Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care.

OBJECTIVES: Anxiety in older people is under-diagnosed and poorly treated despite significant impairments that arise from anxiety. Mindfulness-based cognitive therapy (MBCT) has been shown to be a promising treatment for anxiety. The aim of this study was to determine the effect of an MBCT program on anxiety symptoms in older people living in residential care. METHOD: Fifty-two participants (34 females) were randomly allocated into therapy and control groups using a 2 × 3 mixed design. The average age of participants was 83 years. RESULTS: The group effect showed significant improvements on all measures at the end of the seven-week program in the therapy group, while the control group did not show significant changes. CONCLUSION: This study represents one of the first studies of the effectiveness of an MBCT program on anxiety symptoms for older people using a randomized controlled trial. The study has implications for future research that include the effectiveness of MBCT for the treatment of anxiety symptoms in older people, the utility of group therapy programs in residential care and the benefits of using specialized instruments for older populations.

Exercise and executive functioning in older women.

Research suggests that exercise can slow the rate of decline in cognitive functioning in older adults. The effects of aerobic and resistance exercise on executive functioning was examined in 68 women over 50 years of age. Participants completed the Tower of London and Benton Controlled Oral Word Association tests. Findings indicated that individuals participating in both aerobic and resistance exercises performed significantly better than individuals not participating in exercise. Individuals who were participating in both aerobic and resistance exercises did not perform disproportionately better. Thus the form of exercise appears to be less important than engaging in some form of exercise.

The Impact of Tic Severity, Comorbidity and Peer Attachment on Quality of Life Outcomes and Functioning in Tourette's Syndrome: Parental Perspectives.

The aim of this controlled, community-based study based on data from parents of youth (aged 7-16 years) with Tourette's syndrome (TS; n = 86) and parents of age and gender matched peers (n = 108) was to test several hypotheses involving a range of variables salient to the TS population, including peer attachment, quality of life, severity of tics, comorbidity, and psychological, behavioural and social dysfunction. Multivariate between-group analyses confirmed that TS group youth experienced lower quality of life, increased emotional, behavioural and social difficulties, and elevated rates of insecure peer attachment relative to controls, as reported by their primary caregiver. Results also confirmed the main hypothesis that security of peer attachment would be associated with individual variability in outcomes for youth with TS. As predicted, multivariate within-TS group analyses determined strong relationships among adverse quality of life outcomes and insecure attachment to peers, increased tic severity, and the presence of comorbid disorder. Findings suggest that youth with TS are at increased risk for insecure peer attachment and that this might be an important variable impacting the quality of life outcomes for those diagnosed.

A case of dissociative fugue and general amnesia with an 11-year follow-up.

Dissociative fugue refers to loss of personal identity, often with the associated loss of memories of events (general amnesia). Here we report on the psychological assessment of a 54-year-old woman with loss of identity and memories of 33 years of her life attributed to dissociative fugue, along with a follow-up 11 years later. Significant levels of personal injury and stress preceded the onset of the amnesia. A detailed neuropsychological assessment was completed at a university psychology clinic, with a follow-up assessment there about 11 years later with an intent to determine whether changes in her cognitive status were associated with better recall of her life and with her emotional state. Psychomotor slowing and low scores on measures of attention and both verbal and visual memory were present initially, along with significant psychological distress associated with the diagnosis of posttraumatic stress disorder. Although memories of her life had not returned by follow-up, distress had abated and memory test scores had improved. The passage of time and a better emotional state did not lead to recovery of lost memories. Contrary to expectations, performance on tests of executive functions was good on both occasions. Multiple stressful events are attributed as having a role in maintaining the loss of memories.

Cognitive screening of older adults: the utility of pentagon drawing.

BACKGROUND: Drawing tests have a long history in neuropsychological assessment. A popular geometric figure has been the two intersecting pentagons from the Bender Gestalt test. Reproducing the pentagons is the main visuospatial task on the original Mini-Mental State Examination (MMSE), remaining in use in revised versions of that widely used screening test. Scoring criteria on the MMSE are binary: perfect reproduction of the figure is required, while the Modified MMSE of Teng and Chui (1987) uses a more refined ten-point scoring for the elements of the figure. METHODS: Here, I report on the use of pentagon drawing from 8,702 older community-dwelling Canadians (59.3% female), with a mean age of 75.5 years (SD = 6.99) and 10.1 years of education (SD = 3.89). Mean scores for the whole sample are reported, as well as for subsamples who underwent a full clinical assessment and were diagnosed as cognitively intact, with dementia, or cognitively impaired, but without dementia. Logistic regression was used to evaluate the utility of pentagon drawing as a diagnostic tool to diagnose cognitive impairment. RESULTS: Binary scoring was less effective in discriminating groups than the ten-point system and showed weaker properties by other criteria. CONCLUSIONS: The discussion focuses on the role of simple, non-verbal tasks in the cognitive screening of older adults.

Negative stereotyping of older nurses despite contact and mere exposure: the case of nursing recruiters in Western australia.

Ageist attitudes have been identified across different industries. The nursing profession has a high proportion of older workers. As this facilitates regular contact with, as well as exposure to, older nurses, it may be expected to show less ageism. This study investigated 163 Western Australian nursing recruiters' attitudes toward older nurses. Results showed clear evidence of both negative and positive stereotyping of older nurses. Nursing recruiters indicated that they would be more than likely to hire older nurses and that age was less relevant in making hiring decisions. These findings suggest that enhancing the employability of older workers does not necessarily change ageist attitudes. This is relevant to policy formulation, attitude change interventions, and the well-being of older workers.

Incremental contribution of reported previous head injury to the prediction of diagnosis and cognitive functioning in older adults.

BACKGROUND: Severe brain injuries may be a risk factor for the development of dementia in later life. Less severe incidents with relatively short or even no loss of consciousness may not carry the same prognosis. OBJECTIVES: This study used data from the first two waves of the Canadian Study of Health and Ageing (CSHA-1 and CSHA-2) to investigate two questions. (1) Does a history of head injury improve the prediction of the diagnosis of dementia? This analysis was based on the 921 elderly individuals who underwent a clinical assessment in CSHA-2 and, 5 years earlier, had reported whether or not they had had a head injury. (2) Does adding information about a history of head injury improve the prediction of neuropsychological test scores? This second analysis included 585 elderly people who underwent neuropsychological assessment in both waves and who also reported whether or not they had had a history of mild or moderate-to-severe head injury. RESULTS: RESULTS showed that the inclusion of head injury information did not improve the prediction of diagnostic outcome of dementia. Age and overall cognitive status were associated with most neuropsychological test scores, more so than the more limited influence of chronic health problems, which was associated with about half of the neuropsychological measures.

The case of an aging person with borderline personality disorder and possible dementia.

There is little literature on older adults with borderline personality disorder during neuropsychological assessment. Here we report on a 59-year-old woman with borderline personality disorder who referred herself for assessment because she feared the onset of dementia. Results showed an above average level of intelligence, with scores on memory tests that ranged from well below to well above average in a pattern that was not consistent with a dementia or with common forms of neurologically based memory impairments. A test of memory malingering was within normal limits. Results are discussed in terms of somatization within this personality disorder.

Principles of good care for long-term care facilities.

BACKGROUND: The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities aims to support and strengthen mental health services in the long-term care sector. The purpose of this paper is to identify broad principles that may underpin the drive towards meeting the mental health needs of residents of long-term care facilities and their families, as well as to enhance the overall delivery of residential care services. METHODS: Principles of good care are extrapolated from an analysis of international consensus documents and existing guidelines and discussed in relation to the research and practice literature. RESULTS: Although the attention to principles is limited, this review reveals an emerging consensus that: (1) residential care should be situated within a continuum of services which are accessible on the basis of need; (2) there should be an explicit focus on quality of care in long-term care facilities; and (3) quality of life for the residents of these facilities should be a primary objective. We take a broad perspective on the challenges associated with actualizing each of these principles, taking into consideration key issues for families, facilities, systems and societies. CONCLUSIONS: Recommendations for practice, policy and advocacy to establish an internationally endorsed principles-based framework for the evolution and development of good mental health care within long-term care facilities are provided.

Screening for mental disorders in residential aged care facilities.

INTRODUCTION: The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities seeks to improve care of persons in residential aged care facilities (RACFs). As part of that effort the current authors have contributed an overview and discussion of the uses of brief screening instruments in RACFs. METHODS: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted. RESULTS: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated. CONCLUSIONS: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.

Confirmatory analysis of the Bradburn Affect Balance Scale and its relationship with morale in older Canadian adults.

The measurement of psychological constructs depends upon clear definitions and demonstrated relationships among items, scales, and relevant theories. In this study, we examined these relationships for the measurement of affect as reflected in the popular Bradburn Affect Balance Scale (ABS). Results of confirmatory analyses of data from 187 older Canadian adults (Mean age, 69.7 years) showed that a two-dimensional structure fitted the item data much better than the unidimensional, bipolar model suggested by the original scoring key. The two dimensions showed parallel patterns of correlations with two measures of morale and with a measure of social desirability, but these patterns differed from that of the conventional unidimensional ABS score. Results suggested that the ABS should be used with caution and with scoring for two distinguishable dimensions.

Long-term outcome of leucotomy on behaviour of people with schizophrenia.

BACKGROUND: Prefrontal leucotomy was widely used from the late 1930s to early 1950s as a treatment for disorders involving obsessive agitation. Comparatively few studies of the enduring behavioural effects of such surgery exist, while data on mortality and cognition have been better reported. AIMS: We contrast the psychosocial functioning of older individuals with schizophrenia who had undergone prefrontal leucotomy with two groups of their peers who had not undergone such surgery. METHOD: A total of 87 individuals (one female) with a mean age of 70.3 years (SD = 6.84) were evaluated twice 25 months apart using a standardized rating scale. Twenty of the residents, all with schizophrenia, had undergone prefrontal leucotomy approximately 45 years previously. All diagnoses of schizophrenia were confirmed by multiple psychiatrists using DSM-III criteria at the time of the ratings, which were completed by two care staff who knew the residents well. RESULTS: Repeated measures comparisons with schizophrenia and non-schizophrenia patient groups showed no significant differences between the leucotomy and unoperated comparison groups on four of the five Multidimensional Observation Scale for Elderly Subjects (MOSES) scales. CONCLUSIONS: These results are consistent with reports of compromised function among individuals who had undergone leucotomy and contrast with some reports of positive changes in behaviour.

Cognitions related to chronic pain: revision and extension of the cognitive evaluation questionnaire.

OBJECTIVES: The assessment of cognitive reactions to chronic pain is less well developed than other areas of pain assessment. The aim of the first study was to revise the Cognitive Evaluation Questionnaire of Philips whereas the second study examined its properties and validity in a new sample of people with chronic pain. METHODS: The revised scale underwent item analysis in 87 undergraduates, all of whom had pain of at least 1-month duration during the previous year, and was correlated with Skevington's Beliefs about Pain Control Questionnaire and 3 ratings of pain severity over time. In a second study, 96 participants with chronic pain (50 females) completed the Revised Cognitive Evaluation Questionnaire, the Survey of Pain Attitudes-Brief, the Center for Epidemiologic Studies Depression Scale, and sections of the Sickness Impact Profile. Hierarchical regression examined the construct validity of the revised scales in relation to psychosocial functioning and depression. RESULTS: Results showed acceptable internal consistency in both samples, and significant correlations with pain severity and the beliefs scales in Study 1. In Study 2, all but 2 scales showed correlations with the measure of beliefs about pain. The hierarchical multiple regression results showed that only Disability belief predicted psychosocial functioning, whereas Control from the beliefs measure and the new revised Causal Rumination and Concern with Effects of Pain scales predicted the CES-D depression scores. DISCUSSION: The revised cognitive scales in themselves were significant predictors in Study 2, and their contribution was more effective for depression than for psychosocial functioning. The results showed promise for the revised scale and are discussed in relation to previous research, with recommendations for future research into the cognitive reactions of individuals with chronic pain.

A Western Australian survey on public attitudes toward and knowledge of electroconvulsive therapy.

AIMS: Healthcare professionals have debated the use and effects of electroconvulsive therapy (ECT) for more than 65 years. Yet, knowledge about, and attitudes towards, ECT have not been thoroughly researched within the Australian community. This study focused on a Western Australian perspective on these issues. METHOD: The objectives were achieved with specifically developed questionnaires. Six hundred surveys were distributed across the metropolitan area of Perth, Australia. RESULTS: A total of 379 completed questionnaires indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on individuals with psychosocial issues, on children and on involuntary patients. Public perceptions of ECT were also found to be mainly negative. CONCLUSION: The findings suggest that clinicians should ensure that individuals recommended for ECT are knowledgeable about basic ECT processes and implications in order to ensure their full informed consent.

Performance of psychiatric diagnostic groups on measures and strategies of verbal fluency.

Analysis of cognitive deficits in people with psychiatric disorders can increase our understanding of those disorders. Here we contrast the performance of 5 diagnostic groups (n = 120; schizophrenia, mild-to-moderate and moderate-to-severe depression, panic disorder, and healthy controls) on word and letter fluency tasks using 3 scoring systems (Abwender, Swan, Bowerman, & Connolly, 2001 ; Raskin, Silwinski, & Brood, 1992 ; Troyer, Moscovitch, & Winocur, 1997 ) that differ in complexity to determine what system best differentiates diagnostic groups. The 3 scoring methods differ in the range of cognitive strategies assessed and how strategies are defined. Groups with schizophrenia and major depression were hypothesized to show greater deficits in fluency than groups with panic disorder and healthy controls. Results showed that the group with schizophrenia had the lowest level of fluency regardless of scoring method, with the group with severe major depression also showing deficits. The healthy control and panic disorder groups, and unexpectedly, the mild-to-moderate depression group showed few, if any, deficits. The scoring method proposed by Abwender et al. ( 2001 ) proved to be most comprehensive and sensitive to group differences.

Dimensions of stereotypical attitudes among older adults: Analysis of two countries.

AIM: Much research on attitudes towards older adults has used younger adults as participants and identified a range of negative attitudes towards older persons. Comparatively little literature has explored the attitudes of older adults themselves towards their own age cohort. METHODS: The present study explicitly compared attitudes towards other older adults from samples of 195 older adults in Australia and 172 older Canadians. Attitudinal measures included the Aging Attitudes Questionnaire (assesses older adults' attitudes toward other older adults), Fraboni Scale of Ageism (assesses younger adults' attitudes toward older adults) and the Reactions to Aging Questionnaire (assesses attitudes toward one's own aging), as well as a scale measuring knowledge of aging, the Facts on Aging Quiz, adapted for Australia and Canada. Responses on the three attitudinal measures were subjected to principal components analysis. RESULTS: Two components emerged in both samples, one defined by the Reactions to Aging Questionnaire and Aging Attitudes Questionnaire scales and the second by the Fraboni Scale of Ageism scales. Regression analyses to ascertain prediction of scores on the Facts on Aging Quiz, adapted for Australia and Facts on Aging Quiz, adapted for Canada showed that only the Aging Attitudes Questionnaire scale for Physical Changes predicted scores on the Facts on Aging Quiz, adapted for Australia and no attitudes predicted Facts on Aging Quiz, adapted for Canada scores. CONCLUSIONS: It appears that older adults distinguish between their own aging and aging in others. Knowledge of aging appears to be predicted only by attitudes toward physical changes. Given increasing proportions of older adults in the population, as well as increasing access to aging information available to older cohorts, continued research on how older adults view themselves and the aging process is important, and will almost certainly continue to evolve over time. Geriatr Gerontol Int 2016; 16: 1226-1230.

The Differential Impact of Tourette's Syndrome and Comorbid Diagnosis on the Quality of Life and Functioning of Diagnosed Children and Adolescents.

PROBLEM: Tourette's syndrome (TS) is a neuropsychiatric disorder associated with adverse outcomes. High rates of comorbidity (80-90%) complicate presentation, yet the relationship among TS, common comorbid diagnoses, and adversity is not well understood. This research investigated the impact of comorbidity, and the discrete effects of common comorbid diagnoses, on quality of life (QoL) and functioning of youth with TS. METHODS: A community sample of parents of youth with TS (n = 86) participated in this survey-based study. Differences in QoL (Pediatric Quality of Life Inventory) and rates of psychological, behavioral, and social difficulties (Strength and Difficulties Questionnaire) reported for youth with or without comorbid disorder were determined, in addition to outcomes associated with individual disorders. FINDINGS: Parametric and nonparametric analyses revealed strong associations between comorbidity and decreased global QoL, impaired emotional and school functioning, and increased emotional symptomatology (p < .001). The impact of individual comorbid disorders was restricted and disorder specific, and TS was uniquely associated with impaired social functioning and peer relationship problems. CONCLUSIONS: Understanding the risks associated with TS, particularly to psychosocial well-being, and the specific risks accompanying individual comorbid disorders, may improve assessment, prioritization of treatment goals, and interventions targeting the individual, multidimensional needs of youth with TS.

Preparing for pain management: a pilot study to enhance engagement.

UNLABELLED: A significant proportion of individuals fail to engage in cognitive-behavioral treatments for pain. The aim of this pilot study was to develop and evaluate a Preparation for Pain Management Intervention administered before community-based therapy (CBT) pain management workshops. Participants (N = 78) were randomly assigned to a treatment group receiving a 2-session intervention including assessment and feedback based on the Preparation for Pain Management Profile (PPMP) or to a control group receiving assessment (treatment as usual) and an attention placebo interview in place of the feedback session. The interviews were conducted with both groups before patients were offered participation in pain management workshops. Results demonstrate that participants in the treatment group were significantly more likely to attend workshops than were participants in the control group (P < .01). PERSPECTIVE: This paper describes a randomized controlled trial assessing a brief motivational intervention aimed at increasing engagement in community-based pain management workshops.

Associations between Benzodiazepine Use and Neuropsychological Test Scores in Older Adults.

Benzodiazepines are widely prescribed for anxiety, although use of this class of medications has been associated with dependency and cognitive changes. This article describes the study in which we investigated the relationship between the class of benzodiazepine available for use and associated performance on neuropsychological tests in a community sample of 1,754 older Canadians from the Canadian Study of Health and Aging. Benzodiazepines were classified as short-, intermediate-, and long-acting. Associations were calculated between each class of benzodiazepine and eight neuropsychological measures, using multiple regression analysis and controlling for demographic variables. Results showed different effects of the co-variates across the three drug classes, and short half-life benzodiazepines were not associated with any neuropsychological measure. Intermediate half-life and long half-life benzodiazepine use were each associated with two measures. Increased focus on specific domains of cognitive function is needed to improve our understanding of how benzodiazepine use influences cognition.