"Something we can all share": Exploring the social significance of food insecurity for young people in KwaZulu-Natal, South Africa.

Food insecurity remains a pressing global issue and South Africa continues to face socioeconomic inequalities that make securing food a challenge for many young people. To address this challenge, we need better understanding of the social context of food and its importance in driving perceptions and behaviours about food and its scarcity. In this study, we examine the meaning of food for young people living in urban informal settlements and rural villages in KwaZulu-Natal, and investigate how they exert agency in the face of food insecurity. We use qualitative data from 17 photo/video elicitation interviews conducted from December 2020-January 2021 with young people experiencing food insecurity. The sample consisted of 9 women and 8 men who were part of the Siyaphambili Youth ("Youth Moving Forward") project. Data were analysed using thematic analysis. Themes included the challenges young people face in securing food and money for food. However, in exploring young people's agency, food also plays a critical role in shaping their identities and social networks. Relevant themes included the use of food as a means of bonding with others; solidifying relationships; and as a signifier of social status and gender roles. Despite the challenges of food insecurity, young people demonstrated resilience and agency, utilising social and gendered coping strategies to secure food and to maintain their social networks. Our study contributes to the understanding of food insecurity amongst young people in South Africa and highlights the need for a comprehensive and culturally sensitive approach to addressing this issue. We argue that interventions aimed at addressing food insecurity should prioritise the empowerment of local communities and consider the sociocultural and gendered context of food in their design and implementation.

What are the Correlates of Hearing Aid Use for People Living With Dementia?

OBJECTIVES: To identify correlates of hearing aid use in people with dementia and age-related hearing loss. METHODS: Bivariate and multivariate logistic regression analyses of predictor variables from 239 participants with dementia and hearing loss in the European SENSE-Cog Randomized Controlled Trial (Cyprus, England, France, Greece, and Ireland). RESULTS: In multivariate analysis, four variables were significantly associated with hearing aid use: greater self-perceived hearing difficulties (OR 2.61 [CI 1.04-6.55]), lower hearing acuity (OR .39 [CI .2-.56]), higher cognitive ability (OR 1.19 [CI 1.08-1.31]), and country of residence. Participants in England had significantly increased odds of use compared to Cyprus (OR .36 [CI .14-.96]), France (OR .12 [CI .04-.34]) or Ireland (OR .05 [CI .01-.56]) but not Greece (OR 1.13 [CI .42-3.00]). CONCLUSIONS: Adapting interventions to account for cognitive ability, country of residence, self-perceived hearing difficulties, and hearing acuity may support hearing aid use in people with dementia.

Enablers and Barriers to Hearing aid Use in People Living With Dementia.

Hearing loss is highly prevalent in dementia; however, people with dementia are less likely to use hearing aids consistently than people with intact cognition are. This qualitative study is the first of its kind to explore factors that influence hearing aid use from the perspective of community-living people with mild to moderate dementia and their care partners. Eleven UK-based dyads from the European SENSE-Cog Randomized Controlled Trial of a sensory intervention for people with dementia completed semi-structured interviews based on the Theoretical Domains Framework (TDF). Our findings suggest that the TDF domains environmental context and resources, behavioral regulation, reinforcement, and social influences are of greatest relevance to hearing aid use in dementia. Within these domains, we identified a range of factors that may influence the target behavior of hearing aid use. The findings suggest that adoption of multifaceted, flexible intervention approaches may support hearing aid use in dementia.

Aberrant oscillatory activity in neurofibromatosis type 1: an EEG study of resting state and working memory.

BACKGROUND: Neurofibromatosis type 1 (NF1) is a genetic neurodevelopmental disorder commonly associated with impaired cognitive function. Despite the well-explored functional roles of neural oscillations in neurotypical populations, only a limited number of studies have investigated oscillatory activity in the NF1 population. METHODS: We compared oscillatory spectral power and theta phase coherence in a paediatric sample with NF1 (N = 16; mean age: 13.03 years; female: n = 7) to an age/sex-matched typically developing control group (N = 16; mean age: 13.34 years; female: n = 7) using electroencephalography measured during rest and during working memory task performance. RESULTS: Relative to typically developing children, the NF1 group displayed higher resting state slow wave power and a lower peak alpha frequency. Moreover, higher theta power and frontoparietal theta phase coherence were observed in the NF1 group during working memory task performance, but these differences disappeared when controlling for baseline (resting state) activity. CONCLUSIONS: Overall, results suggest that NF1 is characterised by aberrant resting state oscillatory activity that may contribute towards the cognitive impairments experienced in this population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03310996 (first posted: October 16, 2017).

Experimental investigation of training schedule on home-based working memory training in healthy older adults.

Introduction: The efficacy of working memory training (WMT) for cognitive enhancement in healthy older adults has been extensively investigated. Typically, WMT results in improved performance on the training task, but limited or no transfer of improvement to other cognitive tasks. Accordingly, there is a need to identify optimal intervention parameters to maximize training and transfer task effects of WMT. The current study aimed to investigate the effect of training schedule on training and transfer task performance of WMT in healthy older adults. A secondary aim was to examine the feasibility of participants performing the intervention online at home, unsupervised, and using their personal devices. Methods: Participants (N = 71; mean age: 66 years) completed sixteen WMT or active-control sessions over eight (distributed) or four (intensive) weeks. Adaptive verbal and spatial n-back tasks were used as the WMT tasks. We tested near transfer effects to a digit-span task and far transfer effects to an abstract relational reasoning task. Results: Participants successfully performed the cognitively demanding intervention using their own devices, online at home, and with minimal contact with the researcher. We observed a significant improvement in WMT task performance in the WMT group relative to active-controls, but no evidence of near or far transfer. Similar training effects were observed irrespective of the intensity of the training schedule. Discussion: Our results suggest that comparable benefits could be observed when using less intensive schedules that may be more easily accommodated into everyday life.

Love Shouldn't Hurt - E le Saua le Alofa: Co-designing a theory of change for preventing violence against women in Samoa.

Despite the widespread adoption of Theories of Change (ToC) for programme evaluation, the process of collaboratively developing these theories is rarely outlined or critical analysed, limiting broader methodological discussions on co-production. We developed a ToC as part of E le Saua le Alofa ('Love Shouldn't Hurt') - a participatory peer-research study to prevent violence against women (VAW) in Samoa. The ToC was developed in four phases: (1) semi-structured interviews with village representatives (n = 20); (2) peer-led semi-structured interviews with community members (n = 60), (3) community conversations with 10 villages (n = 217) to discuss causal mechanisms for preventing VAW, and (4) finalising the ToC pathways. Several challenges were identified, including conflicting understandings of VAW as a problem; the linearity of the ToC framework in contrast to intersecting realities of people's lived experiences; the importance of emotional engagements, and theory development as a contradictory and incomplete process. The process also raised opportunities including a deeper exploration of local meaning-making, iterative engagement with local mechanisms of violence prevention, and clear evidence of ownership by communities in developing a uniquely Samoan intervention to prevent VAW. This study highlights a clear need for ToCs to be complemented by indigenous frameworks and methodologies in post-colonial settings such as Samoa.

Challenges and opportunities in coproduction: reflections on working with young people to develop an intervention to prevent violence in informal settlements in South Africa.

Coproduction is widely recognised as essential to the development of effective and sustainable complex health interventions. Through involving potential end users in the design of interventions, coproduction provides a means of challenging power relations and ensuring the intervention being implemented accurately reflects lived experiences. Yet, how do we ensure that coproduction delivers on this promise? What methods or techniques can we use to challenge power relations and ensure interventions are both more effective and sustainable in the longer term? To answer these questions, we openly reflect on the coproduction process used as part of Siyaphambili Youth ('Youth Moving Forward'), a 3-year project to create an intervention to address the social contextual factors that create syndemics of health risks for young people living in informal settlements in KwaZulu-Natal province in South Africa. We identify four methods or techniques that may help improve the methodological practice of coproduction: (1) building trust through small group work with similar individuals, opportunities for distance from the research topic and mutual exchanges about lived experiences; (2) strengthening research capacity by involving end users in the interpretation of data and explaining research concepts in a way that is meaningful to them; (3) embracing conflicts that arise between researchers' perspectives and those of people with lived experiences; and (4) challenging research epistemologies through creating spaces for constant reflection by the research team. These methods are not a magic chalice of codeveloping complex health interventions, but rather an invitation for a wider conversation that moves beyond a set of principles to interrogate what works in coproduction practice. In order to move the conversation forward, we suggest that coproduction needs to be seen as its own complex intervention, with research teams as potential beneficiaries.

'I like to feel needed, you know?': a qualitative examination of sense of purpose in older care home residents.

OBJECTIVES: To explore older care home residents' experiences of maintaining a sense of purpose in life: a core component of psychological wellbeing. METHODS: Fifteen residents (9 female; 6 male), aged 60-95 years, from four care homes, were interviewed about their sense of purpose. Interview transcripts were analysed using inductive thematic analysis. RESULTS: Theme 1 ('Experiencing Loss') comprises two sub-themes that describe the impact of age-related losses on residents' sense of purpose (sub-theme 1) and the different responses that participants had to these losses (sub-theme 2). Theme 2 ('The Protective Effects of Social Connections') describes how social relationships could provide a sense of purpose, as well as the difficulties participants experienced in forming these relationships. Finally, theme 3 ('The Roles of Activities') describes the types of activities that could help residents to maintain a sense of purpose. CONCLUSION: Care home residents experience losses and barriers that make it more difficult to maintain a sense of purpose. However, with appropriate support and opportunities, residents are able to engage in activities and relationships that provide a sense of purpose. To support residents' mental health and wellbeing, care homes should offer varied opportunities for residents to engage in purposeful activities.

High-Risk Contexts for Violence Against Women: Using Latent Class Analysis to Understand Structural and Contextual Drivers of Intimate Partner Violence at the National Level.

Introduction: Intimate partner violence (IPV) affects 1 in 3 women and poses a major human rights threat and public health burden, yet there is great variation in risk globally. Whilst individual risk factors are well-studied, less research has focussed on the structural and contextual drivers of IPV and how these co-occur to create contexts of high risk. Methods: We compiled IPV drivers from freely-accessible global country-level data sources and combined gender inequality, natural disasters, conflict, colonialism, socioeconomic development and inequality, homicide and social discrimination in a latent class analysis, and identified underlying 'risk contexts' based on fit statistics and theoretical plausibility (N=5,732 country-years; 190 countries). We used multinomial regression to compare risk contexts according to: proportion of population with disability, HIV/AIDS, refugee status, and mental health disorders; proportion of men with drug use disorders; men's alcohol consumption; and population median age (N=1,654-5,725 country-years). Finally, we compared prevalence of physical and/or sexual IPV experienced by women in the past 12 months across risk contexts (N=3,175 country-years). Results: Three distinct risk contexts were identified: 1) non-patriarchal egalitarian, low rates of homicide; 2) patriarchal post-colonial, high rates of homicide; 3) patriarchal post-colonial conflict and disaster-affected. Compared to non-patriarchal egalitarian contexts, patriarchal post-colonial contexts had a younger age distribution and a higher prevalence of drug use disorders, but a lower prevalence of mental health disorders and a smaller refugee population. IPV risk was highest in the two patriarchal post-colonial contexts and associated with country income classification. Conclusions: Whilst our findings support the importance of gender norms in shaping women's risk of experiencing IPV, they also point towards an association with a history of colonialism. To effectively address IPV for women in high prevalence contexts, structural interventions and policies are needed that address not only gender norms, but also broader structural inequalities arising from colonialism.

Assessment of non-directed computer-use behaviours in the home can indicate early cognitive impairment: A proof of principle longitudinal study.

OBJECTIVES: Computer-use behaviours can provide useful information about an individual's cognitive and functional abilities. However, little research has evaluated unaided and non-directed home computer-use. In this proof of principle study, we explored whether computer-use behaviours recorded during routine home computer-use i) could discriminate between individuals with subjective cognitive decline (SCD) and individuals with mild cognitive impairment (MCI); ii) were associated with cognitive and functional scores; and iii) changed over time. METHODS: Thirty-two participants with SCD (n = 18) or MCI (n = 14) (mean age = 72.53 years; female n = 19) participated in a longitudinal study in which their in-home computer-use behaviour was passively recorded over 7-9 months. Cognitive and functional assessments were completed at three time points: baseline; mid-point (4.5 months); and end point (month 7 to 9). RESULTS: Individuals with MCI had significantly slower keystroke speed and spent less time on the computer than individuals with SCD. More time spent on the computer was associated with better task switching abilities. Faster keystroke speed was associated with better visual attention, recall, recognition, task inhibition, and task switching. No significant change in computer-use behaviour was detected over the study period. CONCLUSION: Passive monitoring of computer-use behaviour shows potential as an indicator of cognitive abilities, and can differentiate between people with SCD and MCI. Future studies should attempt to monitor computer-use behaviours over a longer time period to capture the onset of cognitive decline, and thus could inform timely therapeutic interventions.Supplemental data for this article can be accessed online at http://dx.doi.org/10.1080/13607863.2022.2036946.

'It's just incredible the difference it has made': family carers' experiences of a specialist Lewy body dementia Admiral Nurse service.

BACKGROUND: Lewy body dementia (LBD) is characterised by a complex array of symptoms. Being a family carer of someone with LBD can be challenging, and is associated with high levels of stress, depression and anxiety. Admiral Nursing services support family carers of people with dementia in the UK by providing tailored information, advice and therapeutic support. Recently, the Admiral Nurse model has been adapted to the needs of more specific populations, including the introduction of a new, specialist LBD Admiral Nurse. OBJECTIVE: to explore family carers' experiences of the LBD Admiral Nurse service. METHODS: fourteen family carers of people with LBD were interviewed about their experiences of the LBD Admiral Nurse service. Interview transcripts were analysed using thematic analysis. RESULTS: four themes were identified: theme 1 described how participants valued the LBD Admiral Nurse's specialist expertise, which contrasted with the lack of knowledge they encountered in other services. In theme 2, participants described how the practical, tailored support provided by the LBD Admiral Nurse enabled them to better manage a variety of caring-related challenges. Theme 3 captured the emotional benefits that participants gained from being able to talk to someone who understood their situation. In theme 4, participants explained how the reliability of the LBD Admiral Nurse's support helped them feel supported in their role. CONCLUSIONS: the specialist knowledge and expertise of the LBD Admiral Nurse enabled family carers to better support the people they cared for, and to relieve some of the emotional stress associated with caring.

Systematic Review of Factors Associated With Hearing Aid Use in People Living in the Community With Dementia and Age-Related Hearing Loss.

OBJECTIVES: To investigate factors that influence hearing aid use according to the Theoretical Domains Framework (TDF). The TDF is a behavioral science framework that aids understanding of factors that influence behavior. DESIGN: Systematic review. SETTING AND PARTICIPANTS: People living in the community with dementia and age-related hearing loss who have air conduction hearing aids. METHODS: Systematic literature review following PRISMA guidelines. We searched for studies in 9 databases, including Ovid MEDLINE, Scopus, and OpenGrey. We undertook an interpretive data synthesis by mapping findings onto the TDF. We assessed confidence in the findings according to the GRADE-CERQual approach. RESULTS: Twelve studies (6 quantitative, 3 qualitative, and 3 mixed methods) were included in the review. The majority of these were rated low-moderate quality. We identified 27 component constructs (facilitators, barriers, or noncorrelates of hearing aid use) nested within the 14 domains of the TDF framework. Our GRADE-CERQual confidence rating was high for 5 findings. These suggest that hearing aid use for people living in the community with dementia and hearing loss is influenced by (1) degree of hearing aid handling proficiency, (2) positive experiential consequences, (3) degree of hearing aid comfort or fit, (4) person-environment interactions, and (5) social reinforcement. CONCLUSIONS AND IMPLICATIONS: Hearing aid interventions should adopt a multifaceted approach that optimizes the capabilities of people with dementia to handle and use hearing aids; addresses or capitalizes on their motivation; and ensures their primary support network is supportive and encouraging of hearing aid use. The findings also emphasize the need for further high-quality research that investigates optimal hearing aid use, influencing factors, and interventions that support hearing aid use.

Formulation-led care in care homes: Staff perspectives on this psychological approach to managing behaviour in dementia care.

INTRODUCTION: Many people living with dementia will move to specialist care facilities as the syndrome progresses. Psychological formulation offers a promising non-pharmacological approach to managing behaviours that challenge in dementia care. However, little is known about how formulation is viewed by non-qualified care staff who are responsible for the day-to-day care of residents. Therefore, the present study aimed to explore the experiences of care staff in relation to formulation as an approach to managing behaviour in dementia care. DESIGN: This was a qualitative design involving semi-structured, individual interviews. METHOD: Interviews were conducted with 13 care staff with experience of psychological formulation from five care facilities. Data were analysed using thematic analysis. RESULTS: Three themes emerged from the data that offer an insight into the factors contributing to care staff's perspectives of formulation-led care. The themes were defined as expectation, working together and understanding. CONCLUSION: The findings suggest that formulation-led care approaches are viewed by care staff as a favourable approach to supporting people living with dementia who present with behavioural difficulties. Psychologists can aid care staff's investment within formulation approaches through managing expectations and fostering effective working relationships with care teams to develop understanding of the context around behaviours that challenge. IMPLICATIONS FOR PRACTICE: By aiding effective, collaborative communication between nursing and psychology team members and providing clear feedback to aid nurses' understanding of formulations, this study highlights that consideration of biopsychosocial factors when attempting to understand behaviour offers a safe, person-centred alternative to pharmacological approaches.

The effects of transcranial alternating current stimulation on memory performance in healthy adults: A systematic review.

The recent introduction of Transcranial Alternating Current stimulation (tACS) in research on memory modulation has yielded some exciting findings. Whilst evidence suggests small but significant modulatory effects of tACS on perception and cognition, it is unclear how effective tACS is at modulating memory, and the neural oscillations underlying memory. The aim of this systematic review was to determine the efficacy with which tACS, compared to sham stimulation, can modify working memory (WM) and long-term memory (LTM) performance in healthy adults. We examined how these effects may be moderated by specific tACS parameters and study/participant characteristics. Our secondary goal was to investigate the neural correlates of tACS' effects on memory performance in healthy adults. A systematic search of eight databases yielded 11,413 records, resulting in 34 papers that included 104 eligible studies. The results were synthesised by memory type (WM/LTM) and according to the specific parameters of frequency band, stimulation montage, individual variability, cognitive demand, and phase. A second synthesis examined the correspondence between tACS' effects on memory performance and the oscillatory features of electroencephalography (EEG) and magnetencephalography (MEG) recordings in a subset of 26 studies. The results showed a small-to-medium effect of tACS on WM and LTM performance overall. There was strong evidence to suggest that posterior theta-tACS modulates WM performance, whilst the modulation of LTM is achieved by anterior gamma-tACS. Moreover, there was a correspondence between tACS effects on memory performance and oscillatory outcomes at the stimulation frequency. We discuss limitations in the field and suggest ways to improve our understanding of tACS efficacy to ensure a transition of tACS from an investigative method to a therapeutic tool.

Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study.

BACKGROUND: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. OBJECTIVE: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. METHODS: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. RESULTS: This co-design approach resulted in multiple patient and care partner-led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. CONCLUSIONS: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing.

Healthcare professionals' experiences of using a biopsychosocial approach to understand behavioural and psychological symptoms of dementia: A qualitative interview study.

BACKGROUND: Biopsychosocial approaches to understanding behavioural and psychological (otherwise known as "non-cognitive" or "neuropsychiatric") symptoms of dementia tend to be conducted by specialist psychology professionals. To increase service users' access to these approaches, healthcare professionals from nursing and allied health disciplines are being trained to use them. However, little is known about healthcare professionals' experiences of implementing biopsychosocial approaches in everyday practice. OBJECTIVES: To explore nursing and allied healthcare professionals' views of using the "Newcastle Model," which is a biopsychosocial approach to understanding behavioural and psychological symptoms of dementia. METHOD: Thirteen community mental healthcare professionals from nursing, social work and occupational therapy backgrounds were interviewed about their views and experiences of using the Newcastle Model to understand and work with behavioural and psychological symptoms of dementia. Data were analysed using thematic analysis. RESULTS: Five themes were identified. The first theme reflected the perceived positive value of taking a more psychosocial approach to understanding behavioural and psychological symptoms of dementia. The second theme reported participants' expressions of low confidence in using the approach, as well as their reported difficulties in prioritising it. The third theme highlighted the perceived time-consuming nature of the approach, and the adaptations that some staff made to increase its practicality. The fourth theme highlighted the importance of working in collaboration with those who provided direct care and support to the person with dementia. The final theme reflected participants' positive view of the effectiveness of the approach for delivering person-centred care CONCLUSION: Community healthcare professionals valued the integration of a biopsychosocial approach into their practice, although identified key implementation barriers. IMPLICATIONS FOR PRACTICE: Formalising this approach within professional role descriptions; increasing collaborative working within multidisciplinary teams; and increasing carers' psychological understanding of dementia, are key ways in which this biopsychosocial approach could be implemented more effectively.

Supported decision-making and mental capacity assessment in care homes: A qualitative study.

Up to 75% of UK care home residents may lack the mental capacity to make certain decisions (Wade, Clinical Rehabilitation, 2019, 33, 1561-1570). Care home staff need evidence-based tools to help them assess residents' mental capacity and provide decision-making support (NICE, Decision-making and mental capacity NICE guideline NG108, 2018). The Mental Capacity Assessment Support Toolkit (MCAST) was designed to support multidisciplinary healthcare staff to prepare, complete and document legally compliant mental capacity assessments. MCAST has not yet been trialled in care homes. This study used a descriptive qualitative design to: (a) understand the current challenges faced by care home staff when supporting residents to make decisions and participate in mental capacity assessments; (b) explore staff members' support needs in this context and (c) to identify if and how the toolkit could be adapted for use in care homes. A purposive sample of 29 staff working as managers (n = 18), nurses (n = 7) and care assistants (n = 4) across five care homes in North West England participated in five semi-structured focus groups between May and July 2019. Data from the focus group transcripts were analysed thematically (Braun & Clarke, Qualitative Research in Psychology, 2006, 3, 77-101). Five main themes were identified: (a) involvement of residents in decision-making; (b) approaches to mental capacity assessment; (c) working with residents with communication difficulties; (d) feelings about practice and (e) responses to MCAST. Participants appeared competent and confident about supporting decision-making and assessing capacity, but recognised the complexity of this area of practice, and identified a need for further support. They reported a range of challenges, including accessing support from speech and language therapists for residents with communication needs. They responded positively to the toolkit and were keen to use it in practice. This study suggests that care home staff would benefit from, and welcome, support to develop their practice. Furthermore, MCAST appears usable in this context and formal feasibility testing is justified.

Enhancing Older Adults' Well-Being and Quality of Life Through Purposeful Activity: A Systematic Review of Intervention Studies.

BACKGROUND AND OBJECTIVES: Population aging represents a significant challenge for health and social care services. Older adults who engage in activities that offer a sense of purpose have significantly better physical and psychological health outcomes. However, age-related functional limitations and losses of social roles can present barriers to engaging in purposeful activity, especially for those older adults within the "oldest-old" age range (i.e., 80 years and older). This review aimed to determine the nature and effectiveness of purposeful activity interventions in older adults, aged 80 years and older, with respect to well-being and quality-of-life outcomes. RESEARCH DESIGN AND METHODS: Three databases were searched from their inception to April 2020. The search yielded 8,916 records, which resulted in eight eligible studies. RESULTS: The interventions were divided into two groups: (a) interventions that gave participants a specific functional role, such as volunteer or mentor (n = 5), and (b) interventions that supported participants to develop a new skill (n = 3). The quality of the evidence was variable. The strongest evidence was for interventions that assigned a functional role, which appeared to be somewhat effective in improving well-being outcomes. DISCUSSION AND IMPLICATIONS: There is preliminary evidence that purposeful activity interventions, particularly those that involved taking on a functional role, can improve well-being and quality-of-life outcomes in older adults aged 80 years and older. These findings have implications for professionals and carers to support older adults to access more purposeful social roles and create opportunities for helping and reciprocation.

Aging well with psychosis.

BACKGROUND AND OBJECTIVES: Despite the unique challenges faced by people living with a severe mental illness, little work has been done to understand how these populations can age well. This study therefore aimed to explore the views of mid to older aged adults living with a psychosis on what it means to age well, and how they might be supported in this endeavor. RESEARCH DESIGN AND METHODS: Semi-structured interviews were conducted with sixteen individuals (age 50-74 years) diagnosed with psychosis-related disorders (e.g. schizophrenia). Inductive thematic analysis was used to analyze the data. RESULTS: Four themes were identified: (i) Engagement with Life - referring to participating in, and maintaining, activities that bring satisfaction and value; (ii) Attitude to Life and Aging - referring to a positive attitude and outlook, and accepting aging-related challenges; (iii) Health and Wellbeing - relating to keeping as physically and mentally fit as possible and (iv) Social Connections - referring to both personal and professional relationships, and feeling heard and understood by others. DISCUSSION AND IMPLICATIONS: Whilst there were clear parallels between these results and those reported from other populations, participants aging with a psychosis revealed challenges, perceptions, and nuances that were unique to their situation. The importance of relationships with professionals, developing a mastery over their mental health difficulties, and the continued impact of stigma on aging well were highlighted. This suggests that approaches that target external societal factors, as well as therapeutic interventions focused on the individual, may help this population to age well.