Identifying predictors of transition to a care home for people with dementia: findings from the IDEAL programme.

OBJECTIVES: This study investigates factors associated with the person with dementia and the caregiver to identify those associated with an increased risk of transition to a care home. METHOD: IDEAL data were collected at baseline and at 12- and 24-month follow-up for 1545 people with dementia and 1305 caregivers. Modified Poisson regressions with an offset for 'person years at risk' were used. Person with dementia factors explored were personal characteristics, cognition, health, self- and informant-rated functional ability, and neuropsychiatric symptoms. Caregiver factors explored were personal characteristics, stress, health, and quality of the dyadic relationship. RESULTS: A 5% people moved into care. Risk of moving into a care home was higher among people with dementia who were ≥80 years, among people with Parkinson's disease dementia or dementia with Lewy bodies, and among those without a spousal caregiver. Poorer cognition and more self-rated or informant-rated functional difficulties increased the risk of moving into care. CONCLUSION: Factors related to increased dementia severity and greater disability are the primary influences that place people with dementia at greater risk of moving into a care home. Strategies that help to maintain everyday functional ability for people with dementia could help delay people with dementia moving into care.

Categorising interventions to enhance vaccine uptake or reduce vaccine hesitancy in the United Kingdom: A systematic review and meta-analysis.

BACKGROUND: Vaccination is one of the most important public health interventions to combat infectious disease. However, vaccine hesitancy prevents us reaching the global target of vaccine uptake (e.g., 75 % of influenza vaccination in at-risk groups). This review summarises all interventions designed to reduce vaccine hesitancy and increase vaccine uptake for all types of vaccines offered to adults (≥18 years) since 2000, in the United Kingdom (UK). METHODS: PubMed, Cochrane Reviews, CINAHL EBSCO, and Scopus were searched (September 19, 2023). The PRISMA Checklist 2020 was used for quality checking. Data from randomised-controlled trials (RCTs) were analysed with a meta-analysis and narrative analysis. In all included studies, a narrative synthesis was undertaken to summarise, evaluate and characterisethe reported behaviour change interventions into four categories: organisational-level, public demand, provider-level, and multidimensional interventions. Findings are evaluated based on the MINDSPACE framework to understand the possible psychological mechanisms underpinning the interventions. FINDINGS: A total of 9,842 articles were identified, 50 met the inclusion criteria. Interventions aimed to boost vaccine uptake or reduce hesitancy of influenza (50 %), COVID-19 (32 %), hepatitis B (6 %), and other vaccines. A meta-analysis was conducted for nine RCTs evaluating various interventions impact on vaccine uptake. The pooled effect was statistically significant (OR with 95 % CI = 1.23 [1.07 to 1.41]). Providing certain and understandableinformation and using a reminder system with personal messages or letters were the most frequently documented and effective interventions to enhance public demand (enhance information salience). Organisational level interventions intended to make vaccinations more accessible (e.g., providing vaccination at alternative places or times). Provider-oriented interventions encouraged healthcare workers to focus on reducing vaccine hesitancy or enhancing vaccine uptake. INTERPRETATION: Among the main MINDSPACE techniques, enhancing the salience of vaccine information and priming vaccination by improving access were identified as the most applied and effective interventions in the UK.

Felt Age and Its Psychological Correlates in Dementia Spousal Caregiving Dyads: Findings From the IDEAL Programme.

OBJECTIVES: Evidence suggests spouses influence each other's subjective views on aging. Aligned with the Theory of Dyadic Illness Management, we investigated for the first time similarities in felt age (how old people feel relative to their chronological age) between people with dementia and their spousal caregivers, and how each partner's felt age was related to psychological correlates in the other partner. METHODS: We used baseline (2014-2016) data from 1,001 people with dementia and their spousal caregivers who participated in the British Improving the experience of Dementia and Enhancing Active Life study. We ran linear regressions to analyze the extent to which the felt age of people with dementia and their caregivers were similar, and whether relationship quality was associated with the similarity. We utilized actor-partner interdependence models to analyze whether the felt age of people with dementia and their caregivers were associated with each other's well-being, satisfaction with life, and self-efficacy. RESULTS: The felt age of people with dementia was associated with the felt age of their caregivers (ß = 0.10; p = .001). Caregivers and people with dementia reported a more similar felt age when caregivers rated the caregiving relationship more positively (ß = 0.07; p = .04). Caregivers' felt age was associated with well-being (ß = 0.07; p = .02) and satisfaction with life (ß = 0.06; p = .04), but not with self-efficacy, in people with dementia. DISCUSSION: Felt age in caregivers and people with dementia may be interwoven, and important psychological variables in people with dementia are related to caregivers' felt age. Findings offer empirical evidence on dementia caregiving dynamics and how family relationships are related to views on aging.

Successful Aging and Subjective Aging: Toward a Framework to Research a Neglected Connection.

Research related to subjective aging, which describes how individuals perceive, interpret and evaluate their own aging, has substantially grown in the past two decades. Evidence from longitudinal studies shows that subjective aging predicts health, quality of life, and functioning in later life. However, the existing literature on successful aging has mostly neglected the role of subjective aging. This paper proposes an extended framework of successful aging linking subjective aging conceptually and empirically to Rowe and Kahn's (1997) three original key criteria of successful aging (i.e., avoiding disease and disability, maintaining high cognitive and physical function, and engagement with life). A particular focus is placed on subjective aging as an antecedent of successful aging. A review of the empirical subjective aging literature shows that subjective aging concepts consistently predict all three of Rowe and Kahn's criteria of successful aging. Mechanisms underlying these relations are discussed at three levels, namely psychological, behavioral, and physiological pathways. The proposed addition also takes into consideration the interconnections between subjective aging and successful aging throughout the lifespan and across historical time. Finally, we discuss the importance of facilitating successful aging through systematic interventions that support more positive views of aging at the individual and societal level.

Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme.

OBJECTIVES: Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.

Daily Dynamics of Awareness of Aging and Basic Psychological Need Satisfaction and Frustration in Middle and Older Adulthood.

OBJECTIVES: This daily diary study examined associations between awareness of age-related change (AARC) and satisfaction/frustration of basic psychological needs of autonomy, competence, and relatedness in a sample of midlife and older adults. We expected that greater satisfaction and lower frustration of needs would be associated with higher AARC-gains and lower AARC-losses. We also examined whether within-person associations of need satisfaction/frustration with AARC were moderated by age. METHODS: Participants (N = 152; aged 53+) completed measures of AARC and basic psychological need satisfaction and frustration on their smartphones for 10 consecutive days. Data were analyzed using multilevel models, with time-varying basic need satisfaction/frustration variables disaggregated into between-person and within-person components. RESULTS: On days participants reported higher than usual overall satisfaction of needs, and lower than usual frustration of needs, AARC-gains was higher, and AARC-losses was lower. Analysis of individual needs showed that autonomy and competence were more consistently related to higher AARC-gains and lower AARC-losses than relatedness. Within-person autonomy satisfaction was more strongly (negatively) associated with AARC-losses at older ages. DISCUSSION: Findings suggest that daily experiences related to satisfaction and frustration of goals related to autonomy and competence in particular may be proximal antecedents of short-term variation in AARC.

Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme.

BACKGROUND: Most people with dementia have multiple health conditions. This study explores (1) number and type of health condition(s) in people with dementia overall and in relation to age, sex, dementia type, and cognition; (2) change in number of health conditions over two years; and (3) whether over time the number of health conditions at baseline is related to social isolation, loneliness, quality of life, and/or well-being. METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised people with dementia (n = 1490) living in the community (at baseline) in Great Britain. Health conditions using the Charlson Comorbidity Index, cognition, social isolation, loneliness, quality of life, and well-being were assessed over two years. Mixed effects modelling was used. RESULTS: On average participants had 1.8 health conditions at baseline, excluding dementia; increasing to 2.5 conditions over two years. Those with vascular dementia or mixed (Alzheimer's and vascular) dementia had more health conditions than those with Alzheimer's disease. People aged ≥ 80 had more health conditions than those aged < 65 years. At baseline having more health conditions was associated with increased loneliness, poorer quality of life, and poorer well-being, but was either minimally or not associated with cognition, sex, and social isolation. Number of health conditions had either minimal or no influence on these variables over time. CONCLUSIONS: People with dementia in IDEAL generally had multiple health conditions and those with more health conditions were lonelier, had poorer quality of life, and poorer well-being.

SARS-CoV-2 infection and cognition in community-dwelling and nursing home residents in southern Switzerland.

Background: COVID-19 patients can report 'brain fog' and may exhibit cognitive symptoms for months after recovery (Cognitive COVID). However, evidence on whether and the extent to which SARS-CoV-2 infection impacts cognition irrespective of COVID-19 course and severity is limited to clinical samples and mainly comes from prognostic studies. We aimed to explore the association between serologically confirmed SARS-CoV-2 infection and cognitive functioning in community-based and institutionalized older adults, irrespective of COVID-19 symptoms. Methods: We conducted a case-control study nested into two cohorts in Southern Switzerland. Eligible subjects were Italian speaking older adults, without a previous diagnosis of dementia, who underwent serological testing for anti-SARS-CoV-2 antibodies between November 2020 and July 2021. We manually selected age-, sex- and education-matched cases (i.e., individuals with a serologically confirmed SARS-CoV-2 infection), with seronegative controls, and we conducted in-person neuropsychological assessments using validated, highly sensitive cognitive tests. Results: We completed 38 neuropsychological assessments in a mostly female sample of older adults (Mean age: 83.13 ± 8.95; 86.8% women). 17 were community dwelling individuals while 21 lived in a nursing home. As expected, socio-demographic characteristics of age, gender and educational level were similarly distributed between cases (n = 14) and controls (n = 24). In linear regression models, cases had significantly lower scores in cognitive tasks of memory (ß = -0.367, p = 0.023), attention (ß = 0.428, p = 0.008) and executive functions (ß = 0.326, p = 0.046). We found no significant difference in tests of language and spatial-temporal orientation (all p values > 0.05). Conclusions: SARS-CoV-2 infection was associated with cognitive impairment in memory, attention, and executive functions in older adults. Our findings are consistent with mechanistic evidence of the neurotropism of the virus and provide empirical support for the "Cognitive COVID" construct also in non-clinical samples. With nearly 800 million COVID-19 cases (in April 2023), and many more infections worldwide, the clinical and public health implications of Cognitive COVID due to SARS-CoV-2 infection may be massive and warrant further epidemiological investigations.

Correlates of felt age in caregivers of people with dementia: findings from the IDEAL study.

Objective: Family relationships influence how people appraise their own aging and how their appraisals impact their health. We analyzed felt age (FA) among family caregivers of people with dementia. Methods and measures: We used a stratified sample of 1,020 spousal and 202 adult-child caregivers from the IDEAL study. We estimated cross-sectional associations and bidirectional influences between caregivers' FA and their health and wellbeing (depression, number of health conditions, stress, positive aspects of caregiving) over 2 years. Results: Among spousal caregivers, 25% had a younger FA and 36% had an older FA. Among adult-child caregivers, 21.8% had a younger FA and 36.1% had an older FA. In spousal and adult-child caregivers an older FA was cross-sectionally associated with higher depression, number of health conditions, and stress, and fewer positive aspects of caregiving. In spousal caregivers, hours of care per day moderated the association between FA and depression, and FA was associated with stress 1 year later. Conclusion: Caregiving may impact FA and its relationship with health. We urge continued research on the connections between caregiving and FA, and how interventions might support caregivers' positive views on their own aging, which will translate views on aging scholarship to meaningfully improve caregivers' lives.