Investigating the role of perception of aging and associated factors in death anxiety among the elderly.

BACKGROUND AND OBJECTIVES: The world's growing elderly population highlights the necessity for further attention to the psychological problems of the elderly, such as death anxiety. Analysis of the elderly's perception of aging and associated factors can contribute to prediction of their future physical and mental health. The purpose of this study was to determine the relationship of perception of aging, and a group of demographic factors, with death anxiety in the elderly living in Gonabad, Iran. SUBJECTS AND METHODS: This analytical descriptive study was conducted on 330 elderly residents of Gonabad, who were selected by stratified random sampling. Research tools were a standard demographic questionnaire, Barker's Brief Aging Perceptions Questionnaire, and Collett-Lester Fear of Death Scale. Data were collected by interview of respondents at their home. Data analysis was carried out in SPSS 16 using descriptive statistics, analysis of variance, Pearson's test, independent t-test, and linear regression. RESULTS: Respondents had a mean age of 73.97±7.68 years, 42.4% of respondents were men and 57.6% were women. The total Barker's Brief Aging Perceptions Questionnaire score was 63.18±8.75, with the highest score (17.10±4.70) associated with negative consequences and control. The total Collett-Lester Fear of Death Scale score was 128±14.80, with the highest score (35.13±4.06) pertaining to the subscale fear of other people's death. Regression results indicated that the death anxiety score was predictable according to the age and all dimensions of perception of aging, except for the consequences and negative control dimension. CONCLUSION: Age and the perception of aging are good predictors of death anxiety. The authors recommend further research on the determinants of death anxiety in the elderly and the development of a comprehensive care plan to reduce this anxiety among Iranian elderly.

Older African Americans' Beliefs about Pain, Biomedicine, and Spiritual Medicine.

Persistent (chronic) pain prompts older African Americans (AAs) to utilize a combination of biomedicine (BM) and spiritual medicine (SM)for pain management. Because less is known about how older AAs use these pain management interventions, healthcare providers are unable to provide holistic care and optimal pain management. Using a Christian and Afrocentric perspective, this article reviews older AAs use of BM and SM, offering reconmendations on how to integrate BM and SM for pain management.

Do older t'ai chi practitioners have better attention and memory function?

OBJECTIVES: Cognitive declines are common in older people and can be a major health issue in an aging world. One type of body-mind exercises, t'ai chi, can be a possible means to help maintaining older adults' cognitive abilities, in addition to beneficial effects of physical exercises. The purpose of this study was to investigate whether t'ai chi practitioners had better attention and memory functions than older people with or without regular exercises. METHODS: A cross-sectional study examining the relationship between t'ai chi practice and age-, gender- and education-similar older peoples' attention and memory functions. Forty-two (42) community-dwelling elderly subjects, aged 60 or older, recruited from t'ai chi clubs in Hong Kong formed the t'ai chi group. Another 49 elderly having regular exercise habits were recruited from community centers for inclusion in the exercise group. A nonexercise group (normal healthy control) consisting of 44 subjects were also recruited by random selection and through contacting local elderly centers. They were also screened by the Modified Barthel Index, Chinese Mini-mental Status Examination, Geriatric Depression Scale, and evaluated by attention tests (Color Trail Form A-1 and 2) and memory tests (including Rivermead Behavioral Memory Test and The Hong Kong List Learning Test). RESULTS: The main finding was that the three groups differed in attention and memory functions, and the t'ai chi group had demonstrated better performance than the other two groups in most subtests. CONCLUSIONS: As a causal relationship cannot be assumed in the present cross-sectional study, future research is required to examine how t'ai chi can improve cognitive function using a randomized control trial as well as determining whether t'ai chi practice can lead to better health status among elderly people.

[Dance therapeutic workshop for elderly people living in a home]. / Atelier de danse thérapie à destination des personnes agées en maison de retraite.

Elderly persons are often depressive; thus they are in loss of desire and motivation. They don't take care anymore of themselves and seem disembodied. It is exactly on this loss of desire that arts therapies have an impact. This involvement of the body facilitates the awareness of one's often unexploited capacities but also allows the emergence of pleasure and finally desire. Arts therapies are based on the conscience of here and now, with the perspective to become a creative being. It is the matter of helping people to recognize their own creativity that was underestimated by themselves up to here. These sessions allow the patients to go out of their room while bringing them a sensation of relaxation and well-being. They are proud to produce something by themselves and recover thus a certain self-esteem. And, through this activity, they are able to express what they feel. The statistical computations are made with the data of 10 elderly persons aged 77 to 95 years. We analyze the rating scales for self-expression through movement during 10 sessions. The subjects also filled in the Campbell's Index of Well-being in T1 and T2. Arts therapies improve in a significant way the cognitive functioning and the psychological well-being of elderly persons, as well as their quality of life.

Association between body mass index and cognitive function among Chinese nonagenarians/centenarians.

AIMS: We examined the individual association between body mass index (BMI) and cognitive function among the very elderly. METHODS: The present study analyzed data from a survey that was conducted on all residents aged 90 years or more from a district which had 2,311,709 inhabitants in 2005. The subjects were divided into 4 groups according to quartiles of BMI (<16.6, 16.6-18.9, 18.9-21.1 and >21.1), and according to classification criteria of underweight, normal weight, overweight and obesity in BMI (<18.5, 18.5-23.0, 23.0-27.5 and >27.5), respectively. RESULTS: The subjects included in the statistical analysis were 211 men and 427 women. Those in the 3rd quartile of BMI (18.9-21.1) had higher cognitive function scores (p < 0.001) and were less likely to present possible dementia (p = 0.016) than the others. However, there was no difference in cognitive function scores (p = 0.350) or prevalence of possible dementia (p = 0.263) among obesity, overweight, normal weight and underweight groups. CONCLUSIONS: Concerning longevity in Chinese, there is an association between BMI and cognitive function. BMI of around 20 (18.9-21.1) is associated with the lowest risk of prevalence of possible dementia and the highest cognitive function scores.

Perceptions of spirituality and spiritual care among older nursing home residents at the end of life.

BACKGROUND: Spirituality is of particular importance in the lives of many older adults at the end of life. While the role of spirituality may differ among older adults, spirituality may offer a purpose and meaning toward the end of life and provides a framework for managing concerns and decisions at this time. Despite the increasingly evident role of spirituality in the United States, the spirituality of older adults has been neglected. Moreover, little research has been undertaken to determine how nurses may best help older adults improve spiritual health. PURPOSE: The purpose of this analysis was to investigate perceptions of spirituality and spiritual care among older nursing home residents at the end of life. METHODS: A total of 26 older long-term care residents were surveyed using the Spirituality and Spiritual Care Rating scale from 2 faith-based nursing facilities to better understand residents' spirituality and perception of spiritual care. FINDINGS: Descriptive statistics were used to analyze the participant's perceptions of spirituality and spiritual care. The 2 samples in this study received a mean score of 51.36 (SD = 5.99) with a range of 43 to 68, indicating moderately high views of aspects of spirituality and spiritual care among the sample, supporting spirituality as a framework for life. The sample reported on several interventions that nurses could use to support spirituality, including arranging visits with religious personnel, showing kindness, spending time listening to residents (presence), and showing respect for resident's needs. IMPLICATIONS: The results of the study provide information that may be used to increase knowledge and improve spiritual interventions for nursing home residents at the end of life.

The meaning of time in oldest-old age.

In a phenomenological study that described the lived experience of adults older than 85 years, 19 oldest-old adults' lived time is illuminated by 5 themes: Defining Self Through Experience, Being Situated in Time, Knowing Lifetime Is Limited, Planning for the Future, and Leaving a Legacy.

Views on dignity of elderly nursing home residents.

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

Perceived barriers to trying self-management approaches for chronic pain in older persons.

OBJECTIVES: To examine older persons' willingness to participate in exercise and relaxation programs for managing chronic pain, to identify characteristics associated with willingness to participate, and to ascertain their barriers to participation. DESIGN: Cross-sectional survey. SETTING: A geriatric ambulatory care practice located in New York, New York, and the General Clinical Research Center of Weill Cornell Medical College. PARTICIPANTS: Sixty-eight English-speaking patients aged 70 and older with chronic pain. MEASUREMENTS: Participants' level of willingness to participate in the programs was assessed using 5-point Likert scales, and information regarding their demographic, clinical, psychological, and pain status was obtained. Qualitative methods were used to ascertain participants' perceived barriers to participation. RESULTS: Participants had a mean age+/-standard deviation of 81.9+/-7.0 and were mostly white (85%) and female (68%). Although only 16% of participants reported current use of exercise as a pain-management strategy, 73% reported a willingness to try the exercise program. Four percent reported current use of relaxation methods; 70% reported an interest in learning these techniques. Moderate correlations were found between increasing days of restricted activity due to pain and greater willingness to participate. Seventeen unique barriers were identified; the mean number of barriers reported per person was 2.9+/-1.8 for exercise and 2.2+/-1.4 for relaxation. Commonly reported barriers to participating in either program included time conflicts, transportation, treatment efficacy concerns, and fear of pain or injury. CONCLUSION: Older primary care patients with chronic pain are willing to try exercise and relaxation therapies to help manage pain but report a substantial number of barriers to participating in these programs. Addressing patient-level barriers could improve engagement in and adherence to exercise and relaxation therapies for managing pain in older persons.

A randomized, observer-blind, controlled trial of the traditional Chinese medicine Yi-Gan San for improvement of behavioral and psychological symptoms and activities of daily living in dementia patients.

OBJECTIVE: This randomized, observer-blind, controlled trial examined the efficacy and safety of the traditional Chinese herbal medicine Yi-Gan San (YGS, Yokukan-San in Japanese) in the improvement of behavioral and psychological symptoms of dementia (BPSD) and activities of daily living (ADL). METHOD: Fifty-two patients with mild-to-severe dementia (24 men and 28 women, mean +/- SD age = 80.3 +/- 9.0 years) according to DSM-IV criteria were investigated. Participants were randomly assigned to the YGS group (N = 27) or control (drug-free) group (N = 25) and treated for 4 weeks. The Neuropsychiatric Inventory (NPI) for the assessment of BPSD, the Mini-Mental State Examination (MMSE) for cognitive function, and the Barthel Index for ADL were administered at baseline and the end of the treatment. The frequency of extrapyramidal symptoms (EPS) and other adverse events was recorded. If patients showed insufficient response to treatment after 1 week, tiapride hydrochloride, a dopamine D(1) selective neuroleptic, was added to the regimen. Data were collected from January 2004 to March 2004. RESULTS: All participants in both groups completed the trial. In the control group, 11 patients required treatment with tiapride hydrochloride. Significant improvements in mean +/- SD NPI (from 37.9 +/- 16.1 to 19.5 +/- 15.6) and Barthel Index (from 56.4 +/- 34.2 to 62.9 +/- 35.2) scores were observed in the YGS group, but not in the control group. MMSE results were unchanged in both groups. EPS were not observed in either group, but dizziness and impaired postural sway were observed in 6 patients treated with tiapride hydrochloride. CONCLUSION: Yi-Gan San improves BPSD and ADL. Follow-up studies using a double-blinded, placebo-controlled design are recommended.

Living will, resuscitation preferences, and attitudes towards life in an aged population.

BACKGROUND: The growth of life-sustaining medical technology and greater attention to medical care at the end of life have provoked interest in issues related to advance care planning. OBJECTIVE: To investigate how having a living will (LW), resuscitation preferences, health condition, and life attitudes are related in home-dwelling elderly people. METHODS: In a cross-sectional descriptive study, detailed assessments were made of 378 home-dwelling elderly individuals participating in a cardiovascular prevention study (DEBATE Study). The participants were inquired about a preexistence of a written document (LW) concerning life-sustaining care, preferences of cardiopulmonary resuscitation (CPR) in their current situation, and attitudes towards life. General health, physical and cognitive functioning, the presence of depression, and quality of life were also assessed. RESULTS: Forty-four of the 378 participants (12%) had a LW. As compared with those without one (n = 334), there were more women [82% (36/44) vs. 63% (210/334)] and widows [57% (25/44) vs. 41% (135/334)] among those with a LW. They were also more educated and considered their health to be better. Despite having a LW, 46% (20/44) of them preferred CPR in their current condition, a proportion not statistically different from the 58% (194/334) of the individuals without a LW. In the whole sample, 39% (149/378) of the individuals preferred to forgo CPR. As compared with those preferring CPR, they were older, more often women, and widowed. Participants preferring to forgo CPR had a poorer quality of life, were more lonely, and showed signs of depression more often than those preferring CPR. The preference to forgo CPR was related to attitudes towards life regardless of physical or cognitive functioning. CONCLUSIONS: Having a LW does not reduce the reported preference of CPR which is related more to current mental status and life attitudes. In-depth assessment of the patient's preferences should be performed in any comprehensive care plan.

Spirituality and well-being in frail and nonfrail older adults.

Previous studies have identified that spiritual beliefs contribute to psychological well-being (PWB) in older people, but limited research has considered the effects of spirituality on PWB when physical health deteriorates and people become frail. We recruited 233 British participants from warden-controlled retirement housing to complete interviewer-administered questionnaires. Results showed that, after we controlled for marital status, age, education, other health problems, and gender, degree of frailty had a negative effect on PWB. Spirituality was also a significant predictor of PWB and moderated the negative effects of frailty on PWB. Therefore, this study suggests that spirituality is a resource in maintaining PWB, and that the use of this resource is more significant for individuals with greater levels of frailty.

Depression and anxiety in older women.

The recommended shift in paradigm for assessment and treatment of depression and anxiety in the primary care setting includes a more holistic medical care approach, one that pays attention to the patient's mental health status and her functional level of social role recovery in addition to symptom relief. Practice Guidelines of professional specialities should be expanded to include attention to initializing mental health care in primary care practice and parameters for early referral and, if indicated, later follow-up. Our medical education system, at all levels, needs to become considerably more inclusive of issues of aging, gender, and mental health. Ongoing attention must be given to the health care cost burden of under recognition and under treatment of anxiety and depression, alleviation of stigma, treatment to functional recovery, and alleviation of caregiver burden.

[Holistic perspective is needed in care of multiimpaired elderly. A proposal for structural change of the organization of care in the county of Stockholm]. / Helhetssyn behövs i vården av multisviktande äldre. Förslag till förändring av vård- och omsorgsstrukturen i Stockholms län.

Studies in the County of Stockholm reveal a malfunctioning care system for elderly persons with one or more diseases in conjunction with immobility and reduced strength. These multi-impaired elderly consume a substantial proportion of care and rehabilitation services. They would need a health co-ordinator to monitor the entire care process, dealing with all aspects of care, and whose sphere of responsibility is not unduly restricted. The communication of information from inpatient care to the primary care setting is highly problematic. Therefore it is proposed that the transfer of multi-impaired elderly individuals from inpatient care to outpatient primary care be a carefully monitored process. In addition, outside of the hospital an "elderly team" that would be composed of doctors, district nurses, rehabilitation personnel and care assistants is proposed. This team should have a geographically well-defined area of responsibility, in which they would provide care in the homes of these multi-impaired elderly.

Nurturing hope and spirituality in the nursing home.

Nurturing body, mind, and spirit is part of holistic care, and yet often the primary focus of care in nursing homes is physical needs. As part of a larger study examining factors related to hope among institutionalized elders, spirituality emerged as the only significant predictor of hope. Findings supported the active presence of hope despite age and functional limitations. The significant contribution of spirituality to hope calls for attention to the provision of opportunities to support and enhance spiritual practices in the nursing home setting. Nurses in nursing homes have the opportunity to establish close relationships with residents over time, often substituting for family and friends no longer available. Because length of stay is long, more time is available to enter into meaningful spirit-sharing relationships with residents. Suggestions for interventions that nurture hope and spirituality within a holistic and caring framework are presented.