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Dao-Tran TH, Yeoh L, Comans T, Karusoo-Musumeci A, Auret KA, Sinclair R, Hilgeman MM, Clayton JM, Halcomb E, Campbell E, Meller A, Walton R, Kurrle S, Sinclair C. Factors Associated with Advance Care Planning Engagement Among Community-Dwelling Older Adults: A Cross-Sectional Study. J Clin Nurs 2024. [PMID: 39301973 DOI: 10.1111/jocn.17458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/21/2024] [Accepted: 09/06/2024] [Indexed: 09/22/2024]
Abstract
AIM To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults. DESIGN A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022. METHODS Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis. RESULTS Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement. CONCLUSION Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning. IMPACT Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning. REPORTING METHOD The STROBE statement checklist was used as a guide to writing the manuscript. PATIENT OR PUBLIC CONTRIBUTION The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.
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Affiliation(s)
- Tiet-Hanh Dao-Tran
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ling Yeoh
- School of Psychology, University of New South Wales, Sydney, Western Australia, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | | - Kirsten A Auret
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Ron Sinclair
- University of Adelaide, Adelaide, South Australia, Australia
| | - Michelle M Hilgeman
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Josephine M Clayton
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Western Australia, Australia
- The Palliative Centre, Hammond Care, Sydney, Western Australia, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elissa Campbell
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anne Meller
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | | | - Susan Kurrle
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Western Australia, Australia
| | - Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, Western Australia, Australia
- Neuroscience Research Australia, Sydney, Western Australia, Australia
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Monaghan C, Avila-Palencia I, Han SD, Power JM. Procrastination, depressive symptomatology, and loneliness in later life. Aging Ment Health 2024; 28:1270-1277. [PMID: 38695380 PMCID: PMC11324379 DOI: 10.1080/13607863.2024.2345781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/15/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Procrastination is an almost universal behaviour and yet little research to date has focused on procrastination among older adults. The purpose of this study was to explore the potential association between age and procrastination, and the potential mediating roles of depressive symptomatology and loneliness. METHOD Structural equation modelling was applied to data from 1309 participants (aged 29-92) from two waves United States Health and Retirement Study (2016-2020). Within the model, sex, education, marital status, and job status were added as covariates. RESULTS There was no statistically significant direct effect between age and procrastination (β = 0.06, p = 0.106). However, an indirect effect was present via depressive symptomatology (β = -0.40, p < 0.001). No mediating effect of loneliness was observed (β = - 0.01, p = 0.371). Subsequent analysis revealed that the symptoms, fatigue, loneliness, and lack of motivation significantly predicted procrastination. CONCLUSION While age was not directly associated with procrastination, increasing age was associated with a decreased likelihood of depressive symptomatology, which was in turn associated with an increased likelihood of procrastination. Such findings indicates that age demonstrates no association with procrastination because of the suppressing effect of depressive symptomatology.
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Affiliation(s)
| | | | - S. Duke Han
- Department of Psychology, University of Southern California
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Therrien S, Anthony M, Turnbull A, Lin FV. Risk-Taking Behavior Differs Between Older Adults with and without Mild Cognitive Impairment. J Alzheimers Dis 2024; 100:1227-1235. [PMID: 39031355 DOI: 10.3233/jad-231448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Adequately evaluating risk and making decisions is vital but understudied for older adults living independently but with compromised cognition, as seen in those with mild cognitive impairment (MCI), specifically those with amnestic MCI (aMCI) which is associated with higher risk of conversion to Alzheimer's disease. Objective We propose to comprehensively evaluate risk-taking behaviors across domains important for everyday activities between an aMCI group and their cognitively healthy counterparts (HC). Methods A case-control study design. Data on risk-taking behaviors via the Domain-Specific Risk-Taking Scale (DOSPERT), and candidate confounding mental health factors (i.e., neurodegeneration, depression, and fatigue) were collected. Analyses on group difference and interaction between group and confounding factors on risk-taking behaviors were conducted. Results The aMCI group showed a higher likelihood of risk-taking than HC (t = 4.38, df = 73, p < 0.001). Moderation analysis showed fatigue (F = 5.91, p = 0.018) and presence of depression (F = 4.52, p = 0.037), but not neurodegeneration, as significant moderators for group and DOSPERT total score, controlling for sex. In post-hoc analyses, there was a significant relationship between both fatigue (B = -7.83, SE = 3.65, t = -2.14, p = 0.036), and presence of depression (B = -20.80, SE = 9.97, t = -2.09, p = 0.041), with DOSPERT total score for HC but not for aMCI. There were no significant relationships between neurodegeneration, fatigue, or depression with any specific risk-taking domains after correction for multiple comparisons. Conclusions Our results show differences in risk-taking behavior between older adults with and without intact cognition, and overall decision-making is affected by fatigue and depression in HC but not aMCI, together suggesting the importance of cognition in the ability to adjust risk-taking behaviors.
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Affiliation(s)
- Sarah Therrien
- Department of Psychiatry and Behavioral Sciences, CogT Lab, Stanford University, Palo Alto, CA, USA
| | - Mia Anthony
- Department of Psychiatry and Behavioral Sciences, CogT Lab, Stanford University, Palo Alto, CA, USA
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, USA
| | - Adam Turnbull
- Department of Psychiatry and Behavioral Sciences, CogT Lab, Stanford University, Palo Alto, CA, USA
| | - F Vankee Lin
- Department of Psychiatry and Behavioral Sciences, CogT Lab, Stanford University, Palo Alto, CA, USA
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Poptsi E, Moraitou D, Tsatali M, Papaliagkas V, Tzanakaki-Melissari M, Kyriakoulaki E, Kounti F, Markou N, Liapi D, Batsila G, Ouzouni F, Vasiloglou M, Tsolaki M. Examining Voting Capacity in Older Adults with and without Cognitive Decline. Brain Sci 2022; 12:brainsci12121614. [PMID: 36552074 PMCID: PMC9776084 DOI: 10.3390/brainsci12121614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nowadays, controversy exists regarding the stage of cognitive decline and/or dementia where voting capacity is diminished. AIM To evaluate whether general cognitive status in advancing age predicts voting capacity in its specific aspects. METHODS The study sample comprised 391 people: 88 cognitively healthy older adults (CH), 150 people with Mild Cognitive Impairment (MCI), and 153 people with Alzheimer's disease dementia (ADD). The assessment included CAT-V for the voting capacity and Mini Mental State Examination (MMSE) for general cognitive ability. ANOVAs and ROC curves were the tools of statistical analysis towards (a) indicating under which MMSE rate participants are incapable of voting and (b) whether the CAT-V total score can discriminate people with dementia (PwADD) from people without dementia (PwtD). RESULTS Out of the six CAT-V questions, one question was associated with a low MMSE cutoff score (19.50), having excellent sensitivity (92.5%) and specificity (77.20%), whilst the other five questions presented a higher MMSE cutoff score, with a good sensitivity (78.4% to 87.6%) and specificity (75.3% to 81.7%), indicating that voting difficulties are associated with cognitive status. Secondarily, the total CAT-V score discriminates PwADD from PwtD of 51-65 years (sensitivity 93.2%/specificity 100%-excellent), PwADD from PwtD of 66-75 years (sensitivity 73.3%/specificity 97.1%-good), PwADD from PwtD of 76-85 years (sensitivity 92.2%/specificity 64.7%-good), whilst for 86-95 years, a cutoff of 9.5 resulted in perfect sensitivity and specificity (100%). CONCLUSION According to MMSE, PwADD have no full voting competence, whilst PwtD seem to have intact voting capacity. The calculated cut-off scores indicate that only people who score more than 28 points on the MMSE have voting capacity.
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Affiliation(s)
- Eleni Poptsi
- Laboratory of Psychology, Department of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
- Lab of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki (CIRI—AUTh), 54124 Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Department of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
- Lab of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki (CIRI—AUTh), 54124 Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Marianna Tsatali
- Lab of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki (CIRI—AUTh), 54124 Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
- Department of Psychology, School of Humanities and Social Sciences, University of Western Macedonia, 50100 Kozani, Greece
- Correspondence: ; Tel.: +30-2310-351-451
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, International Hellenic University, 57001 Thessaloniki, Greece
| | | | - Elia Kyriakoulaki
- Institute of Research and Education of Psychiatric and Dementia Patient’s, 73100 Chania, Greece
| | - Fotini Kounti
- Heraklion Association of Alzheimer’s Disease and Healthy Aging “ALLILENGII”, 71201 Heraklion, Greece
| | - Nefeli Markou
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Despina Liapi
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Georgia Batsila
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Fani Ouzouni
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Maria Vasiloglou
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Magda Tsolaki
- Laboratory of Psychology, Department of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
- Lab of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation, Aristotle University of Thessaloniki (CIRI—AUTh), 54124 Thessaloniki, Greece
- Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
- Heraklion Association of Alzheimer’s Disease and Healthy Aging “ALLILENGII”, 71201 Heraklion, Greece
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
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Siqueira ASS, Biella MM, Borges MK, Mauer S, Apolinario D, Alves TCDTF, Jacob-Filho W, Oude Voshaar RC, Aprahamian I. Decision-making executive function profile and performance in older adults with major depression: a case-control study. Aging Ment Health 2022; 26:1551-1557. [PMID: 34263687 DOI: 10.1080/13607863.2021.1950617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.
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Affiliation(s)
| | - Marina Maria Biella
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sivan Mauer
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Apolinario
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
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Novel insights into "hot" executive functioning profiles in elderly individuals. Int Psychogeriatr 2020; 32:669-671. [PMID: 32616116 DOI: 10.1017/s1041610219001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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