Improving depressive symptoms and maintaining cognitive abilities of seniors within the nursing homes: A pilot study of brief mindfulness-based interventions for seniors in a semi-randomized trial

Introduction

Seniors in nursing homes are at higher risk for depression and emotional distress. The COVID-19 crisis and isolation have even increased the risk for cognitive decline and suicidality. Since social media is often unfamiliar to older adults, their treatment options were diminished during quarantine. Recently, studies showed the potential for Mindfulness-Based Intervention in improving cognitive functioning and psychological well-being among healthy older adults. Standardized courses such as MBSR and MBCT are not suited to the majority of seniors for several reasons. First, the interventions are too long and demanding, physically and cognitively. Second, they require an instructed counselor for delivery, which makes it almost impossible in times of quarantine, and third, very expensive. Hence, the purpose of this study was to examine whether similar improvements in emotional distress and cognitive functioning can be achieved through a brief intervention, that can be delivered by workers in nursing homes.

Methods

A course of 8 half-hour sessions each (MBIS: Mindfulness-Based Intervention for Seniors) was employed in two versions: (1) An 8-week course with weekly meetings (2) A 4-week course with 2 sessions per week and compared to a control care-as-usual group. Depression and mood were measured, as well as cognitive abilities in the Simon task. In addition, the level of Mindfulness skills was measured before and after the interventions.

Results

We showed that brief interventions succeeded in improving mindfulness Non-reactivity and produced changes in the facets Acting with awareness and Non-judging. More importantly, the brief intervention, in both frequency versions, improved the level of depression and mood (BDI and PHQ-9). At the cognitive level, an adaptive sequential effect appeared after the intervention only in the 8-week MBIS group.

Discussion

These findings indicate the effectiveness of this pilot of a short, simple, mindfulness-based intervention, in improving depression and psychological distress, as well as improving cognitive control over time. This may enhance significant developments in the field of treatment solutions for seniors, with a ready-to-use protocol to administer in nursing homes.

Development and Evaluation of an Artificial Intelligence–Based Cognitive Exercise Game: A Pilot Study

Recently, cognitive serious games have successfully been employed to train cognitive abilities in elderly people with mild cognitive impairment, Alzheimer’s disease, and related disorders. However, despite the continuous rehabilitation game design and its applications, the existing cognitive exercise games fall short of user interaction and personalized elements with regard to difficult levels, which leads to users leaving early and losing interests during the gameplay. In this regard, the purpose of the study was to design and develop the serious game inclusive of playful elements for user motivation, the web-based mobile application system for easy accessibility, and Artificial Intelligence– (AI–) based difficulty level adjustment system for prevention from earlier leaving out in the middle of the play so that the elderly users can feel entertaining and immersed into the cognitive game voluntarily. This study was designed as an eight-week pilot experiment with thirty-seven participants in their 60s to 80s for the game’s usability assessment purpose. Results of the study showed that the AI-based cognitive exercise game was acceptable, interesting, and motivating for the elderly people and the test results before and after the eight-week training suggest a relationship between longer the training on the game and lower cognitive assessment scores including geriatric quality of life scale, geriatric depression scale, and Korean version of mini-mental state examination (MMSE). These correlations demonstrate the potential value of serious games in clinical assessment of cognitive status for the elderly users with varying cognitive ability. Based on these results, the elderly-centered serious game with playful element can be potentially used in clinical settings, allowing the cognitive training to be more enjoyable and more medically effective. Given these promising results, a more focused study can extend to the game system or additional game tools or features to be explored that solely target the elderly by applying AI and advanced visualization devices.

Depression in Home-Based Care: The Role of the Home Health Nurse

Depression is a major health issue among older adults receiving home-based services yet is underdiagnosed and undertreated, which can result in negative health outcomes. Despite the recognized need for improved mental health services, significant gaps and barriers exist that contribute to less than optimal home-based depression management interventions. Home healthcare clinicians are well positioned to drive this effort for improving depression care with enhanced learning. Thus, the purpose of this article is to provide guidelines on improving depression care in homebound older adults based on four clinical functions central to home healthcare: screening, assessment, medication management, and patient/family education.

The importance of neighborhood ecological assets in community dwelling old people aging outcomes: A study in Northern Portugal

Human development is a bidirectional, person-context relational process, but scarce evidence is available about the relation between the individual variability across the life-span and the neighborhood ecological assets. Therefore, it is important that research focus not only on personal characteristics but on ecological assets as well. This way this study aims to analyze the association between neighborhood ecological assets categorized into four dimensions: human, physical or institutional, social or collective activity, accessibility, and the individual functioning. A 3% sample of residents aged 65 years and older in two downtown and three uptown parishes stratified by age and sex was interviewed at home using a protocol that included the Portuguese version of the Barthel Index in basic activities of daily living (BADL), the Lawton Instrumental Activities of Daily Living Scale (IADL), the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 items (GDS) for evaluating functionality, cognitive performance, and depression. The 162 participants were aged on average 75 years (sd = 7.0), 54% were women and 90% had less than 7 years of education. The majority of participants were independent in BADL (M = 90; sd = 17.7) and moderately dependent in IADL (M = 13, sd = 6.0), 20% showed cognitive impairment and a mean score of 8 (sd = 2.1) in GDS-15. After controlling for the effect of socio-demographic characteristics, functionality, and cognitive performance decreases in persons with worst outdoor mobility. On the other hand depressive symptoms are less common as the number of recreation opportunities, namely associative groups (cultural, educative, professional), increases. These results suggest that aging policies and practices must be ecologically embedded.

Discrimination of the cognitive profiles of MCI and depression using the KBNA

OBJECTIVE

The current study sought to determine if the Kaplan-Baycrest Neurocognitive Assessment (KBNA) was capable of discriminating individuals with subjective memory complaints associated with depression from individuals with mild cognitive impairment (MCI).

METHODS

Scores on 12 subtests of the KBNA were compared for 27 participants with MCI and 28 participants being treated for depression using Bonferroni correct between-group comparisons for each subtest. KBNA subtest scores were corrected for age and education.

RESULTS

Significant between-group differences were obtained on six subtests with large effect sizes (Cohen's d) ranging from 1.19 - 1.58. The six subtests involved encoding and delayed episodic memory for verbal and visual information. Using logistic regression analysis, five subtests of the KBNA were able to correctly classify 96.4% of study participants.

CONCLUSION

The results from this preliminary investigation indicate that the KBNA has the potential to serve as a brief and reliable assessment tool capable of distinguishing individuals with subjective memory complaints associated with depression from individuals with MCI in a clinical setting. Limitations of the current study and future research are discussed.