Association of dietary inflammation with tooth loss and cognitive decline in older adults from cross-sectional data: The moderated role of albumin.

OBJECTIVE: Growing evidence suggests a potential connection between tooth loss and cognitive function in recent years. Increasing studies have focused on their inter-relationship, however, the underlying mechanism has yet to be fully elucidated. Few studies have considered the role of dietary inflammation and serum albumin in the association between tooth loss and cognitive function. Therefore, the aim of this study was to explore the role of dietary inflammation and serum albumin in the association between tooth loss and cognitive impairment. METHODS: A sample of 1,009 US adults from the National Health and Nutrition Examination Survey (NHANES) provided data on oral condition, cognitive function, dietary intake, and serum tests. The association between tooth loss (exposure variable) and cognitive function (outcome variable) was assessed by linear regression. Furthermore, a moderated mediation model was established to examine the influence of dietary inflammation on the association between tooth loss and cognitive tests, and the visualization of the moderating effect of serum albumin concentration was displayed through the Johnson-Neyman curve. RESULTS: Participants with impaired dentition had worse cognitive function and a higher Dietary Inflammation Index (DII). DII was highly correlated with Immediate Recall Test (IR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST), which mediated 16.46 %, 14.41 % and 11.28 % of the effect between tooth loss and cognitive functions. Additionally, the relationship between DII and DSST was moderated by serum albumin concentration. CONCLUSION: Tooth loss was associated with cognitive function which was affected by pro-inflammatory dietary patterns and serum albumin level. CLINICAL SIGNIFICANCE: This study presents evidence for dentists that dietary pattern change due to tooth loss plays a role in cognitive deterioration, which can also be moderated by serum albumin level. Therefore, the preservation of natural teeth is important for cognitive function, especially in an immunocompromised population with decreased serum albumin concentrations.

Projecting the 10-year costs of care and mortality burden of depression until 2032: a Markov modelling study developed from real-world data.

Background: Based on real-world data, we developed a 10-year prediction model to estimate the burden among patients with depression from the public healthcare system payer's perspective to inform early resource planning in Hong Kong. Methods: We developed a Markov cohort model with yearly cycles specifically capturing the pathway of treatment-resistant depression (TRD) and comorbidity development along the disease course. Projected from 2023 to 2032, primary outcomes included costs of all-cause and psychiatric care, and secondary outcomes were all-cause deaths, years of life lived, and quality-adjusted life-years. Using the territory-wide electronic medical records, we identified 25,190 patients aged ≥10 years with newly diagnosed depression from 2014 to 2016 with follow-up until 2020 to observe the real-world time-to-event pattern, based on which costs and time-varying transition inputs were derived using negative binomial modelling and parametric survival analysis. We applied the model as both closed cohort, which studied a fixed cohort of incident patients in 2023, and open cohort, which introduced incident patients by year from 2014 to 2032. Utilities and annual new patients were from published sources. Findings: With 9217 new patients in 2023, our closed cohort model projected the 10-year cumulative costs of all-cause and psychiatric care to reach US$309.0 million and US$58.3 million, respectively, with 899 deaths (case fatality rate: 9.8%) by 2032. In our open cohort model, 55,849-57,896 active prevalent cases would cost more than US$322.3 million and US$60.7 million, respectively, with more than 943 deaths annually from 2023 to 2032. Fewer than 20% of cases would live with TRD or comorbidities but contribute 31-54% of the costs. The greatest collective burden would occur in women aged above 40, but men aged above 65 and below 25 with medical history would have the highest costs per patient-year. The key cost drivers were relevant to the early disease stages. Interpretation: A limited proportion of patients would develop TRD and comorbidities but contribute to a high proportion of costs, which necessitates appropriate attention and resource allocation. Our projection also demonstrates the application of real-world data to model long-term costs and mortality, which aid policymakers anticipate foreseeable burden and undertake budget planning to prepare for the care need in alternative scenarios. Funding: Research Impact Fund from the University Grants Committee, Research Grants Council with matching fund from the Hong Kong Association of Pharmaceutical Industry (R7007-22).

Non-Pharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Non-pharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different non-pharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. RESEARCH DESIGN AND METHODS: Following the PRISMA guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to 21 March 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. RESULTS: Twenty-five trials (N = 2394 participants) were identified. Six types of non-pharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Non-pharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms and catastrophizing beliefs and improvement in physical performance (standardized mean differences [SMDs] -0.34 to 0.54). Subgroup analyses based on different non-pharmacological approaches revealed the benefits of psychological approaches combined with physical activity. DISCUSSION AND IMPLICATIONS: Non-pharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.

Hybrid-delivered community psychoeducation for people aged 50 and older: A mixed-method evaluation and lesson learned.

Introduction: Hybrid training mode comprising in-person and teleconferencing sessions is effective and sustainable, yet no standardized principles guide its development for older people. This study aimed to develop a set of principles for hybrid-mode psychoeducation for older people from the experiences of middle-aged and older people in two folds: (1) examining the effects of hybrid-mode community psychoeducation and (2) identifying features that could enhance participants' experience. Methods: We delivered 12-hour Older Person Mental Health First Aid and 3-hour late-life depression training to adults aged 50 and older in in-person and hybrid modes. Hybrid group participants received technology-related support, including in-advance training and on-site support. All participants completed assessments on depression literacy, depression stigma, meaning in life, social support, depressive symptoms, and anxiety pre-and post-intervention and evaluated the program in open-ended questions. Results: A total of 471 in-person and 346 hybrid group participants completed the psychoeducation and post-assessment (80.4 % female, mean age = 64.73 years, SD = 7.29). Linear mixed models revealed improvements in depression literacy, depression stigma, meaning in life, social support, and anxiety (B = -1.43 to 0.13, all p < .001), with no significant difference between in-person and hybrid groups. Thematic analysis of open-ended questions identified three themes: (1) informational content with case studies, (2) hardcopy course handouts, and (3) interactive learning environment. Discussion/conclusion: Hybrid-mode and in-person psychoeducation had comparable benefits on middle-aged and older people. The TORCH principles, an acronym for Technology provision, On-site technical support, Rehearsal, Connection with group members, and Hardcopy notes, was derived from practice wisdom and qualitative findings to support older people in online learning.

Stigma towards mental illness, resilience, and help-seeking behaviours in undergraduate students in Hong Kong.

AIM: Early interventions have great impact on reducing burden of mental illness. Young people are however the least likely to seek help for psychological issues. Resilience and stigma towards mental illness have been identified as contributing factors, although previous findings were mixed with potentially complex interaction with symptom severity. We investigated the relationship between stigma, resilience, depressive symptom severity, and help-seeking behaviours in undergraduate students in Hong Kong. METHODS: A cross-sectional online survey was conducted among undergraduates from a university in Hong Kong (n = 945). The 21-item Stigma and Acceptance Scale, Connor-Davidson Resilience Scale, and the Patient Health Questionnaire-9 were used. History of help-seeking for psychological issues was self-reported. Path analysis was conducted to test a conceptual model of their relationships. RESULTS: Among those with moderate-to-severe depressive symptoms (39.5%), only one-fourth had sought professional help. The path model showed that depressive symptom severity and stigma were positively associated with help-seeking behaviours, while resilience was negatively associated with help-seeking behaviours independently (all p < .001). Subgroup analyses showed differential contribution of stigma and resilience to a history of help-seeking in those with minimal-to-mild symptoms compared with moderate-to-severe symptoms. CONCLUSIONS: Stigma may be a barrier for help-seeking particularly in students with moderate-to-severe depression. Higher levels of resilience in young people may be protective and reduce the unnecessary seeking of professional help. Therefore, enhancing resilience among students in general, and reducing stigma and promoting help-seeking behaviours for those who have moderate-to-severe symptoms should be consider in parallel as strategies to enhance mental wellbeing of students.

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study.

Background: There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years. Methods: Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates. Findings: A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates. Interpretation: ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time. Funding: None.

Technology Affordance in an Information and Communication Technology Delivered Group Psychotherapy and Exercise Program for Older People With Depressive Symptoms: A Multiple Triangulation Qualitative Study.

Background and Objectives: Health and mental health interventions, such as psychotherapy and exercise programs, delivered via information and communication technology (ICT) may improve service access. However, adjustment among older people and in synchronous group interventions is more challenging. Technology affordance concerns the possibilities engendered by technology for various users and purposes and can help understand challenges in ICT-delivered groups and identify possible solutions. Research Design and Methods: Adopting a multiple triangulation approach, we observed ICT-delivered groups of acceptance and commitment therapy and exercise for older people with depressive symptoms, conducted focus groups with older people who had received group psychotherapy with or without an exercise component, and obtained clinical notes from interventionists. We conducted a thematic analysis of the observation notes, focus group transcriptions, and clinical notes. Results: Four focus groups were conducted with 22 participants (mean age = 72.6 years, standard deviation = 7.2, 86% female). We identified 3 challenges: (1) seeing-be seen dilemma, (2) speaking-hearing dilemma, and (3) blurred therapy-home boundary, and 2 solutions: (1) maneuvering layouts and collaborative tools, and (2) cross-platform mediated strategies. Participants struggled to observe the interventionist while simultaneously demonstrating their posture in front of a camera. Remaining silent and moderated turn-taking allowed for clearer hearing but limited interactions. Interruptions from the background environment and intersections of family living spaces disrupted audio-visual communication and jeopardized the sense of security. As a solution, interventionists maneuvered layouts and collaborative tools on teleconferencing applications to achieve intervention goals and provided support through different media. Discussion and Implications: The identified challenges and potential solutions can be understood from interactivity, portability, temporality, persistence, and multimediality. Technology affordance can guide ICT-delivered group design by matching the affordance of various technologies and communication media with the characteristics of the intervention and users to enhance efficacy and avoid an unnecessary digital divide.

Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context.

BACKGROUND AND OBJECTIVES: Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers' reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. RESEARCH DESIGN AND METHODS: We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. RESULTS: Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers' views, infantilization, treachery, and exclusion and imposition. DISCUSSION AND IMPLICATIONS: These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.

"Participation Is Fun and Empowering": A Participatory Approach to Co-Design a Cultural Art Program for Older Chinese at Risk of Depression in Hong Kong.

Background and Objectives: Internalized ageism and stigma of mental illness may disempower older people and impede help-seeking among those at risk of depression. Arts are deemed enjoyable, stigma-free, and conducive to mental health, and a participatory approach can engage and empower potential service users. This study aimed to co-design a cultural art program and test its feasibility in empowering older Chinese people in Hong Kong and preventing depression. Research Design and Methods: Adopting a participatory approach and guided by the Knowledge-to-Action framework, we co-designed a 9-session group art program using Chinese calligraphy as the channel for gaining emotional awareness and facilitating expression. The iterative participatory co-design process engaged 10 older people, 3 researchers, 3 art therapists, and 2 social workers through multiple workshops and interviews. We tested the program's acceptability and feasibility in 15 community-dwelling older people at risk of depression (mean age = 71.6). Mixed methods were used, including pre- and postintervention questionnaires, observation, and focus groups. Results: Qualitative findings suggest the feasibility of the program, and quantitative findings indicated its effects in increasing empowerment (t(14) = 2.82, p < .05), but not in other mental health-related measurements. Participants reflected that active participation and learning new art skills were fun and empowering, arts enabled them to gain insight into and express deeper feelings, and groups with peers made them feel relatable and accepted. Discussion and Implications: Culturally appropriate participatory arts groups can effectively promote empowerment in older people, and future research should balance eliciting meaningful personal experiences and measurable changes.

A core competency framework for mental health peer supporters of older adults in a Chinese community: cross-culturally informed Delphi study.

AIMS AND METHOD: Non-Western literature on the core competencies of mental health peer supporters remains limited. Therefore, we used a three-round Delphi study with peer supporters, service users (i.e. someone using peer support services) and mental health professionals to develop a core competency framework for peer supporters in the Chinese context. RESULTS: The final framework included 35 core competencies, the conceptual origins of which were local (14.3%), Western (20%) and both local and Western (65.7%). They were grouped into five categories in ascending peer supporter role specificity: (1) self-care and self-development, (2) general work ethics, (3) work with others, (4) work with service users and (5) peer support knowledge. CLINICAL IMPLICATIONS: A culturally valid mental health peer support competency framework can minimise role confusion and refine training and practice guidelines. In a Chinese context, peer supporters were valued as generic support companions, whereas functions highlighted in the West, such as role modelling, were perceived as less critical.

The association between tooth loss and cognitive decline in the aged population: The mediating role of HDL-cholesterol.

OBJECTIVE: Tooth loss and its impact on cognitive impairment have become a heated topic over the past decade as the global population continues to age. Despite the proliferation of research in this area, the underlying mechanism linking tooth loss and cognitive decline remains poorly understood. Limited investigation has been conducted to explore the potential role of lipid metabolism and its impact on the association between tooth loss and cognitive function. This study endeavored to identify the role of high-density lipoprotein cholesterol (HDL-C) concentration among older adults and its contribution to the link between tooth loss and cognitive impairment. METHODS: Data were retrieved from a public database, namely, the National Health and Nutrition Examination Survey (NHANES). Among 1,124 included participants who were aged above 60 years old, linear regression was performed to determine the association between tooth loss (moderate and severe tooth loss) and cognitive function [Consortium to Establish a Registry for Alzheimer's Disease-Immediate Recall (CERAD-IR), Delayed Recall (CERAD-DR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST)]. Mediation analysis was used to test the effect of HDL-C on the association of tooth numbers and four cognitive tests. RESULTS: Participants with moderate and severe tooth loss had lower scores on cognitive performance (p<0.001) and lower levels of HDL-C (p<0.05). The HDL-C levels were highly correlated with CERAD-IR and DSST, which mediated 2.11% to 5.24% of the total effect between tooth numbers and cognitive function. CONCLUSION: Tooth loss was negatively associated with cognitive function which was mediated by serum HDL-C levels. CLINICAL SIGNIFICANCE: Dentists should realize that the potential broader implications of tooth loss on overall well-being, including cognitive performance. The preservation of natural dentition might serve as a preventive measure against cognitive impairment, possibly mediated by abnormal lipid metabolism.

Dimensionality and risk factors of the personal stigma of depression in adults aged 50 years and older at risk of depression.

Objectives: Knowledge about the mechanism of the personal stigma of depression may inform strategies to reduce stigma and promote help-seeking. We examined the dimensionality and risk factors of the personal stigma of depression in older adults at risk of depression.Methods: Seven-hundred and one Hong Kong adults aged 50 years and older at risk of depression completed the personal stigma subscale of the depression Stigma Scale (DSS-personal) at two-time points. We used exploratory factor analysis (EFA) to explore the factor structure of DSS personal and confirmatory factor analysis to examine the model fit of the EFA-informed factor structure and structures proposed in previous studies. Regression analyses examined the relationships between risk factors and personal stigma dimensions.Results: Factor analyses identified a 3-factor structure of DSS-personal resembling the social-cognitive model consistent over time and included stereotype, prejudice, and discrimination (CFI = 0.95, TLI = 0.92, RMSEA = 0.05). Regression analyses indicated all stigma dimensions were associated with older age, less education, and no personal history of depression (B = -0.44 to 0.06); discrimination was also associated with more depressive symptoms (B = 0.10 to 0.12).Conclusion: Findings illustrated the potential theoretical underpinning of DSS-personal. Stigma reduction interventions could target and tailor to older adults with risk factors to enhance effectiveness and promote help-seeking.

Depression risk among community-dwelling older people is associated with perceived COVID-19 infection risk: effects of news report latency and focusing on number of infected cases.

Awareness of COVID-19 infection risk and oscillation patterns ('waves') may affect older people's mental health. Empirical data from populations experiencing multiple waves of community outbreaks can inform guidance for maintaining mental health. This study aims to investigate the effects of COVID-19 infection risk and oscillations on depression among community-dwelling older people in Hong Kong.A rolling cross-sectional telephone survey method was used. Screening for depression risk was conducted among 8,163 older people (age ≥ 60) using the Patient Health Questionnaire-2 (PHQ-2) from February to August 2020. The relationships between PHQ-2, COVID-19 infection risk proxies - change in newly infected cases and effective reproductive number (Rt), and oscillations - stage of a 'wave' reported in the media, were analysed using correlation and regression.8.4% of survey respondents screened positive for depression risk. Being female (ß = .08), having a pre-existing mental health issue (ß = .21), change in newly infected cases (ß = .05), and screening during the latency period before the media called out new waves (ß = .03), contributed to higher depression risk (R2 = .06, all p <.01).While depression risk does not appear alarming in this sample, our results highlight that older people are sensitive to reporting of infection, particularly among those with existing mental health needs. Future public health communication should balance awareness of infection risks with mental health protection.

Visual-stress-related cortical excitability as a prospective marker for symptoms of depression and anxiety in young people.

Visual stress is thought to reflect cortical excitability and has been associated with many neurological, neuropsychiatric, and neurodevelopmental conditions. However, its relationships with symptoms of depression and anxiety have not yet been elucidated. We conducted two separate studies to first examine visual stress in a longitudinal community sample of 104 participants (aged 12-24) in association with prospective symptoms of depression, anxiety, and distress after 3 months, and subsequently in a cross-sectional epidemiological sample of 530 participants (aged 15-24) to validate its associations with current mood and distress symptoms. The Pattern Glare Test was used to examine visual stress to three grating patterns with the spatial frequencies (SF) of 0.3, 2.3, and 9.4 cycles per degree (cpd). Other known factors of mental health, including functioning, as well as resilience, hopelessness, and loneliness, were also assessed at baseline. In both studies, we showed that perceptual distortions were highest toward the pattern with mid-SF (2.3 cpd). Multiple linear regression analyses revealed that greater visual stress was significantly associated with not only baseline but also 3-month symptom outcomes, even when accounting for age, years of education, days of no functioning, resilience, hopelessness, and loneliness. Our findings suggest the importance of visual stress in understanding and predicting poor mental health outcomes. As mental health can lead to far-reaching consequences that extend to adulthood, our findings may inform state-of-the-art innovative strategies for the prediction of poor mental health outcomes and suggest visual stress as a potential marker for early risk detection among young people.

Understanding and Addressing Older Adults' Loneliness: The Social Relationship Expectations Framework.

Loneliness is an experience resulting from a perceived discrepancy between expected and actual social relationships. Although this discrepancy is widely considered the "core mechanism" of loneliness, previous research and interventions have not sufficiently addressed what older adults specifically expect from their social relationships. To address this gap and to help situate research on older adults' loneliness within broader life span developmental theories, we propose a theoretical framework that outlines six key social relationship expectations of older adults based on research from psychology, gerontology, and anthropology: availability of social contacts, receiving care and support, intimacy and understanding, enjoyment and shared interests, generativity and contribution, and being respected and valued. We further argue that a complete understanding of loneliness across the life span requires attention to the powerful impacts of contextual factors (e.g., culture, functional limitations, social network changes) on the expression and fulfillment of older adults' universal and age-specific relationship expectations. The proposed Social Relationship Expectations Framework may fruitfully inform future loneliness research and interventions for a heterogeneous aging population.

Team cohesiveness and collective efficacy explain outcomes in interprofessional education.

BACKGROUND: Team cohesiveness and collective efficacy have been construed as important characteristics of a high-functioning team. However, the psychological mechanism through which they promote positive outcomes remains unknown. Understanding this psychological process is important to teachers and programme implementers to yield actionable interventions that can be used to craft effective practices for optimizing team outcomes. This is especially true in interprofessional education (IPE) in medical education, where a team-based approach to patient management is promoted. Drawing from the social-cognitive theory, we examined a hypothesized model where team cohesiveness predicts collaboration outcomes (teamwork satisfaction, overall satisfaction with the team experience, and IPE goal attainment) via collective efficacy. METHODS: We used data from Chinese medicine, medicine, nursing, and social work students in Hong Kong (n = 285) who were enrolled in IPE. They were invited to respond to scales in two time points. We performed mediation analysis using structural equations modelling to test the indirect effect model: team cohesiveness → collective efficacy → outcomes. RESULTS: Results of structural equation modelling revealed that collective efficacy fully mediated the relationships between team cohesiveness and all three team outcomes, providing support for the hypothesised model [RMSEA = 0.08, NFI = 0.90, CFI = 0.93, IFI = 0.93, TLI = 0.93]. Team cohesiveness predicted the achievement of collaboration outcomes via collective efficacy. CONCLUSION: The findings demonstrated the important roles of team cohesiveness and collective efficacy in promoting successful team collaboration. Team cohesiveness predicted collective efficacy, and collective efficacy, in turn, predicted collaboration outcomes. This study contributed to theorising the pathways towards successful team collaboration outcomes.

Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial.

BACKGROUND: Late-life depression is common, modifiable, yet under-treated. Service silos and human resources shortage contribute to insufficient prevention and intervention. We describe an implementation research protocol of collaborative stepped care and peer support model that integrates community mental health and aged care services to address service fragmentation, using productive ageing and recovery principles to involve older people as peer supporters to address human resource issue. METHODS/DESIGN: This is a non-randomised controlled trial examining the effectiveness and cost-effectiveness of the "Jockey Club Holistic Support Project for Elderly Mental Wellness" (JC JoyAge) model versus care as usual (CAU) in community aged care and community mental health service units in 12 months. Older people aged 60 years and over with mild to moderate depressive symptoms or risk factors for developing depression will be included. JoyAge service users will receive group-based activities and psychoeducation, low-intensity psychotherapy, or high-intensity psychotherapy according to the stepped care protocol in addition to usual community mental health or aged care, with support from an older peer supporter. The primary clinical outcome, depressive symptoms, and secondary outcomes, self-harm risk, anxiety symptoms, and loneliness, will be measured with the Patient Health Questionnaire-9 (PHQ-9), Self-Harm Inventory, Generalized Anxiety Disorder 7-item scale (GAD-7), and UCLA Loneliness 3-item scale (UCLA-3) respectively. Cost-effectiveness analysis will assess health-related quality of life using the EQ-5D-5L and service utilisation using the Client Service Receipt Inventory (CSRI). We use multilevel linear mixed models to compare outcomes change between groups and calculate the incremental cost-effectiveness ratio in terms of quality-adjusted life years. DISCUSSION: This study will provide evidence about outcomes for older persons with mental health needs receiving collaborative stepped care service without silos and with trained young-old volunteers to support engagement, treatment, and transitions. Cost-effectiveness findings from this study will inform resource allocation in this under-treated population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03593889. Registered on 20 July 2018.

The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey.

Background: Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an "infodemic" of overabundant and questionable information that has affected older adults' mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization's Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. Objective: This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. Methods: Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district-based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. Results: Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=-0.39, P=.002) and AFC-Communication Technology (b=-1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=-0.03, P=.002) and AFC-Communication Technology (b=-0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=-0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=-0.65, P<.001; AFC-Information × social media use b=-2.18, P<.001; 3-way interaction b=0.40, P=.003). Conclusions: Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults.

Asymmetric left-right hippocampal glutamatergic modulation of cognitive control in ApoE-isoform subjects is unrelated to neuroinflammation.

The glutamatergic cycle is essential in modulating memory processing by the hippocampal circuitry. Our combined proton magnetic resonance spectroscopy (1 H-MRS) and task-based functional magnetic resonance imaging (fMRI) study (using face-name paired-associates encoding and retrieval task) of a cognitively normal cohort of 67 healthy adults (18 ApoE4 carriers and 49 non-ApoE4 carriers) found altered patterns of relationships between glutamatergic-modulated synaptic signalling and neuronal activity or functional hyperaemia in the ApoE4 isoforms. Our study highlighted the asymmetric left-right hippocampal glutamatergic system in modulating neuronal activities in ApoE4 carriers versus non-carriers. Such brain differentiation might be developmental cognitive advantages or compensatory due to impaired synaptic integrity and plasticity in ApoE4 carriers. As there was no difference in myoinositol levels measured by MRS between the ApoE4 and non-ApoE4 subgroups, the mechanism is unlikely to be a response to neuroinflammation.

The relationship between insomnia symptoms and frailty in community-dwelling older persons: a path analysis.

BACKGROUND: The relationship between sleep and frailty in older age is complex. Most previous studies focused on sleep duration, while insomnia, a common sleep problem in older adults, has not been adequately examined and the factors implicated in its association with frailty were under-explored. METHODS: A community-based sample of 345 prefrail and frail older adults were recruited and completed the measures on insomnia symptoms (Pittsburgh Sleep Quality Index) and frailty status (FRAIL Scale). The relationship between insomnia symptoms and frailty, with potential mediators including physical performance (Short Physical Performance Battery), depression (Patient Health Questionnaire-9), and level of physical activity (Physical Activity Scale for the Elderly), were tested in path analysis adjusting for age, gender, body mass index and sleep medications. RESULTS: The prevalence of sleep-onset insomnia was higher in frail participants than their prefrail counterparts (48% vs. 34%, aOR = 1.73; 95% CI 1.09, 2.76; p = 0.02), but there was no significant difference in the prevalence of sleep-maintenance insomnia (61% vs. 54%). The association between sleep-onset insomnia and frailty was explained by reduced physical performance (standardized coefficient = 0.11; 95% BCa CI [0.002, 0.233]), but not depression and level of physical activity. Sleep-maintenance insomnia was not associated with frailty. CONCLUSIONS: Insomnia symptoms are prevalent in frail and prefrail older adults. Sleep-onset insomnia is associated with poorer physical performance, which is further linked to a higher risk for frailty in older persons. The findings highlight the importance of timely assessing and managing insomnia among older adults at risk of frailty.