Validation of the Spanish version of the Perceived Control Scale: Perceived Constraints on Personal Control and Perceived Mastery.

OBJECTIVES: Perceived control is a relevant variable for understanding middle and older adults' mental health. The Perceived Control Scale has two dimensions, Perceived Constraints on Personal Control and Perceived Mastery, and is a widely used instrument for assessing perceived control in adults. The aim of this study was to analyze the psychometric properties of the Spanish version of the Perceived Control Scale with data from two different studies. METHOD: In Study 1, 348 older adults between 60 and 92 years old were assessed through face-to-face assessments. In Study 2, 334 adults between 40 and 90 years completed an online survey. Perceived control, self-perceptions of aging, and anxiety and depressive symptomatology were assessed. An exploratory (Study 1) and confirmatory (Study 2) factor analysis of the Perceived Control Scale were performed, and reliability and its relationship with the other assessed variables were evaluated. RESULTS: Results from parallel, exploratory, and confirmatory factor analyses suggested that the Spanish version of the Perceived Control Scale has a bidimensional structure: Perceived Constraints on Personal Control and Perceived Mastery. Good internal consistency was found for the scale in both samples. The results revealed negative and significant associations with negative self-perceptions of aging, and anxiety and depressive symptomatology. CONCLUSION: The Spanish version of the Perceived Control Scale shows good psychometric properties which endorse its use with middle-aged and older adults assessed either face-to-face or through online surveys.

'Who tells me when to stay active or to leave?' age differences in and predictors of endorsement of prescriptive views of aging.

OBJECTIVES: Prescriptive views of aging (PVoA) are normative age-based expectations about age-appropriate behavior for older adults, e.g. that they should stay fit/active (active aging norms) but also behave altruistically toward younger generations (altruistic disengagement norms). We aimed at examining age differences in endorsement of active aging and altruistic disengagement and investigated predictors of endorsement. METHOD: In the AGEISM Germany survey, a representative sample of N = 1,915 German participants was recruited, covering a wide age range (Mage=56.57 years, 16-96 years). Cross-sectional data was collected via computer-assisted telephone interviews. RESULTS: Active aging was more strongly endorsed than altruistic disengagement. Endorsement of both PVoA was higher in older age groups - even more pronounced for altruistic disengagement. Endorsement of both norms was positively associated with positive age stereotypes. Furthermore, active aging was predicted by age centrality whereas altruistic disengagement was predicted by negative age stereotypes. Age was still a robust predictor of PVoA even after entering additional predictors. CONCLUSION: Although associated, prescriptive age norms (i.e. beliefs how older people should behave) and descriptive age norms (i.e. beliefs about how older adults and the aging process are like) represent partly independent belief systems, highlighting the importance to assess & further investigate predictors and consequences of PVoA, which become more prevalent with age.

Associations Between Dysfunctional Thoughts, Leisure Activities, and IL-6 in Caregivers of Family Members With Dementia.

OBJECTIVE: Dementia caregiving is associated with negative physical health consequences, including inflammation processes. The objective of this study was to analyze the associations between dysfunctional thoughts, frequency of leisure activities, and interleukin 6 (IL-6) in a sample of dementia family caregivers. METHODS: One hundred forty dementia caregivers participated in this cross-sectional study. The relationships among caregivers' dysfunctional thoughts, leisure activities, and IL-6 were adjusted for demographic characteristics, stressors, and physical and mental health indicators in a linear regression analysis. RESULTS: Higher levels of dysfunctional thoughts ( t = -2.02, p = .045) were significantly associated with lower frequency of leisure activities. In turn, lower frequency of leisure activities was significantly associated with higher levels of IL-6 ( t = -2.03, p = .045). Dysfunctional thoughts were no longer significantly associated with IL-6 levels when both dysfunctional thoughts and leisure activities were included in the same model ( t = 1.78, p = .076). A significant indirect effect was found for the association between higher levels of dysfunctional thoughts and higher levels of IL-6 (standardized indirect effect = 0.036, bootstrap standard error = 0.026, 95% confidence interval = 0.0001-0.1000) through its association with fewer leisure activities. CONCLUSIONS: Our findings suggest that the direct effect of caregivers' dysfunctional thoughts on IL-6 may be mediated by the impact on caregivers' frequency of leisure activities. Results suggest that training caregivers in reducing dysfunctional thoughts to thereby increase leisure activities may be useful in reducing inflammation.

'I feel old and have aging stereotypes'. Internalized aging stereotypes and older adults' mental health: the mediational role of loneliness.

OBJECTIVES: The main objective of this study was to analyze the role of aging stereotype activation (when older adults with aging stereotypes begin to consider themselves as older persons) in the relationship between ageist stereotypes, depressive, anxiety, loneliness, and comorbid anxiety-depressive symptoms. METHODS: Participants were 182 autonomous community-dwelling people between 60 and 88 (mean age = 72.30; SD = 5.53). Three path models were tested exploring the role of considering oneself as an older person as a moderator variable. Ageist stereotypes were included as the independent variable, loneliness as the mediating variable, and anxiety symptoms, depressive symptoms, and comorbid anxiety-depressive symptoms as dependent variables for each model. RESULTS: The results suggest an influence of ageist stereotypes on anxiety, depressive, and comorbid anxiety-depressive symptoms only in older adults who consider themselves as older persons, and mediated by loneliness. CONCLUSION: This study suggests that, when someone considers him or herself as an older person, ageist stereotypes activate loneliness feelings, and this activation is associated with psychological distress, including anxiety, depressive, and comorbid anxiety-depressive symptoms.

Family caregivers of people with dementia in the context of the sociocultural stress and coping model: An examination of gender differences.

The study assessed gender differences in the associations between familism dimensions, dysfunctional thoughts, and resource and outcome variables in 190 Spanish dementia family caregivers. A theoretical model was tested through path analysis, obtaining an excellent fit of the model to the data. Higher scores in the familial obligations dimension were associated with lower self-efficacy for self-care and obtaining respite and leisure frequency, and higher anxious and depressive feelings, in female caregivers only. Significant between-gender differences were obtained, suggesting that female caregivers holding strong familistic values are more vulnerable to the negative consequences of caregiving compared to male caregivers.

Associations between pleasant events, activity restriction, stressors, and blood pressure in caregivers of persons with dementia.

OBJECTIVES: Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure. DESIGN: Face-to-face interviews and cross-sectional analyses. SETTING: Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain. PARTICIPANTS: One hundred and two family caregivers of a spouse or parent with dementia. MEASUREMENTS: Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer. RESULTS: The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events. CONCLUSIONS: The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers' levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers' activity restriction in the theoretical framework of the model.

To pay attention or not: The associations between attentional bias towards negative emotional information and anxiety, guilt feelings, and experiential avoidance in dementia family caregivers.

Caring for a relative with dementia has been linked to negative consequences for caregivers' psychological health, such as anxiety or guilt. Cognitive theories of psychopathology propose that attentional bias towards negative stimuli contribute to the development and maintenance of emotional disorders and clinical symptomatology. However, attentional bias has scarcely been explored in dementia family caregivers. The aim of this study was to examine the relationship between attentional bias and anxiety symptomatology, guilt feelings, and experiential avoidance in a sample of dementia family caregivers. Participants were 226 dementia family caregivers. Attentional bias was measured using a novel priming adaptation of the dot-probe task. The sample was divided into high and low anxiety symptomatology, guilt feelings, and experiential avoidance groups. The results revealed two opposite patterns of emotional information processing in dementia family caregivers. While anxiety was found to be associated with an attentional preference for negative information, experiential avoidance was related to attentional avoidance of this information. Although guilt was also related to an attentional preference for negative information, this relationship was no longer significant when controlling for anxiety levels. These inflexible attentional patterns may have negative clinical consequences, given that in both cases relevant information necessary for adaptive coping with the stressful situation of caregiving may be unattended to or omitted.

"I Feel Guilty". Exploring Guilt-Related Dynamics in Family Caregivers of People with Dementia.

Objectives: Family caregivers of people with dementia often report feelings of guilt. However, the number of studies analyzing guilt and the factors associated with its appearance are scarce. The aim of this study is to explore the subjective experience of guilt in the family care of people with dementia.Methods: A qualitative analysis of the narratives of 13 family caregivers of people with dementia about their feelings of guilt was done.Results: Seven categories for understanding guilt in caregiving were obtained: guilt derived from actions themselves; guilt derived from one's limitations; guilt for feeling negative emotions; guilt associated with the change in the relationship with the person cared for; guilt for neglecting other areas; guilt induced by the person cared for, and guilt induced by others. The results showed the existence of cases in which guilt is absent by distress-avoiding processes.Conclusions: Guilt is a relevant variable in understanding caregiver distress, and its analysis is necessary for therapeutic work in the field of care.Clinical implications: Psychological interventions aimed at family caregivers should include specific techniques in order to address guilt feelings.

Guilt Focused Intervention for Family Caregivers. Preliminary Results of a Randomized Clinical Trial.

OBJECTIVES: A pilot randomized controlled trial study was conducted for testing the efficacy of a novel Guilt Focused Intervention (GFI), that was compared with a Cognitive Behavioral Intervention (CBI) for caregivers of people with dementia with high levels of guilt and distress. METHODS: Participants were 42 caregivers who were randomized assigned to the intervention conditions. RESULTS: Participants in the GFI showed significant reductions in depression, anxiety, and guilt at posttreatment and follow-up. Participants in the CBI presented reductions in anxiety and guilt at posttreatment and follow-up. Clinically significant change for guilt was found in 62.5% in the GFI and 9.09% in the CBI group at posttreatment. At follow-up, 58.33% in GFI and 12.5% in the CBI group were recovered. CONCLUSIONS: The preliminary results of this pilot study suggest that caregivers with significant levels of guilt and distress might benefit from an intervention specifically designed to target guilt feelings. CLINICAL IMPLICATIONS: A novel and initial intervention approach specifically designed for targeting caregivers' feelings of guilt might have the potential to reduce caregiver's emotional distress.

Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers and Care-recipients.

OBJECTIVES: To analyze caregivers' perceived impact of the pandemic in their mental health and the well-being of the care-recipients. METHODS: Caregivers (N = 88) were asked if they had COVID-19 and about their perceptions of change of care-recipients' health conditions as well as whether their own mental health, conflicts with care-recipients and other relatives, thoughts of giving up caregiving, and feelings of coping well with the situation. RESULTS: A large percentage of caregivers perceived a worsening of care-recipients' symptoms and of their own negative emotions, an increase in the number of conflicts and thoughts of needing to give up caregiving. Having had COVID-19 and reporting higher levels of distress as well as giving up caregiving were related to perceived worsening in care-recipients well-being. Perceived increases were mainly reported by younger caregivers, those who perceived to have not coped well, and those reporting an increase in conflicts. Some caregivers perceived an increase in positive emotions. CONCLUSIONS: The pandemic has a negative impact on caregivers' perceptions about the course of their own emotions and care-recipients' well-being. CLINICAL IMPLICATIONS: Interventions are needed to train caregivers in strategies to cope with the sources of stress caused by the pandemic and to promote social support.

The Role of Caregivers' Sleep Problems in the Association between Behavioral Symptoms of Dementia and Caregiving Depression and Anxiety.

OBJECTIVES: Behavioral problems in people with dementia are a source of depression and anxiety for caregivers, who experience high levels of sleep problems. The present study aims to explore the role of sleep problems on the relationship between behavioral problems associated with dementias - considering its different dimensions - and family caregivers' depressive and anxious symptoms. METHOD: 264 family caregivers participated in the study. Through face-to-face interviews, sociodemographic and health variables, caregivers' depressive and anxious symptoms were measured, as well as their sleep problems. Data related to people with dementia symptoms and their level of independence in daily life activities were also collected. Data analysis consisted of simple mediational models using the PROCESS method for SPSS. RESULTS: the test for the indirect effect of disruptive behaviors on depression through sleep problems was statistically significant, as it was for disruptive behaviors on anxiety through sleep problems. The effect of sleep problems in the association between depressive and memory problems in the person with dementia, and caregivers' depression and anxiety were not statistically significant. CONCLUSIONS: Sleep problems are significantly and positively associated with care-recipients' disruptive behaviors, but not with depressive and memory problems. The indirect effect of disruptive behaviors on caregivers' mood through sleep problems suggests that disruptive behaviors seem to play an important role for understanding caregivers' sleep problems.

Guilt for perceiving oneself as a burden in healthy older adults. Associated factors.

METHODS: Participants were 317 community-dwelling people over 60 years without cognitive or functional limitations. A path model that explores the role of self-perceived burden in the relationship between negative self-perception of aging, perceived control, depressive symptoms and guilt associated with self-perception as a burden was analyzed. RESULTS: The model presented excellent fit to the data, explaining 41% of the depressive symptomatology and 45% of guilt for perceiving oneself as a burden. Negative self-perceptions of aging, lower sense of control, and a perception of being a burden were significantly associated with depressive symptoms and guilt for perceiving oneself as a burden. DISCUSSION: This study documents potential correlates of psychological distress in older adults with no explicit physical or cognitive problems, suggesting paths through which feelings of guilt for perceiving oneself as a burden may be reported by this population.

Personal values profiles in dementia family caregivers: their association with ambivalent feelings and anxious and depressive symptoms.

OBJECTIVE: Culture-related variables, such as personal values, have been suggested as important in stress processes, such as family caregiving of people with dementia. Personal values may be categorized into two dimensions: family and own personal values. Drawing upon the Sociocultural Stress and Coping model, the objective of this study is to analyze differences between caregivers depending on their values profiles. METHOD: Participants were 333 family caregivers of a spouse or a parent with dementia. Caregivers chose their two most important values, apart from caregiving, from a list of eight family-related and non-family-related values (own values). Therefore, three values profiles were possible: Family-values profile (FVP: the two values are family related), Mixed-values profile (MVP: one family related value and one own value), and Own-values profile (OVP: two own values were selected). In addition to values, sociodemographic variables, commitment and satisfaction with caregiving value and with chosen values, ambivalent feelings, and anxiety and depression symptomatology were assessed. ANOVA analyses were conducted. RESULTS: The analyses suggest that caregivers in the FVP had lower levels of anxiety and ambivalent feelings and a higher commitment to and satisfaction with their chosen values than the other profiles. No differences were found for commitment and satisfaction with the caregiving value. CONCLUSION: Caregivers' value profiles seem to play an important role in the effects of stress over psychological health. Possible explanations of these effects about potential role conflicts and a higher commitment to values are discussed.

Validation of the Guilt associated with Self-Perception as a Burden Scale (G-SPBS).

BACKGROUND: One of the main health-related worries for older adults is becoming dependent. Even healthy older adults may worry about becoming dependent, generating guilt feelings due to the anticipation of future needs that others must solve. The guilt associated with self-perception as a burden has not been studied in older adults, and there is no instrument available to measure these feelings. AIMS: To adapt the Self-Perceived Burden Scale (SPBS; Cousineau et al., 2003) for the assessment of feelings of guilt for perceiving oneself as a burden for the family in older adults without explicit functional or cognitive impairment. METHOD: Participants were 298 older adults living independently in the community. Participants completed the assessment protocol, which included measures of guilt associated with self-perception as a burden, depressive and anxious symptomatology, self-perceived burden, and sociodemographic information. RESULTS: Results from exploratory, parallel and confirmatory factor analyses suggest that the scale, named Guilt associated with Self-Perception as a Burden Scale (G-SPBS), has a unidimensional structure, explaining 57.04% of the variance of guilt. Good reliability was found (Cronbach's alpha = .94). The results revealed significant (p < .01) positive associations with depressive and anxious symptomatology. DISCUSSION: These findings suggest that the G-SPBS shows good psychometric properties which endorse its use with healthy community older adults. Also, guilt associated with perceiving oneself as a burden seems to be a relevant variable that can contribute to improving our understanding of psychological distress in older adults.

Physical limitations and loneliness: The role of guilt related to self-perception as a burden.

BACKGROUND: Limitations in performing physical activities have been associated with greater loneliness in older adults. This association could be moderated by maladaptive social cognition or feelings, such as guilt related to perceiving oneself as a burden. This study analyzes the effect of guilt related to self-perception as a burden on the relationship between physical limitations and loneliness in older adults. METHODS: Participants were 190 community-dwelling people aged over 60 years who did not show cognitive or functional limitations in daily life activities. We used linear regression to test the influence of guilt related to self-perception as a burden on the association between physical limitations and loneliness. RESULTS: The interaction between physical limitations and guilt related to self-perception as a burden was found to be significant in the explanation of loneliness, explaining 18.10% of the variance. Specifically, the relationship between physical limitations and loneliness was stronger when levels of guilt related to self-perception as a burden were high or medium than when these levels were low. CONCLUSIONS: The findings suggest that feelings of loneliness are more frequent in people who report more physical limitations and, at the same time, report guilt for perceiving themselves as a burden. Guilt related to perceiving oneself as a burden seems to be a relevant modulator variable for understanding the effects of physical limitations on loneliness.

Comorbid Depressive and Anxiety Symptomatology in Older Adults: The Role of Aging Self-Stereotypes, Loneliness, and Feelings of Guilt Associated with Self-Perception as a Burden.

The main objective of this study was to analyze the differences between older adults' symptom profiles (subclinical, anxiety, depressive, and comorbid) in negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden. Participants were 310 community-dwelling people aged 60 years and over. The sample was grouped into four symptom profiles of older adults: anxiety, depressive, comorbid anxiety-depression, and subclinical symptoms. We carried out multinomial logistic regression analyses to analyze the role of assessed variables in the explanation of the four symptom profiles. Older adults who reported a comorbid symptomatology presented higher negative aging self-stereotypes and feelings of loneliness than the other three profiles. Compared with the subclinical profile, older adults who reported clinical symptomatology (anxiety, depressive, and comorbid profile) presented higher feelings of guilt associated with self-perception as a burden. The findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.

Marital Satisfaction and Mental Health in Adults Over 40 Years Old. Associations with Self-Perceptions of Aging and Stress Related to the COVID-19 Pandemic.

Being married has been associated with a better attitude to aging and a buffer against stressful situations, factors that influence mental health. The study analyzes the role of self-perceptions of aging and stress related to the COVID-19 pandemic in the association between marital satisfaction and participants' mental health. 246 people older than 40 years in a marital/partner relationship were assessed. A path analysis was tested, where self-perceptions of aging and stress from the COVID-19 situation were proposed as mechanisms of action in the association between marital satisfaction and anxious and depressive symptoms. Marital satisfaction, self-perceptions of aging, and stress associated with the COVID-19 pandemic significantly contributed to the model and explained 31% of the variance in participants´ anxious symptomatology, and 42% of the variance in depressive symptomatology. The indirect path of self-perceptions of aging and stress associated with the COVID-19 pandemic in the link between marital satisfaction and anxious and depressive symptoms was statistically significant for both outcome variables. The findings of this study suggest that lower perceived marital satisfaction is associated with higher levels of negative self-perceptions of aging and with higher anxiety and depressive symptoms. Public significance statements: This study suggests that higher marital satisfaction may be a buffer for negative self-perception of aging, and both factors are related with experiencing less stress from COVID-19. These links are associated with less anxious and depressive symptoms.

[Guilt for perceiving oneself as a burden: A relevant variable associated with the psychological distress of older adults]. / Culpa por percibirse como una carga. Una variable relevante asociada al malestar psicológico de las personas mayores.

AIMS: To analyze the relationship between guilt for perceiving oneself as a burden and negative self-perceptions of aging, perceived control and anxious and depressive symptomatology in older people without cognitive or functional limitations. METHODS: Participants were 351 community-dwelling people over 60 years without explicit cognitive or functional limitation. Indirect effet analysis were conducted that examined the indirect effect of negative self-perceptions of aging through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology in guilt for perceiving oneself as a burden. RESULTS: Both models showed an indirect relationship between negative self-perceptions of aging and guilt for perceiving oneself as a burden through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology, explaining 26.37% of anxious symptomatology, 48.51% of depressive symptomatology and 13.73% and 14.44% of guilt for perceiving oneself as a burden, respectively. DISCUSSION: The results obtained suggest that higher negative self-perceptions of aging is associated with a lower perception of control and greater psychological distress (anxiety and depression), and this process increases the feeling of guilt for perceiving oneself as burden to family members in older people without functional or cognitive limitations.

Longitudinal Correlates of Loneliness and Psychological Distress During the Lockdown Situation due to COVID-19. Effects of Age and Self-Perceptions of Aging.

OBJECTIVES: To longitudinally analyze the correlates of loneliness and psychological distress in people exposed to the coronavirus disease 2019 (COVID-19) lockdown, exploring the effects of age and self-perceptions of aging (SPA). METHODS: A longitudinal follow-up of 1,549 participants was carried out at four different time points during the lockdown in Spain. Questions about the risk of COVID-19, age, SPA, family and personal resources, loneliness, and psychological distress were measured. RESULTS: Changes in loneliness showed a linear longitudinal trajectory through time, but changes in psychological distress showed a U-shaped relationship with time. Age was a relevant predictor of differences in distress, with older people reporting less psychological distress. Change in both dependent variables was related to change in different predictors like family and personal variables and also to negative SPA. DISCUSSION: In a stressful situation such as the COVID-19 pandemic, older adults may be more resilient to adverse mental health outcomes by using more adaptive resources that strengthen their resilience. Support is provided for the importance of stereotyped views of the aging process that, independently of chronological age, may put people at risk of suffering adverse mental health outcomes such as loneliness and psychological distress in times of crisis.

Sociocultural Influences on the Feeling of Loneliness of Family Caregivers of People with Dementia: The Role of Kinship.

The extent to which familism, dysfunctional thoughts, and coping variables contribute to explaining feelings of loneliness in caregivers, controlling for kinship, is analyzed. Participants were 273 family caregivers of people with dementia. Sociodemographic variables, familism, dysfunctional thoughts, coping strategies for requesting and receiving help, perceived social support, and leisure activities were assessed. The fit of a theoretical model for explaining the effect of cultural and psychological variables on feelings of loneliness in each kinship group was tested. No significant differences in the distribution of loneliness by kinship were found. Higher levels of familism are associated with more dysfunctional thoughts, that are linked to more maladaptive strategies for coping with caring (e.g., less social support and fewer leisure activities). This in turn is associated with higher scores in the feeling of loneliness. The model bore particular relevance to the group of daughters, husbands, and sons, yet not in the case of wives. Sociocultural and coping factors associated with the caring process seem to play an important role in explaining feelings of loneliness in caregivers. Sociocultural factors associated with the care process seem to play an important role in explaining feelings of loneliness in caregivers.