Prevention of Delirium in Older Adults With Dementia: A Systematic Literature Review.

Although dementia is the largest independent risk factor for delirium and leads to poor health outcomes, we know little about how to prevent delirium in persons with dementia (PWD). The purpose of the current systematic literature review was to identify interventions designed to prevent delirium in older PWD. Seven studies meeting inclusion criteria were extracted. Five studies were in the acute care setting and two were community settings. One study used a randomized controlled trial design. Five of the seven interventions comprised multiple components addressing delirium risk factors, including education. Two studies addressed delirium by administration of medication or vitamin supplementation. Using the GRADE framework for the evaluation of study quality, we scored three studies as moderate and four studies as low. Thus, high-quality research studies to guide how best to prevent delirium in PWD are lacking. Although more research is required, the current review suggests that multicomponent approaches addressing delirium risk factors should be considered by health care professionals when supporting older PWD. [Journal of Gerontological Nursing, 46(10), 43-54.].

Longitudinal Association of Physical Activity, Mastery and Psychological Distress in Mid-Aged Adults over 9-Years.

Psychological distress is highly prevalent and associated with significant adverse health outcomes and economic burden. Mastery and physical activity are potential resources to reduce distress and promote wellbeing; however, previous research has not examined their potential interactive relationship over time. The purpose of this study was to explore associations between mastery, physical activity, and distress in mid-aged adults over nine years. Data from a longitudinal mail survey study including the Kessler 6, Pearlin Mastery Scale, and items assessing time spent in physical activity were examined in a sample of 4404 adults aged 40 to 54 years at baseline. Group-Based Trajectory Models identified two distinct trajectories of psychological distress (elevated and low). Generalized Estimating Equations were used to assess mastery and physical activity, adjusting for sociodemographic and health variables, as predictors for the probability of distress group membership. The odds of elevated distress over time were significantly reduced in people with higher mastery (OR = 0.13; 95% 0.11-0.15) and doing at least 150 min/week of physical activity (OR = 0.81; 95% 0.68-0.96). There was no significant interaction between mastery and physical activity. Mastery and physical activity may be important resources to mitigate distress and further research is needed to evaluate interventions promoting these resources and the impact on mid-aged adults experiencing psychological distress.

Total Sedentary Time and Cognitive Function in Middle-Aged and Older Adults: A Systematic Review and Meta-analysis.

BACKGROUND: An estimated 47 million people have dementia globally, and around 10 million new cases are diagnosed each year. Many lifestyle factors have been linked to cognitive impairment; one emerging modifiable lifestyle factor is sedentary time. OBJECTIVE: To conduct a systematic review and meta-analysis of peer-reviewed literature examining the association between total sedentary time with cognitive function in middle-aged and older adults under the moderating conditions of (a) type of sedentary time measurement; (b) the cognitive domain being assessed; (c) looking at sedentary time using categorical variables (i.e., high versus low sedentary time); and (d) the pattern of sedentary time accumulation (e.g., longer versus shorter bouts). We also aimed to examine the prevalence of sedentary time in healthy versus cognitively impaired populations and to explore how experimental studies reducing or breaking up sedentary time affect cognitive function. Lastly, we aimed to conduct a quantitative pooled analysis of all individual studies through meta-analysis procedures to derive conclusions about these relationships. METHODS: Eight electronic databases (EMBASE; Web of Science; PsycINFO; CINAHL; SciELO; SPORTDiscus; PubMed; and Scopus) were searched from inception to February 2021. Our search included terms related to the exposure (i.e., sedentary time), the population (i.e., middle-aged and older adults), and the outcome of interest (i.e., cognitive function). PICOS framework used middle-aged and older adults where there was an intervention or exposure of any sedentary time compared to any or no comparison, where cognitive function and/or cognitive impairment was measured, and all types of quantitative, empirical, observational data published in any year were included that were published in English. Risk of bias was assessed using QualSyst. RESULTS: Fifty-three studies including 83,137 participants met the inclusion criteria of which 23 studies had appropriate data for inclusion in the main meta-analysis. The overall meta-analysis suggested that total sedentary time has no association with cognitive function (r = -0.012 [95% CI - 0.035, 0.011], p = 0.296) with marked heterogeneity (I2 = 89%). Subgroup analyses demonstrated a significant negative association for studies using a device to capture sedentary time r = -0.035 [95% CI - 0.063, - 0.008], p = 0.012). Specifically, the domains of global cognitive function (r = -0.061 [95% CI - 0.100, - 0.022], p = 0.002) and processing speed (r = -0.067, [95% CI - 0.103, - 0.030], p < 0.001). A significant positive association was found for studies using self-report (r = 0.037 [95% CI - 0.019, 0.054], p < 0.001). Specifically, the domain of processing speed showed a significant positive association (r = 0.057 [95% CI 0.045, 0.069], p < 0.001). For prevalence, populations diagnosed with cognitive impairment spent significantly more time sedentary compared to populations with no known cognitive impairments (standard difference in mean = -0.219 [95% CI - 0.310, - 0.128], p < 0.001). CONCLUSIONS: The association of total sedentary time with cognitive function is weak and varies based on measurement of sedentary time and domain being assessed. Future research is needed to better categorize domains of sedentary behaviour with both a validated self-report and device-based measure in order to improve the strength of this relationship. PROSPERO registration number: CRD42018082384.

Migraine and Suicidal Behaviors: A Systematic Literature Review.

OBJECTIVE: The aim of this systematic review was to provide a picture of suicidality (suicide ideation and behavior, both fatal and nonfatal) among indviduals with migraine. BACKGROUND: Migraine is a leading cause of disability around the world. Migraine may manifest with a number of symptoms, ranging from severe headaches to neurological sensory disturbances. Comorbid psychological conditions, such as depression, have also been linked to chronic migraine. DATA SOURCES: Articles were retrieved from SCOPUS, PubMed, Proquest, and Web of Science. SEARCH TERMS: Suicid* AND migrain* in English-language peer-reviewed journals between January 1, 1966 and December 31, 2014. ELIGIBILITY CRITERIA: Original research papers providing empirical evidence about the potential link between migraine and suicidal behaviors. RESULTS: Initial search identified 510 papers; the titles and abstracts of 360 unique results were examined for their relevance to the combination of migraine and suicidality. In total, 17 papers reporting original empirical analyses were included in this review. CONCLUSIONS: Research has empirically documented a link between migraine and suicide ideation and behavior, particularly concerning the subtype of migraine with aura. Overall, nonfatal suicidal behavior among people with migraine has primarily been investigated, with only 2 studies analyzing suicide mortality. In addition, majority of studies originated from the United States or Canada (n=10). Future research should thoroughly define migraine and investigate link between migraine and suicide mortality.