The Promotion of Well-Being in Aging Individuals Living in Nursing Homes: A Controlled Pilot Intervention with Narrative Strategies

Network analysis of correlations between suicide exposure, depression, and anxiety symptoms in adolescents

BACKGROUND

Adolescents with a history of suicide exposure, defined as experiencing the suicide death of a family member, friend, or other acquaintances, are more likely to experience mental health issues such as depression or anxiety.

AIMS

This study aimed to explore prevalence rates and the network of adolescents' suicide exposure, depression, and anxiety symptoms, and to clarify the correlations between suicide exposure and symptoms of depression and anxiety.

METHOD

A total of 8,957 adolescents were included in this cross-sectional study. Data regarding general information, symptoms of depression and anxiety, and suicide exposure were collected from mid-September to early October 2021. Network analysis was employed to assess relationships between suicide exposure and individual symptoms of both depression and anxiety. Central symptoms were identified by strength; the flow network was visualized to identify symptoms directly related to suicide exposure.

RESULTS

The prevalence rates of suicide exposure, depression, and anxiety were 5.28%, 12.87%, and 10.48%. Results indicated that suicide exposure was associated with both depression and anxiety, and had the strongest positive association with suicidal ideation. Central symptoms of the network were sad mood, nervousness, fatigue, irritability, and uncontrollable worry. Bridge symptoms were suicidal ideation and irritability. Appetite changes, suicidal ideation, uncontrollable worry, sleep difficulties, and irritability were symptoms directly related to suicide exposure.

CONCLUSIONS

There were significant inter-symptom associations between suicide exposure, depression, and anxiety in adolescents. It is recommended that future studies explore whether targeted interventions and long-term monitoring concerning these inter-symptom associations can protect adolescents with suicide exposure.

Development and evaluation of a narrative therapy program combined with a solution-focused approach for nursing home residents: A quasi-experimental study

The transition from the family home to a nursing home can be an emotionally stressful experience for older adults. This study aimed to examine the feasibility and effects of a narrative therapy combined with a solution focus (NTCSF) program on the psychological adjustment, depression, and self-efficacy of nursing home residents. A non-random concurrent controlled trial was conducted in Fujian, China that involved 81 participants (intervention = 41, comparison = 40) from four separate nursing homes. The control group received routine institutional care, while the intervention group underwent a three-week NTCSF program in addition to receiving routine care. In the variance analyses, significant differences were found in "psychological adjustment" (T = 4.007, P < 0.001) and "self-efficacy" (T = 3.204, P = 0.002), compared to the control group. There was no significant difference in "depression" (t = -1.550, P = 0.125) between the groups at the baseline, but the experimental group showed a significant decrease in depression (t = -2.204, P = 0.033) after the intervention. The NTCSF program was found to be effective in improving the psychological adjustment of nursing home residents. Trial registration This study was registered on the Chinese Clinical Trial Registry (Registration No: ChiCTR-2100042767).

Adapted Physical Activity Can Increase Life Appreciation in Patients with Parkinson's Disease

Objectives:This study aimed to measure the effect of a treatment of adapted physical activity (APA) on motor symptoms and on positive psychological resources in a group of patients with PD. Methods: 37 patients with PD (Mage= 71.5; 70.3% male) completed measures of disability level, motor performance, distress, well-being, and quality of life before and after participating in a program of APA (duration: 7 months). Analysis of variance - repeated measures was performed to evaluate the effect of APA on disability, distress, and well-being. Results: After intervention, patients reported significant improvements in their motor autonomy, disability level, psychological distress, and in life appreciation. Discussion: A brief physical activity program was beneficial not only to patients' motor functioning, but also to their mental health, by reducing distress and promoting life appreciation.

Social connections and participation among people with mild cognitive impairment: barriers and recommendations

Objective

Social connections and participation are essential for individuals with mild cognitive impairment (MCI) to prevent the progression of cognitive decline and enhance their overall well-being. However, existing research has primarily focused on environmental barriers, overlooking personal factors and the interconnected nature of these barriers. Moreover, there is a lack of understanding regarding social connections and participation challenges specific to people with MCI in low- and middle-income countries. Therefore, this study aimed to explore the barriers that hinder social connections and participation among people with MCI in China and investigate opportunities to design appropriate supportive interventions.

Methods

Thirty-one people with MCI (13 males and 18 females; mean age = 82.74 years, SD = 7.69; mean MoCA score = 21.26, SD = 2.44) and 13 caregivers were recruited to attend focus groups. In addition, 10 therapists were interviewed using a semi-structured interview guide. Focus groups and interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach.

Results

We found that the ability to build social connections among people with MCI is affected by mobility challenges, intensive grandparenting responsibilities, availability of suitable activities, and feelings of exclusion in a closed-minded community environment. Personal reasons, such as lower social efficacy, inability to find suitable social activities, and intensive family responsibilities, discourage people with MCI from social participation. The digital literacy of people with MCI depends on their motivation to learn and use digital tools; people with MCI who live in a community have a higher digital literacy than those living in care centers. The motivation to achieve digital literacy is affected by perceived benefits, costs of technology use, and social influence.

Conclusion

Multidimensional initiatives are needed to address barriers to social connections, participation, and technology adoption among individuals with MCI. This includes organizing and engaging in social activities, promoting awareness and education on the importance of social participation, and exploring technology-based interventions to improve memory and storytelling abilities. These efforts can create a supportive environment and empower individuals with MCI to participate actively in social interactions, enhancing their overall well-being.

Determinants of physical, psychological, and social well-being in older adults: a cross-sectional study in senior care facilities of Pakistan (2019/20)

BACKGROUND

Published research on senior care facilities in Pakistan is scarce and no large-scale study has been conducted to assess factors affecting well-being of older adults in these facilities. This study, therefore, investigated the effects of relocation autonomy, loneliness, and satisfaction with services along with socio-demographic characteristics on physical, psychological, and social well-being of older residents living in senior care facilities of Punjab, Pakistan.

METHODS

This cross-sectional study collected data from 270 older residents living in 18 senior care facilities across 11 districts of Punjab, Pakistan from November 2019 to February 2020 using multistage random sampling. Existing reliable and valid scales were used to collect information from older adults related to relocation autonomy (Perceived Control Measure Scale), loneliness (de Jong-Gierveld Loneliness Scale), satisfaction with service quality (Service Quality Scale), physical and psychological well-being (General Well-Being Scale), and social well-being (Duke Social Support Index). A psychometric analysis of these scales was carried out followed by three separate multiple regression analyses to predict physical, psychological, and social well-being from socio-demographic variables and key independent variables (relocation autonomy, loneliness, and satisfaction with service quality).

RESULTS

The results of multiple regression analyses showed that the models predicting physical (R² = 0.579), psychological (R² = 0.654), and social well-being (R² = 0.615) were statistically significant (p < 0.001). Number of visitors was a significant predictor of physical (b = 0.82, p = 0.01), psychological (b = 0.80, p < 0.001), and social (b = 2.40, p < 0.001) well-being. Loneliness significantly predicted physical (b = -0.14, p = 0.005), psychological (b = -0.19, p < 0.001), and social (b = -0.36, p < 0.001) well-being. Control over relocation process significantly predicted physical (b = 0.56, p < 0.001) and psychological (b = 0.36, p < 0.001) well-being. Satisfaction with services significantly predicted physical (b = 0.07, p < 0.001) and social (b = 0.08, p < 0.001) well-being.

CONCLUSION

Pragmatic, equitable and cost-effective interventions are needed to improve the wellbeing of older residents living in senior care facilities. Friendly behavior of mobilizing staff and adjusted residents to facilitate new residents, therapeutic interventions such as relocation support programs, reminiscence therapy and intergenerational support, and increasing their exposure and connection to the outside world, can raise their physical, psychological, and social well-being.

Promouvoir la santé mentale des personnes âgées avec des incapacités physiques : revue systématique des interventions proposées à domicile et en établissement

Introduction&#160;: Promoting the mental health of vulnerable elderly patients is a public health priority.Context&#160;: In many cases, mental health interventions for elderly people are not appropriate for those with multiple physical disabilities.Objectives&#160;: This article aims to provide gerontology professionals with an overview of the types of interventions available based on their practice setting (home or long-term care facility) and the characteristics of the people who use them (over 75 years old with physical disabilities).Method&#160;: A systematic literature review was conducted using the PsycInfo, PubMed, and Cochrane databases, using data ranging from 2001-2022. All interventions aimed at addressing mental health issues were included, regardless of their research methodology.Results&#160;: A total of 18 studies were included in this systematic review. The methodological limitations of these studies had a negative impact on our ability to draw conclusions and generalizations about the results of this review. However, the social and psychological support interventions studied seem to hold much promise.Discussion&#160;: The provision of personalized support seems to be an important factor in determining the success of an intervention, whether at home or in a long-stay facility.Conclusion&#160;: Further studies are needed to provide evidence of the effectiveness of these interventions.

Relationship of Purpose in Life to Dementia in Older Black and White Brazilians

OBJECTIVES

To test the hypothesis that higher level of purpose in life is associated with lower likelihood of dementia and mild cognitive impairment (MCI) in older Brazilians.

METHODS

As part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), informants of 1,514 older deceased Brazilians underwent a uniform structured interview. The informant interview included demographic data, the Clinical Dementia Rating scale to diagnose dementia and MCI, the National Institute of Mental Health Diagnostic Interview Schedule for depression, and a 6-item measure of purpose in life, a component of well-being.

RESULTS

Purpose scores ranged from 1.5 to 5.0 with higher values indicating higher levels of purpose. On the Clinical Dementia Rating Scale, 940 persons (62.1%) had no cognitive impairment, 121 (8.0%) had MCI, and 453 (29.9%) had dementia. In logistic regression models adjusted for age at death, sex, education, and race, higher purpose was associated with lower likelihood of MCI (odds ratio = .58; 95% confidence interval [CI]: .43, .79) and dementia (odds ratio = .49, 95% CI: .41, .59). Results were comparable after adjusting for depression (identified in 161 [10.6%]). Neither race nor education modified the association of purpose with cognitive diagnoses.

CONCLUSIONS

Higher purpose in life is associated with lower likelihood of MCI and dementia in older black and white Brazilians.

Activity, Activity Personalization, and Well-Being in Nursing Home Residents With and Without Cognitive Impairment: An Integrative Review

OBJECTIVES

Engagement in personally relevant and pleasant activity is a facet of many theories of well-being. This integrated review and narrative synthesis explored the hypothesis that activity participation improves well-being for nursing home residents.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, Embase, and CINAHL for research published between 2006 and 2018. We included peer-reviewed, English-language studies of nursing-home residents, with interventions focused on activities and on well-being or affect outcomes.

RESULTS

After screening, the search yielded 45 studies: 15 reviews of specific activities and 30 empirical articles. We found consistent support for tailored activity interventions and less consistent support for specific or generic activity interventions with the possible exception of music therapy. Research focused on specific activity types had methodological limitations and confounds with activity preferences.

CONCLUSIONS

Participation in activities may improve well-being in residents of nursing homes. Tailored activities are likely to be superior to those provided indiscriminately to all residents.

CLINICAL IMPLICATIONS

Improving quality of life in long-term care should include opportunities to engage in activities; those most effective will be tailored to individuals and no single activity will be effective for everyone.

A systematic review of language and communication intervention research delivered in groups to older adults living in care homes

BACKGROUND

The communication skills of older adults living in care homes is an underexplored topic. Ageing can lead to reduced communication ability and activity; and in the care home environment there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being, but no systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population.

AIMS

To identify and evaluate the evidence for behavioural interventions with older adults, delivered in groups in care homes, that specifically included a language or communication activity. To explore the impact of such intervention on the specific domains of language, communication and social interaction. To determine whether behavioural mechanisms of action can be identified.

METHODS & PROCEDURES

Embase, Medline, Ovid Nursing database, Psych info and CINAHL complete were searched and produced 158 records for screening, of which 22 remained for review. In order to identify and evaluate the quality of the evidence base presented the following research questions were posed: What research has been conducted in this area? What is the methodological quality of the studies identified? How complete is the intervention reporting? How was change measured in the domains of language, communication and social interaction? Is there evidence of efficacy, indicated by statistically significant improvement, in these domains? How did the interventions work? Synthesis tools employed included the PEDro-P Scale, the TIDieR checklist and the ITAX.

MAIN CONTRIBUTION

A total of 22 studies met the criteria for review. One study used solely language or communication interventions, but the remaining 21 studies used behavioural interventions which incorporated language and communication activities to varying degrees. Studies fell into four broad intervention types: reminiscence or life review; cognitive stimulation; narrative or storytelling; and multi-modality group communication. The majority of studies were of fair methodological quality, with a moderate level of detail provided in treatment reporting. Statistically significant improvement was reported by authors in all four intervention types and across language, communication and social domains. Social interaction, social support and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.

CONCLUSIONS & IMPLICATIONS

Despite limitations in the evidence base, there are important positive signs for the beneficial effects of supporting language and communication in care homes. Blinding of assessors, and the accuracy and accessibility of statistical reporting are important areas to address in order to improve the quality of the evidence base.

WHAT THIS PAPER ADDS

Ageing can lead to reduced communication ability and activity, and in the care home setting there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being. The communication skills of older adults living in care homes is an underexplored topic. No systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. This review reveals important positive signs for the beneficial effects of supporting language and communication in care homes. Social interaction, social support, and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.

Fostering Positive Communities: A Scoping Review of Community-Level Positive Psychology Interventions

Historically, positive psychology research and practice have focused on studying and promoting well-being among individuals. While positive psychology interventions focusing on the well-being of communities and marginalized groups have recently been developed, studies reporting on their nature and characteristics are lacking. The aim of this paper is to examine the nature of community-level positive psychology interventions. It reviews the target populations, intervention modalities, objectives, and desired effects of 25 community-level positive psychology interventions found in 31 studies. This scoping review shows that community-level programs based on positive psychology vary greatly in all these aspects. However, most interventions are aimed at individual-level changes to achieve target group outcomes. Contextual issues such as social conditions, values, and fairness affecting well-being are rarely considered. Discrepancies between community-level positive psychology interventions and community psychology in terms of values and social change are discussed.

The role of meaning in life as a protective factor in suicidal ideation among elderly men with physical illnesses

The highest suicide rates are among elderly men. The aim of the present study is to extend previous findings by focusing on meaning in life as a protective factor for suicidal ideation among elderly men. Self-report measures were administered to 170 elderly men aged 65 and over in community. Meaning in life and physical illness predicted suicidal ideation among elderly men. Physical illness moderated the association between meaning in life and suicidal ideation. In the young-old group (ages 65-74), meaning in life predicted suicidal ideation among those who reported higher rates of physical illness. This moderation effect was not found among the older group (aged 75 years and older). The findings of this study highlight the importance of age-differences in studying suicidal ideation among elderly men. Our findings emphasize the importance of cultivating and maintaining meaning in life when coping with chronic illnesses and point at meaning in life as a goal in therapeutic interventions designed to reduce suicidal ideation among elderly.

Non-pharmacological Approaches to Depressed Elderly With No or Mild Cognitive Impairment in Long-Term Care Facilities. A Systematic Review of the Literature

Introduction: Compared to old people who live at home, depressive symptoms are more prevalent in those who live in long-term care facilities (LTCFs). Different kinds of non-pharmacological treatment approaches in LTCFs have been studied, including behavioral and cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and life review/reminiscence. The aim of the current review was to systematically review non-pharmacological treatments used to treat depressed older adults with no or mild cognitive impairment (as described by a Mini Mental State Examination score > 20) living in LTCFs. Methods: A research was performed on PubMed and Scopus databases. Following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flowchart, studies selection was made. The quality of each Randomized Controlled Trial was scored using the Jadad scale, Quasi-Experimental Design studies and Non-Experimental studies were scored based on the Newcastle-Ottawa Scale (NOS) Results: The review included 56 full text articles; according to the type of intervention, studies were grouped in the following areas: horticulture/gardening (n = 3), pet therapy (n = 4), physical exercise (n = 9), psychoeducation/rehabilitation (n = 15), psychotherapy (n = 3), reminiscence and story sharing (n = 14), miscellaneous (n = 8). Discussion and Conclusion: Despite mixed or negative findings in some cases, most studies included in this systematic review reported that the non-pharmacological interventions assessed were effective in the management of depressed elderly in the LTCFs context. Regrettably, the limitations and heterogeneity of the studies described above hinder the possibility to generalize and replicate results.

Fostering Well-Being in the Elderly: Translating Theories on Positive Aging to Practical Approaches

This article overviews positive aging concepts and strategies to enhance well-being in the elderly and then presents a translation of theories on positive aging to practical approaches for Positive Aging. Drawing upon positive psychology and positive aging research and tools, this program is designed to help older adults improve their well-being by acquiring skills and strategies to cope with present and future challenges. The Mental Fitness Program for Positive Aging (MFPPA) can enhance seniors' quality of life by increasing their vital involvement and active engagement in life. This model is most appropriate for community dwelling individuals. It can easily be conducted in wide range of adult education programs in community centers, sheltered homes, and primary care clinics. It can also be conducted through online psychoeducational training.

Spotlight on eudaimonia and depression. A systematic review of the literature over the past 5 years

BACKGROUND AND AIM

Recent investigations pointed out to the important role of well-being in influencing physical and mental health, with robust findings for the dimension of depression. The aim of this systematic review is to provide an updated summary of articles focused on eudaimonia and depression, including psychosocial interventions that addressed both issues.

METHOD

The literature search was performed by entering the keywords: "eudaimonia" OR "eudaimonic well-being (EWB)" and "depression" and by limiting to "journal article" and to the English language. To be included in this, review articles had to present at least one EWB measure and one depression measure, and had to investigate young and adult populations, including populations with mental health disorders. Articles were excluded if they were published before 2014.

RESULTS

Thirty-four articles were included, with a total of 81,987 participants. About the majority of participants were recruited in two twin studies, followed by college students, and by adults belonging to the general and clinical populations. Sixteen different instruments assessed eudaimonia, being Ryff's psychological well-being scale the most frequently used. The most used instrument for assessing depression was the Depression Anxiety Stress Scale, followed by Center for Epidemiological Studies Depression Scale. The studies confirmed the robust, inverse correlation between eudaimonia and depression, which was only partially explained by genetic common factors and which was mediated by other factors, as self-compassion, personality traits, and defense mechanisms. Various interventions were found to be effective both in promoting eudaimonia and in addressing depression, ranging from cognitive-behavioral therapy, acceptance and commitment therapy, mindfulness, to positive psychotherapy.

CONCLUSION

Clinicians, counselors, and practitioners can select different strategies to promote EWB and to address depression. The findings also suggest the need for a larger consensus on the definition of eudaimonia and on the specific measure(s) to evaluate it in different populations and in different life stages.

Positive Aging: The Impact of a Community Wellbeing and Resilience Program

Objectives: To test the effect of a community wellbeing intervention, delivered by community partners, on the wellbeing, resilience, optimism, and social connection of older adults in the general population (Study 1) and older adult carers (Study 2), a population at risk for low wellbeing. Methods: Participants self-selected to take part in an 8-week multi-component wellbeing and resilience program consisting of weekly training sessions, and optional mentoring/peer support. Program participants and a natural control group were compared, post-intervention, on all outcomes of interest. Results: Intervention participants (Study 1) reported significantly lower scores of social isolation, but no significant difference in wellbeing, optimism, or resilience. Intervention participants (Study 2) showed significantly higher scores on all measured outcomes except social isolation. Conclusion: These studies point towards the potential benefits of wellbeing interventions for older adult from the general population and older adult carers, when delivered by community partners. Clinical implications: Early interventions promoting mental health may contribute to reducing the burden of mental health conditions on individuals and the health care system. Studies with more rigorous designs and extended follow-up measurements are required to consolidate these positive initial findings.

Lighten UP! A Community-Based Group Intervention to Promote Eudaimonic Well-Being in Older Adults: A Multi-Site Replication with 6 Month Follow-Up

Objectives: Eudaimonic well-being (EWB), increasingly recognized as a critical component of health, typically declines in later life, and there are no existing programs to sustain or increase EWB in older adults. Lighten UP! is an 8-week program to promote EWB through facilitated group sessions in community settings and at-home practice. Building on earlier pilot research, the current study assessed the effect of the Lighten UP! Program using a longitudinal, multi-site design. Methods: Men and women (N = 169) aged 60 and over were recruited from three Wisconsin communities. EWB, life satisfaction, depression, and diverse aspects of health were assessed before and after the program and at 6-month follow up. Results: Participants reported significantly increased EWB; these changes were maintained 6 months later. The specific EWB domains of self-acceptance, positive relations, and personal growth showed the most robust gains. Participants also showed significant and sustained declines in depressive symptoms, anxiety, and hostility. Conclusions: Lighten UP! Program confirmed its positive effects for enhancing EWB in older adults living in multiple community settings. Clinical Implications: Programs that sustain or enhance EWB in older adults can be expected to yield improvements in diverse aspects of mental and physical health.

Autobiographical Narration as a Tool for the Empowerment of Older Adults' Subjective and Psychological Wellbeing in Nursing Homes

OBJECTIVES

Conceiving narration as a resource to promote older people's wellbeing, the present work aimed to implement a narrative-based intervention to empower the subjective and psychological wellbeing of older adults living in nursing homes.

METHODS

Twenty-one nursing-home residents took part in a narrative training experience consisting of three weekly interview sessions. During each interview, a psychologist helped the participants to construct an autobiographical narrative about their present life in the nursing home based on a Deconstruction-Reconstruction technique. Subjective and psychological wellbeing variables were assessed before and after the intervention.

RESULTS

Subjective but not psychological wellbeing increased over the course of the intervention. The participants reported to appreciate the intervention.

CONCLUSIONS

Although preliminary, the results suggest that brief narrative training based on narrative therapy can positively affect nursing-home residents' subjective wellbeing.

CLINICAL IMPLICATIONS

Brief narrative interventions implementing deconstruction-reconstruction techniques are feasible for long-term care residents.

Purpose in Life and Hospitalization for Ambulatory Care-Sensitive Conditions in Old Age

OBJECTIVE

To test the hypothesis that higher level of purpose in life is associated with lower subsequent odds of hospitalization.

DESIGN

Longitudinal cohort study.

SETTING

Participants' residences in the Chicago metropolitan area.

PARTICIPANTS

A total of 805 older persons who completed uniform annual clinical evaluations.

MEASUREMENTS

Participants annually completed a standard self-report measure of purpose in life, a component of well-being. Hospitalization data were obtained from Part A Medicare claims records. Based on previous research, ICD-9 codes were used to identify ambulatory care-sensitive conditions (ACSCs) for which hospitalization is potentially preventable. The relation of purpose (baseline and follow-up) to hospitalization was assessed in proportional odds mixed models.

RESULTS

During a mean of 4.5 years of observation, there was a total of 2,043 hospitalizations (442 with a primary ACSC diagnosis; 1,322 with a secondary ACSC diagnosis; 279 with no ACSCs). In initial analyses, higher purpose at baseline and follow-up were each associated with lower odds of more hospitalizations involving ACSCs but not hospitalizations for non-ACSCs. Results were comparable when those with low cognitive function at baseline were excluded. Adjustment for chronic medical conditions and socioeconomic status reduced but did not eliminate the association of purpose with hospitalizations involving ACSCs.

CONCLUSIONS

In old age, higher level of purpose in life is associated with lower odds of subsequent hospitalizations for ambulatory care-sensitive conditions.