Childhood abuse/neglect and temporal patterns in late-life anxiety.

OBJECTIVES: Anxiety has been associated with childhood abuse/neglect, but this relationship and its mechanisms are poorly documented in older adults. This study examined the association between childhood abuse/neglect and late-life anxiety temporal patterns (i.e. absence, remission, incidence, persistence), testing for mediators. METHODS: Data were derived for 724 French-speaking community-living older adults participating in the Étude sur la santé des ainés - Services study with available information at baseline and 4-year follow-up. Past-month anxiety was based on a cutoff score ≥5 on a French translation of the 7-item Generalized Anxiety Disorder at interviews. Questions on childhood abuse/neglect (e.g. psycho-emotional, physical, sexual) were administered. Adjusted multinomial regression analyses and mediation bootstrapping models were used. Tested mediators included traumatic events (excluding childhood abuse/neglect), daily hassles, psychological resilience, and cortisol activity. RESULTS: The absence, remission, incidence and persistence of anxiety was found in 45.3%, 25.3%, 8.7% and 20.7% of the sample, respectively. Participants with incident and persistent late-life anxiety experienced more childhood abuse/neglect. Participants with persistent anxiety also reported lower psychological resilience. The association between childhood abuse/neglect with anxiety incidence was mediated by daily hassles, while its association with anxiety persistence was mediated by daily hassles and psychological resilience. CONCLUSION: Past childhood abuse/neglect was associated with late-life anxiety incidence and persistence, with psychological resilience and daily hassles potentially explaining this relationship. Further research should focus on ascertaining the clinical applications of psychosocial and biological profiles in informing the prevention and personalized treatment of anxiety in older adults.

Social Interactions among Older Adults Who Wish for Death.

Objectives: When the need for relatedness is frustrated, some older adults feel that life is not worth living and wish for death (WD). The aim of this study was to look at the perception of social interactions among older adults who express the WD.Methods: A probabilistic sample of 2787 French-speaking community-dwelling older adults aged 65 to 96 years (M = 73.8) took part in the Seniors Health Survey, a study on the prevalence of mental disorders which also collected information on various demographic and social variables.Results: Results showed that 5% of participants expressed WD. Participants who WD felt significantly more isolated and in conflict with their children than participants without WD. When sociodemographic variables, self-rated physical health, and depression were controlled, three social variables predicted WD in a logistic regression: being distant toward others, dissatisfaction with social life, and a lack of participation in organizations.Conclusions: Results of the present study support the interpersonal theory of suicide, which suggests that self-reported thwarted belongingness can foster WD.Clinical implications: Clinicians should consider social dissatisfaction and withdrawal as risk factors for WD and design interventions that foster social skills or meaningful connections.

Subjective sleep quality in non-demented older adults with and without cognitive impairment.

OBJECTIVE: Sleep problems are prevalent among older adults who are at risk of developing dementia. Until now, there have been relatively few studies investigating subjective sleep quality in these individuals. The first objective of this study was to compare seniors with cognitive impairment no dementia (CIND) and older adults without cognitive impairment (non-CIND) on several subjective sleep measures. The second objective was to verify whether sleep parameters associated with CIND differ between men and women. METHODS: The population sample consisted of 2287 French-speaking older adults from Québec (Canada) aged between 65 and 96 years. Participants were classified as CIND or non-CIND on the basis of their mini mental state examination score using sex, age, and education-stratified normative data. All participants completed the Pittsburgh Sleep Quality Index, and responses of CIND and non-CIND individuals were compared. A series of confounding variables (age, education, chronic diseases, mood disorders, anxiety disorders, and use of psychotropic drugs) were statistically controlled for. Student's t-tests were performed to compare characteristics of CIND and non-CIND individuals; data from male and female participants were analyzed separately. Moreover, the association between each sleep variable and CIND was measured by odds ratios based on logistic regression. RESULTS: On the whole, analyses revealed no significant association between subjective sleep parameters and CIND. Moreover, no difference was observed between men and women regarding subjective sleep quality. CONCLUSIONS: Overall, these results suggest that subjective measures of sleep do not allow differentiating cognitively impaired older individuals from those with normal cognition.

Cognitive fatigue weakens the effects of distraction on pain.

ABSTRACT: Perceived pain can be viewed because of a competition between nociceptive inputs and other competing goals, such as performing a demanding cognitive task. Task performance, however, suffers when cognitively fatigued. We therefore predicted that cognitive fatigue would weaken the pain-reducing effects of performing a concurrent cognitive task, which would indicate a causal link between fatigue and heightened pain sensitivity. In this study, 2 groups of pain-free adults performed cognitive tasks while receiving painful heat stimuli. In 1 group, we induced cognitive fatigue before performing the tasks. We found that fatigue led to more pain and worse performance when the task was demanding, suggesting that fatigue weakens one's ability to distract from pain. These findings show that cognitive fatigue can impair performance on subsequent tasks and that this impairment can lower a person's ability to distract from and reduce their pain.

Character Strengths and Resilience in Older Adults during the COVID-19 Pandemic.

During the pandemic, older adults were perceived as a vulnerable group without considering their various strengths. This study explored the associations between character strengths and resilience, and verified if some of these could predict resilience during the COVID-19 pandemic. A sample of 92 participants (women = 79.1%), ≥ 70 years of age (mean = 75.6 years), completed an online version of the Values in Action Inventory of Strengths - Positively keyed (VIA-IS-P) to assess 24 character strengths (grouped under six virtues) and the Connor and Davidson Resilience Scale. Results showed that 20 of the 24 strengths correlated positively and significantly with resilience. A multiple regression analysis revealed that the virtues of courage and transcendence, as well as attitudes toward aging, uniquely predicted the level of resilience. Interventions should be developed to improve certain strengths (e.g., creativity, zest, hope, humor, and curiosity), while reducing ageism, in order to promote resilience.

Daily hassles, physical illness, and sleep problems in older adults with wishes to die.

BACKGROUND: Factors associated with the wish to die should be investigated in order to gain more opportunities for preventive interventions targeting older adults at risk for suicide. The goal of the research was to study the prevalence and associated factors of wishes to die in older adults living in the community using the data from a survey on the prevalence of mental disorders in this population. METHODS: With a representative sample of community living older adults aged 65 years and over (N = 2777), we compared individuals with the wish to die (n = 163) to those without the wish to die on the basis of the presence and severity of daily hassles, physical illness, and sleep quality. RESULTS: Logistic regression revealed that when depression and sociodemographic variables were held constant, self-rated physical health, number of chronic illnesses, number and intensity of daily hassles, as well as sleep problems were significantly associated with the wish to die in older adults. Painful illnesses and daytime dysfunction due to sleep problems were also associated factors with the wish to die. CONCLUSION: Since desire for death is the first step into the suicidal process, health professionals should seriously consider the important and unique contribution of these variables in order to have more opportunities for detection and intervention.

Evaluation of the Effects of an Intervention Intended to Optimize the Sleep Environment Among the Elderly: An Exploratory Study.

PURPOSE: The objective of this exploratory study was to evaluate the effects of a brief intervention intended to optimize the sleep environment in older people living in the community and to examine the way these effects change over time. METHODS: The sample was made up of 44 participants (19 men and 25 women) aged 65-85 years, with a mean age of 71.4. The intervention consisted in a group training session that covered the reasons for and ways to ("why" and "how") optimize a sleep environment. It comprises six themes: air quality and odors, luminosity, noises and sounds, comfort of the mattress, comfort of the pillow, and temperature. Participants completed a set of questionnaires before the intervention, and one month and four months later. RESULTS: Four months after the intervention, the replies to the questionnaires showed that the participants experienced reduced severity of insomnia, sleep latency and anxiety. The subjective quality of the participants' sleep along with their sleep efficacy also increased significantly during the same period. CONCLUSION: A brief intervention intended to optimize the sleep environment appears promising as an addition or alternative to the two other sleep improvement options generally offered to older people: medication and cognitive behavioral therapy.

Factors involved in sleep efficiency: a population-based study of community-dwelling elderly persons.

STUDY OBJECTIVES: Research indicates that sleep efficiency below 80% substantially increases mortality risk in elderly persons. The aim of this study was to identify factors that would best predict poor sleep efficiency in the elderly, and to determine whether associations between these factors and sleep efficiency were similar for men and women and for younger and older elderly persons. METHODS: A total of 2468 individuals aged 65-96 years (40.7% men) participated. They were recruited via random generation of telephone numbers according to a geographic sampling strategy. The participants agreed to have health professionals visit their home and to answer structured interview questions. Sleep efficiency was calculated based on interview responses. Descriptive statistics and logistic regressions were conducted. RESULTS: The factors most strongly associated with sleep efficiency below 80% were pain, nocturia, sleep medication use, and awakening from bad dreams. Some factors varied by sex: women aged 75 years and older or who had an anxiety disorder were more likely to have sleep efficiency below 80%, whereas being single or having painful illness raised the likelihood for men only. Except for sex, all the factors that showed associations with sleep efficiency affected younger and older elderly persons similarly. CONCLUSIONS: Poor sleep efficiency is prevalent among elderly persons. The results shed new light on factors associated with poor sleep efficiency, highlighting the presence of sex differences and that certain factors make no significant contribution, such as typically proscribed sleep hygiene behaviors, mood disorders, and illness in general.

Sleep Environment and Insomnia in Elderly Persons Living at Home.

The aim of this study was to draw a portrait of the sleep environment of elderly persons living in private households and to determine its relationship with the presence of insomnia. A sample of 599 individuals aged 70 years and older responded to questions about the comfort of their pillow and mattress and the noise level and brightness of their bedroom at night and in the morning. They were also asked whether or not they shared their bed or bedroom with a sleep partner. The Insomnia Severity Index was used to assess insomnia severity. Over 40% of the study participants were using a pillow that was not very comfortable, and almost 30% said that their bedroom was not completely quiet. Binomial logistic regression results revealed that two variables were significantly associated with insomnia symptoms: a pillow rated as moderately comfortable to very uncomfortable and a bedroom that was not completely quiet. No other sleep environment characteristics considered in this study were associated with the risk of insomnia. These results indicate that a nonnegligible proportion of the elderly population endures a suboptimal sleep environment. Although it is difficult to predict the real impact of changes to the sleep environment, this study supports the proposal that simple, minor changes to the bedroom can promote sleep in the elderly.

Sleep cognitions associated with anxiety and depression in the elderly.

PURPOSE: The objective of this study was to identify the maladaptive sleep-related cognitions most often maintained by the elderly, according to the presence or absence of anxiety and mood disorders. The presence of dysfunctional sleep-related beliefs and attitudes at bedtime in asymptomatic, depressive, and anxious seniors was thus compared. The second objective was to verify the relationships between various dysfunctional cognitions and mental disorders. METHOD: The sample in this study consisted of 2,759 participants aged 65 years and over, with a mean age of 73.8 years. They were recruited through a method of random generation of telephone numbers according to a sampling strategy based on geographic location. After the goal of the study was explained to them, the participants agreed to have health professionals visit their home and to answer questions in a 1.5-hour-long structured interview (after signing a consent form). RESULTS: Depressive and anxious seniors adopt dysfunctional sleep-related cognitions in higher proportions than asymptomatic older persons. Once we had controlled for the other factors, we were able to specifically link two sleep-related beliefs and all the sleep-related attitudes studied to the probability of being anxious or depressive. CONCLUSION: The clarifications obtained will make it possible to improve detection, assessment, and intervention processes regarding anxiety or mood disorders, by pinpointing the most direct link between each of the dysfunctional cognitions and the two types of mental disorders, and not just the link to sleep problems.

Sleep problems in anxious and depressive older adults.

PURPOSE: The objective of this study was to identify the sleep problems most often encountered by the elderly according to the presence or absence of anxiety and mood disorders. The aim was also to determine whether groups of anxious, depressive, and asymptomatic individuals differ in relation to sleep onset latency; awakenings at night or early in the morning; subjective quality of sleep; taking of sleep medication; and daytime sleepiness. METHODS: Structured interviews based on the DSM-IV-TR were administered to a sample of 2,759 seniors aged 65 years and older at the participants' home by health professionals. RESULTS: Awakening was found to be the most common disturbance. Increased sleep onset latency was the second most frequent sleep difficulty. Taking more than 30 minutes to fall asleep was associated with the likelihood of meeting the diagnostic criteria for an anxiety disorder, and even reduced the risk of meeting the diagnostic criteria for a mood disorder rather than an anxiety disorder. Awakenings were associated with the probability of suffering from an anxiety disorder or a mood disorder. Quality of sleep, as perceived by the elderly, was not found to be associated with the probability of suffering from a mental disorder. CONCLUSION: These findings should help to facilitate the practitioner's diagnosis and add further nuances to be considered when encountering symptoms of an anxious or depressive appearance. All of these data also add fuel to the ongoing debate about whether anxiety and depression are one or two distinct categories of disorders.

The relationship between sleep habits, anxiety, and depression in the elderly.

PURPOSE: The objective of this study is to determine which sleep-related behaviors are most often used by the elderly according to the presence or absence of anxiety and mood disorders. In particular, we are attempting to determine whether these behaviors are associated with the probability of suffering from a mental disorder. The behaviors being examined in the present study are taking naps, television watching or reading at bedtime, physical exercise at bedtime, relaxing activities at bedtime, and caffeine consumption in the evening. METHODS: The sample in this study consists of 2,759 participants aged 65 and over, with a mean age of 73.8. They were recruited through a method of random generation of telephone numbers according to a sampling strategy based on geographic location. After the goal of the study was explained to them, the participants agreed to have health professionals visit their home and to answer questions in an hour-and-a-half-long structured interview (after signing a consent form). RESULTS: Taking naps is the activity most often practiced by the elderly. Watching television and reading at bedtime are also frequent practices among them. The probabilities of suffering from anxiety are greater if the person never or rarely consumes caffeine after 6 pm, if the individual takes naps during the day, or if the person practices relaxation before bedtime. Television watching, reading, and physical exercise before bedtime are activities that are not associated with the probability of suffering from a mental disorder. CONCLUSION: It would be beneficial for research to be conducted to support the findings on behavioral differences between depressive and anxious seniors so that these behaviors can become further indicators of the presence of mental disorders.

Evolutionary function of dreams: A test of the threat simulation theory in recurrent dreams.

proposed an intriguing and detailed evolutionary theory of dreams which stipulates that the biological function of dreaming is to simulate threatening events and to rehearse threat avoidance behaviors. The goal of the present study was to test this theory using a sample of 212 recurrent dreams that was scored using a slightly expanded version of the DreamThreat rating scale. Six of the eight hypotheses tested were supported. Among the positive findings, 66% of the recurrent dream reports contained one or more threats, the threats tended to be dangerous and aimed at the dreamer, and when facing a threat, the dreamer tended to take defensive or evasive actions that were possible and reasonable. However, less than 15% of the recurrent dreams depicted realistic and probable situations critical for one's physical survival or reproductive success and the dreamer rarely succeeded in fleeing the threat despite important and appropriate efforts. The findings thus provide mixed support for the threat simulation theory.