those with university qualifications. In the oldest but not the younger age groups, abstainers reported significantly higher psychological distress relative to light/moderate drinkers. While abstainers in the oldest age group who were former heavy drinkers showed the highest levels of distress, excluding them from the analysis did not account for differences in distress between current abstainers and light/moderate drinkers. Abstainers aged 40-42 years were less socially integrated, less extraverted and had lower social support than light/moderate drinkers, and controlling for these factors partially explained their increased distress. CONCLUSIONS: Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40-42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.

Volunteering and psychological well-being among young-old adults: how much is too much?

PURPOSE: Research concerned with the relationship between volunteer activity and psychological well-being has typically reported higher levels of well-being among older adult volunteers relative to nonvolunteers. However, few studies have examined nonlinear associations between frequency of volunteer activity and well-being. We examined nonlinear associations between hours spent volunteering and psychological well-being, controlling for employment status, partner status, physical health, and education. We also investigated associations between different domains of volunteer activity and well-being, along with the possible moderating effects of gender on these relationships. DESIGN AND METHODS: We used data from the PATH Through Life Project, a population-based study of Australian adults. Participants consisted of 2,136 older adults aged 64 to 68. RESULTS: Nonlinear associations between hours spent volunteering and psychological well-being were evident, with these associations characterized by inverted U shapes, with nonvolunteers and those volunteering at high levels producing lower well-being scores relative to those volunteering at moderate levels. Few associations between specific domains of volunteer activity and well-being were evident, and no notable gender interactions emerged. IMPLICATIONS: The results point toward optimal frequency of engagement in volunteer activity for psychological well-being as being bounded by upper and lower levels, outside of which benefits to well-being diminish.

Gender differences in depression and anxiety across the adult lifespan: the role of psychosocial mediators.

BACKGROUND: There is robust epidemiological and clinical evidence that a greater number of women than men experience depression and anxiety. This study investigated a number of socio-demographic, health and lifestyle, psychological and social factors as possible mediators for the gender difference in depression and anxiety in three cohorts (20-24, 40-44, 60-64). METHODS: Responses were from a representative, community based survey (n = 7,485) conducted in Canberra and Queanbeyan (NSW), in Australia. Depression and anxiety were measured using the self-report Goldberg Anxiety and Depression Scales. The analyses initially identified gender differences in the potential mediators, followed by univariate and multivariate mediation models. RESULTS: The results indicated several shared mediators for depression and anxiety across the three age groups including: childhood adversity, mastery, behavioural inhibition, ruminative style, neuroticism, physical health, physical activity, and perceived interpersonal and employment problems. There was a decrease in the number of social mediators as age increased. The multivariate models accounted for gender differences in both conditions for all age groups, except for anxiety in the 20-24 years old. This suggests further important unmeasured mediators for this age group. CONCLUSIONS: These findings add to the literature surrounding gender differences in depression and anxiety, and provide a basis for future research exploring variation in these gender disparities over the adult lifespan.

The role of perceived control in explaining depressive symptoms associated with driving cessation in a longitudinal study.

PURPOSE: The purpose of this article was to investigate the role of control beliefs in mediating the relationship between driving cessation and change in depressive symptoms in a population-based sample of older adults. DESIGN AND METHODS: We report results from a prospective, community-based cohort study that included two waves of data collected in 1992 and 1994. Participants consisted of 700 men and women aged 70 and older, including 647 drivers and 53 participants who ceased driving between baseline (1992) and follow-up (1994). Participants took part in interviews that included assessments of driving status, sociodemographic characteristics, self-rated health, sensory function, depressive symptoms (through the Center for Epidemiologic Studies-Depression scale), and expectancy of control. Using multilevel general linear models, we examined the extent to which driving status, expectancy of control, and relevant covariates explained change in depressive-symptom scores between baseline and follow-up. RESULTS: Driving cessation was associated with an increase in depressive symptoms from baseline to follow-up. The higher depressive-symptom scores of ceased drivers relative to those of individuals who remained drivers at both waves was partly explained by a corresponding decrease in the sense of control among ceased drivers, and increased control beliefs among drivers. IMPLICATIONS: Interventions aimed at promoting the maintenance of personal agency and associated control beliefs could be protective against the negative psychological concomitants of driving cessation.

Weekly alcohol consumption, brain atrophy, and white matter hyperintensities in a community-based sample aged 60 to 64 years.

OBJECTIVE: The objective of this study was to determine the association between weekly alcohol consumption and brain atrophy in adults aged 60 to 64 years. METHODS: Brain magnetic resonance imaging scans from 385 adults recruited through a community survey were analyzed. Automated segmentation and manual tracing methods were used to obtain brain subvolumes and automated methods were used to obtain quantification and localization of white matter hyperintensities. Visual measures of cortical atrophy were obtained as were data on health and lifestyle factors. Alcohol consumption was assessed with the Alcohol Use Disorders Identification Test. RESULTS: In men, weekly alcohol consumption had a positive linear association with ventricular volume and gray matter and a negative linear association with white matter. In women, weekly alcohol consumption had a nonlinear relationship with cerebrospinal fluid and white matter. Alcohol consumption was not associated with white matter hyperintensities, corpus callosum size, hippocampal or amygdala volumes in analyses adjusting for confounding variables. CONCLUSION: An association between alcohol consumption and brain atrophy is evident at the population level. In women, detrimental effects of alcohol on the brain appear to occur at lower levels of consumption. It remains possible that low levels of alcohol consumption have neuroprotective benefits but is clear that high levels of consumption are detrimental.

Predicting driving cessation over 5 years in older adults: psychological well-being and cognitive competence are stronger predictors than physical health.

OBJECTIVES: To examine psychological, medical, and sensorimotor risk factors that predict driving cessation in older adults. DESIGN: Prospective cohort study including five waves of data collected in 1992, 1993, 1994, 1995, and 1997. SETTING: The Australian Longitudinal Study of Aging. PARTICIPANTS: One thousand four hundred sixty-six men and women aged 70 and older drawn from the electoral roll and including 753 drivers at baseline. MEASUREMENTS: Interviews, including assessments of self-rated health (indicating general well-being); medical conditions; driving status; and clinical assessments of vision, hearing, cognitive function, and grip strength, were conducted in 1992 (baseline) and 1994. Information on current driving status was obtained at baseline and four subsequent waves (1993, 1994, 1995, and 1997). Drivers and nondrivers were compared at baseline. Risk factors for driving cessation were identified using logistic regression. RESULTS: Drivers were younger and more likely to be male and had better self-rated health, vision, hearing, and cognitive performance than nondrivers at baseline. Seventeen percent of drivers in the study had vision of 6/18 or worse, and 7.3% were classified as possibly cognitively impaired. In those identified as drivers at baseline, subsequent cessation was associated with increasing age, low grip strength, poorer cognitive performance, and poorer self-rated health. CONCLUSION: Self-rated health and cognitive function were more important than medical conditions or sensory function for predicting driving cessation.

Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: the PATH Through Life Project.

AIMS: To investigate associations, including non-linear relationships, between cognitive function and alcohol consumption, testing for moderating effects of age and gender and for differences across outcome measures. Design Cross-sectional general population samples of three age cohorts. Setting Canberra and Queanbeyan, Australia. PARTICIPANTS: The total sample of 7485 consisted of 2404 men and women aged 20-24 years, 2530 aged 40-44 years, and 2551 aged 60-64 years, selected from the electoral rolls. Measurements Self-report data using hand-held computers provided weekly alcohol consumption from the Alcohol Use Disorders Identification Test (AUDIT) frequency, quantity and binge-drinking items, and socio-demographic factors. Spot-the-Word, digits backwards, the Symbol-Digit Modalities Test (SDMT), immediate recall and reaction-time tests were conducted by trained interviewers. FINDINGS: Findings varied across dependent variables, but there was a general tendency for light drinkers (up to 20/10 g alcohol per day in men/women, respectively) to perform better than abstainers, occasional drinkers or those drinking at hazardous/harmful levels (>40/20 g per day in men/women). Poorer performance of hazardous/harmful drinkers was seen only in men, whereas that of abstainers was evident in both sexes but was stronger in women. After adjustment for education and race, male hazardous/harmful drinkers no longer performed significantly less well than light drinkers, whereas male and female abstainers and occasional drinkers still did so. CONCLUSIONS: Abstainers have poorer cognitive function than light drinkers and further investigation is needed to determine what factors contribute to this.

Lower cognitive test scores observed in alcohol abstainers are associated with demographic, personality, and biological factors: the PATH Through Life Project.

AIMS: To identify variables that explain the association between alcohol abstention and cognitive performance. We hypothesized that demographic and personality variables would be important for explaining the association in all age cohorts, but that health variables would be more important in the older age-cohorts. DESIGN: Three age cohorts (20-24, 40-44, 60-64 years) were sampled randomly, yielding a total of 7485 participants, with data from 602 alcohol abstainers and 4158 light or moderate drinkers used in this study. Setting The sample was drawn from the cities of Canberra and Queanbeyan, Australia. MEASUREMENTS: Scales measuring demographic, health and personality variables and cognitive and physical tests were administered. Participants drinking at hazardous or harmful levels were excluded from the analysis. FINDINGS: A range of demographic and physical function measures were found to explain partially the finding of abstainers having lower cognitive test scores. The effects of independent variables were largest in the 60-64-year-old age group with a trend for physical variables such as lung function and grip strength to become more important in the older age groups. In the 20-24-year-olds, the majority of the effect remained unexplained. CONCLUSION: There is evidence that poorer cognitive test performance by abstainers reflects in part selection effects and poorer physical functioning, but does not appear to be due to mental or physical health conditions or personality.

A population survey found an association between self-reports of traumatic brain injury and increased psychiatric symptoms.

OBJECTIVE: This study determined whether self-reported Traumatic Brain Injury (TBI), identified in a community sample and occurring up to 60 years previously, is associated with current psychiatric symptoms, suicidality, and psychologic well-being. STUDY DESIGN AND SETTING: Three age cohorts (20-24, 40-44, 60-64) were randomly sampled from the cities of Canberra and Queanbeyan, Australia, yielding a total of 7,485 participants. The samples were administered scales measuring anxiety, depression, suicidality, positive and negative affect, personality traits, and physical health status. RESULTS: Of the total sample, 5.7% reported history of TBI involving loss of consciousness for at least 15 min, occurring an average of 22 years previously. History of TBI was associated with increased symptoms of depression, anxiety, negative affect, and suicidal ideation. CONCLUSION: History of TBI is a risk factor for psychiatric morbidity. The effect is greatest in young adults, and occurs up to several decades subsequent to the occurrence of TBI.

Understanding ageing in older Australians: the contribution of the Dynamic Analyses to Optimise Ageing (DYNOPTA) project to the evidence base and policy.

AIM: To describe the Dynamic Analyses to Optimise Ageing (DYNOPTA) project and illustrate its contributions to understanding ageing through innovative methodology, and investigations on outcomes based on the project themes. DYNOPTA provides a platform and technical expertise that may be used to combine other national and international datasets. METHODS: The DYNOPTA project has pooled and harmonised data from nine Australian longitudinal studies to create the largest available longitudinal dataset (n= 50652) on ageing in Australia. RESULTS: A range of findings have resulted from the study to date, including methodological advances, prevalence rates of disease and disability, and mapping trajectories of ageing with and without increasing morbidity. DYNOPTA also forms the basis of a microsimulation model that will provide projections of future costs of disease and disability for the baby boomer cohort. CONCLUSION: DYNOPTA contributes significantly to the Australian evidence base on ageing to inform key social and health policy domains.

Interventions to reduce the adverse psychosocial impact of driving cessation on older adults.

As a result of our aging population, the coming years will see increasing numbers of older adults faced with the prospect of giving up driving due to poor health or functional limitations. Driving cessation has been associated with negative psychosocial outcomes for older adults including restricted mobility and depression. While several studies report evaluations of interventions designed to help older adults to drive safely for longer, there is a paucity of published research concerned with the design or implementation of intervention programs intended to reduce the negative consequences of driving cessation. This paper reviews cognitive and educational interventions designed to promote older driver safety, and discusses possible approaches to the design and implementation of clinical interventions for older adults who have ceased driving. A broad framework for adaptable interventions based on the theoretical tenets of social cognitive theory, with an emphasis on planning for cessation, problem-solving and the involvement of friends and family members is proposed.

Hopelessness, demoralization and suicidal behaviour: the backdrop to welfare reform in Australia.

OBJECTIVES: To estimate rates of suicidal ideation and attempts, and psychological characteristics of demoralization among Australian income support recipients. To provide information for policy-makers to inform the current welfare reform discussion. METHOD: Data from the 1997 National Survey of Mental Health and Wellbeing were analysed using sequential logistic regression models, comparing working age people dependent on government income support payments with those having other main sources of income. RESULTS: Three groups of income support recipients, unemployed, lone mothers and disability payment recipients, reported significantly higher levels on all psychological measures related to demoralization (hopelessness, worthlessness and dissatisfaction with life) than non-recipients. A similar pattern was demonstrated for measures of suicidal ideation and reported suicide attempts, with increased odds of between 3 and 9 for these high-risk groups of welfare recipients. The elevated rates of suicidal ideation, attempts and demoralization among income support recipients were in part explained by sociodemographic characteristics (socioeconomic status, age, educational qualification, experience of serious violence, loneliness, experience of psychiatric disorders), though the unemployed and disability payment recipients remained elevated on the psychological measures. CONCLUSIONS: Demoralization, poor mental health and suicidal behaviour are common among income support recipients targeted by recently announced welfare reforms. This needs to be considered in the design and implementation of Australian Government policies. Psychiatric epidemiology has a key role in policy development and evaluation.

Measuring physical and mental health using the SF-12: implications for community surveys of mental health.

OBJECTIVE: The effects of using different approaches to scoring the SF-12 summary scales of physical and mental health were examined with a view to informing the design and interpretation of community-based survey research. METHOD: Data from a population-based study of 7485 participants in three cohorts aged 20-24, 40-44 and 60-64 years were used to examine relationships among measures of physical and mental health calculated from the same items using the SF-12 and RAND-12 approaches to scoring, and other measures of chronic physical conditions and psychological distress. RESULTS: A measure of physical health constructed using the RAND-12 scoring showed a monotonic negative association with psychological distress as measured by the Goldberg depression and anxiety scales. However, a non-monotonic association was evident in the relationship between SF-12 physical health scores and distress, with very high SF-12 physical health scores corresponding with high levels of distress. These relationships highlight difficulties in interpretation that can arise when using the SF-12 summary scales in some analytical contexts. CONCLUSIONS: It is recommended that community surveys that measure physical and mental functioning using the SF-12 items generate summary scores using the RAND-12 protocol in addition to the SF-12 approach. In general, researchers should be wary of using factor scores based on orthogonal rotation, which assumes that measures are uncorrelated, to represent constructs that have an actual association.

Association of pulmonary function with cognitive performance in early, middle and late adulthood.

BACKGROUND: Pulmonary function has been associated with some measures of cognitive performance, mostly in late adulthood. This study investigated whether this association is present for a range of cognitive measures, at three stages of adulthood, and whether it remains after controlling for demographic, health and lifestyle factors. METHOD: The relationship between forced expiratory volume at 1 s (FEV1), a measure of pulmonary function, and cognitive test performance was examined in three cohorts aged 20-24, 40-44 and 60-64. RESULTS: After controlling for demographic variables, smoking, physical activity, and respiratory disease, significant associations between FEV1 and cognitive test performance were evident in each age group for most cognitive measures. The association between FEV1 and measures of speed increased with age. CONCLUSION: FEV1 has a small but reliable positive association with cognitive test performance throughout adulthood, possibly reflecting a common physiological factor.