Mental Health and Aging in the 21st Century

Impact of living arrangements and internet use on the mental health of Chinese older adults

Introduction

The consequences of aged living arrangements on mental health in the digital age have drawn significant research attention.

Methods

This study used empirical data to analyze the impact of living arrangements on the mental health of older adults by ordinary least squares (OLS) and to examine the moderating effect of Internet use in it through the moderating effect test. A total of 17,243 older adults were included in the analytical model.

Results

We found that living independently has a negative impact on the mental health of older adults and Internet use can improve the mental health of older adults. There are moderating mechanisms of Internet use in the impact of living arrangements on the mental health of older adults, but it is necessary to look at the moderating mechanisms of different patterns of Internet use. Using the Internet for social interaction (chatting and information acquisition) can weaken the impact of living arrangements on the mental health of older adults, while unidirectional Internet use (entertainment and financial management) strengthens the impact of living arrangements on the mental health of older adults.

Disscusion

Therefore, this study puts forward the following suggestions: first, to develop family care for older adults and pay attention to the positive role of intergenerational support in the mental comfort of older adults; second, it is imperative for the government and social service departments to assist older adults in establishing correct concepts of Internet use, enhancing their digital literacy, and improving their digital skills.

Older Adults in Administrative Quagmire: A Scoping Review of Policy and Program Coordination Across Six Marginalized Older Adult Populations

BACKGROUND AND OBJECTIVES

Coordination of governmental action is crowded with policies and programs that are highly interdependent, sometimes operating in silos if not contradicting each other. These dilemmas, or administrative quagmires, are heightened for older adults in general, but they are particularly problematic for marginalized older adults because these groups often require public assistance and support. This scoping review studies the coordination of governmental action on aging published in social science journals, focusing on 6 groups of marginalized older adults: those with histories of immigration, individuals with severe mental health problems, those who have had experiences of homelessness, formerly incarcerated individuals, members of the LGBT (lesbian, gay, bisexual, and transgender) community, and individuals living in a rural area.

RESEARCH DESIGN AND METHODS

A 5-stage scoping review methodology was followed, and 53 articles (published between 2000 and 2022) from 5 social science databases were analyzed.

RESULTS

The analysis revealed a limited number of contributions with coordination as a primary focus. Understandings of coordination varied but tended to examine structure, organization, and relationships between sectors. When coordination was the primary object of a study, it was often analyzed in 1 specific policy area or within a clinical setting along the lines of facilitating care coordination.

DISCUSSION AND IMPLICATIONS

This scoping review reveals a mutual neglect on the part of public administration and policy scholars toward marginalized older adults and a lack of public administration considerations on the part of scholars studying long-term care and social service programs for these marginalized older adults.

Measuring Access to Mental Health Services Among Primary Care Patients

BACKGROUND

The lifetime risk of mental health disorders is almost 50% and, in any year, about 25% of the population have a psychiatric disorder. Many of those people are cared for in primary care settings.

RESEARCH OBJECTIVE

Measure access to mental health services, such as getting counselling or prescription mental health medications, using new patient survey questions that can be added to Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

STUDY DESIGN

Surveys were conducted with a stratified probability sample of patients receiving primary care services in a single state in 2018-2019. Medicaid and privately insured patients were surveyed by mail or telephone, respectively.

RESULTS

Approximately 14% of sampled patients responded to a survey. More than 10% of privately insured respondents and about 20% of Medicaid respondents got or tried to get appointments for mental health care. About 15% of privately insured respondents and 11% of Medicaid respondents reported problems getting appointments with counselors. Only 8%-9% of respondents seeking mental health medicines reported problems getting appointments for prescriptions. A composite measure combining access to counselors and prescribers of mental health medicines evidenced adequate internal consistency reliability. Group level reliability estimates were low.

CONCLUSIONS

Many respondents got or tried to get mental health services and a substantial number reported problems getting appointments or getting mental health prescriptions. The tested questions can be combined into an Access to Mental Health Care measure, which can be included in patient experience surveys for ambulatory care to monitor access to behavioral health care.

Built environment and loneliness in later life: productive engagement as the pathway

OBJECTIVES

The built environment is increasingly recognized as being associated with late-life loneliness. However, the pathway remains understudied. This study investigated the mediating effects of productive engagement in relationships between the built environment and loneliness.

METHODS

We conducted a cross-sectional analysis of data from 4,409 community-dwelling people aged 65 years and above in China. We employed the Chinese version of the De Jong Gierveld Loneliness Scale to assess loneliness. The built environment comprises residential density, street connectivity, park-based and vegetation-based green space, land use mix, and the number of and distance to the nearest recreational, health, shopping and community services within 300-meter and 500-meter buffer areas. Structural equation modeling was used.

RESULTS

Only green space (parks) had a direct effect on loneliness. Residential density and green space (parks) had an indirect effect on loneliness through volunteering. The number of recreational services had an indirect effect on loneliness through recreational and sporting activities, although distance to the nearest recreational services did not. All the significant results were only found within 300-meter rather than 500-meter buffers.

CONCLUSIONS

Our findings have implications for environmental gerontology theory and practice. Providing more green space and recreational services can significantly improve older adults' helping behavior, social activities and sporting activities, which can further reduce older adults' loneliness.

"It Makes You Feel Good to Help!": An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care

Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.

The Relationship Between Internet Use and Mental Health Among Older Adults in China: The Mediating Role of Physical Exercise

Objective

Affected by internet applications, mental health among older adults has become an important public health issue in China. This study aimed to use cross-sectional data to explore how internet use affects mental health among older adults in China, along with the moderating role of physical exercise in the above relationship.

Methods

This study employed data from the Chinese General Social Survey (CGSS) conducted in 2017. In addition, OLS regression was adopted to explore the impacts of internet use on the mental health of older adults in China.

Results

Results from the cross-sectional data model showed that internet use had a statistically significant and positive correlation with the mental health of older adults. The regression result of the full sample showed that the regression coefficient of the influence of internet use on the mental health of the elderly was 0.114, which was significant at the 1% level. Furthermore, this study used mediating analysis to explore the possible underlying mechanism by which internet use influenced mental health status through physical exercise. Physical exercise played a mediating role in the relationship between internet use and mental health; the ratio of the indirect effect to total effect mediated was 0.272. It is important to note that the effect size of the indirect effect through physical exercise was quite large.

Conclusion

Our findings suggested that internet use was significantly associated with better mental health status for older Chinese residents, mediated by higher physical exercise frequency, which was consistent with China’s recent efforts to promote health governance with the “Internet Plus Exercise” campaign. Consequently, the government must encourage the development of more internet applications suitable for the elderly to increase their exercise frequency and ultimately improve their mental health. These results also provided insights for clinical solutions.

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Predictors of health service use by family caregivers of persons with multimorbidity

BACKGROUND

Informal caregivers of patients with multiple chronic conditions are socially good, promoting the sustainability of a large part of home care provision. However, this very demanding activity causes health problems that increase their own need for health services. This study analyses the use of health services by informal carers, comparing it with the use made by the general population with similar characteristics.

METHODOLOGY

Cross-sectional analytical study carried out in the Malaga-Valle Guadalhorce Primary Health Care District (Spain). Healthcare demand and perceived health were measured in the family caregivers, compared to the general population. Strobe Statement for observational studies has been used to strength the report of the results.

RESULTS

Final sample consisted of 314 family caregivers together with a subsample of 2.290 non-caregivers taken from data of the National Health Survey. This subsample was paired by gender with our sample. Formal caregivers make fewer annual visits to the health services, with respect to the general population, regardless of the perceived level of health. The difference of the means between those who perceive their health as very poor was 0.11 (95% CI: 0.01 to 0.20) consultations with the family doctor, 0.21 (95% CI: 0.15 to 0.26) consultations with medical specialists and 1.70 (95% CI: 1.52 to 1.87) emergency room attention. Three independent factors were identified that predispose to the increased use of health services: background of greater education achievement (OR 8.13, 95% CI: 1.30 to 50.68), non-cohabitation with the care recipient (OR 3.57, 95% CI: 1.16 to 11.11) and a more positive physical quality of life component (OR 1.06; 95% CI: 1.03 to 1.09).

DISCUSSION AND IMPLICATIONS

Intrinsic components of the caregiver reveal their independent relationship with the provision of informal care and the use of health services. A broader vision is needed for the factors that influence the health of these caregivers to develop multipurpose interventions and improve the consistency and effectiveness of the health services offered to the caregiver.

Social representations, ageing and memory: a holistic approach to cognitive assessment

This paper examines how contextual (conversational) aspects and socially shared meanings might affect the participants' performance on a standardised memory test using the theoretical framework of social representations. A total of 97 members of centres for older adults located in Rome, Italy participated in a screening using the Montreal Cognitive Assessment test. Prior to testing, a group of volunteers had organised a performance focused on events from the distant past, stimulating intergenerational reminiscence. The participants were randomly assigned to one of two conditions. In the first case, prior to administering the test, a psychotherapist talked to each participant about the performance, focusing on ageing and stressing the neutral aspects of its social representations, such as change and time. In the second case, performance was used to concentrate on positive aspects of the social representations of ageing, namely wisdom and experience. In line with the hypothesis, focusing on positive aspects of social representations of ageing (wisdom and experience) versus their neutral aspects (change and time) has resulted in improved performance on a standardised memory test. Practitioners (psychotherapists – experts in psycho-diagnostics) who administered the tests have been involved in the co-construction of the meaning of ageing, discussing a real-life situation: the common experience of intergenerational activity that involved the participants' memories of their urban environment.

Latent change score modeling as a method for analyzing the antidepressant effect of a psychosocial intervention in Alzheimer's disease

BACKGROUND

Developing and evaluating interventions for patients with age-associated disorders is a rising field in psychotherapy research. Its methodological challenges include the high between-subject variability and the wealth of influencing factors associated with longer lifetime. Latent change score modeling (LCSM), a technique based on structural equation modeling, may be well suited to analyzing longitudinal data sets obtained in clinical trials. Here, we used LCSM to evaluate the antidepressant effect of a combined cognitive behavioral/cognitive rehabilitation (CB/CR) intervention in Alzheimer's disease (AD).

METHODS

LCSM was applied to predict the change in depressive symptoms from baseline as an outcome of the CORDIAL study, a randomized controlled trial involving 201 patients with mild AD. The participants underwent either the CORDIAL CB/CR program or standard treatment. Using LCSM, the model best predicting changes in Geriatric Depression Scale scores was determined based on this data set.

RESULTS

The best fit was achieved by a model predicting a decline in depressive symptoms between before and after testing. Assignment to the intervention group as well as female gender revealed significant effects in model fit indices, which remained stable at 6- and 12-month follow-up examinations. The pre-post effect was pronounced for patients with clinically relevant depressive symptoms at baseline.

CONCLUSIONS

LCSM confirmed the antidepressant effect of the CORDIAL therapy program, which was limited to women. The effect was pronounced in patients with clinically relevant depressive symptoms at baseline. Methodologically, LCSM appears well suited to analyzing longitudinal data from clinical trials in aged populations, by accounting for the high between-subject variability and providing information on the differential indication of the probed intervention.

Service provision for older people with mental health problems in a rural area of Australia

OBJECTIVES

Unmet mental health care needs of older people (aged 65 and over) have been identified as a serious problem internationally, particularly in rural areas. In this study we explored the views of health and social care providers of the barriers to effective mental health care for older people in a rural region in Australia.

METHOD

Semi-structured interviews were conducted with 19 participants from 13 organisations providing care and support to older people in a rural region of Australia. A framework analysis approach was used to thematically analyse the data.

RESULTS

Two main themes were identified: 'Recognising the Problem' and 'Service Availability and Access'. In particular the participants identified the impact of the attitudes of older people and health professionals, as well as service inadequacies and gaps in services, on the provision of mental health care to older people in a rural region.

CONCLUSION

This study supports previous work on intrinsic and extrinsic barriers to older people with mental health problems accessing mental health services. The study also offers new insight into the difficulties that arise from the separation of physical and mental health systems for older people with multiple needs, and the impact of living in a rural region on unmet mental health care needs of older people.

Geriatrics: (women's health series)

As women age, they face challenging health issues. Their average life expectancy is longer than their male counterparts, yet they often have multiple chronic, ongoing health problems that complicate their care, accentuate their infirmity, and reduce their quality of life. Often, they fail to receive the same quality or amount of healthcare service, sometimes because of a lack of data specific to their demographics, at other times for myriad unclear reasons. What data are available suggest that they will usually glean the same benefits as their male and younger female counterparts, often with little increased risk of adverse effects from available medical diagnostic and therapeutic options. Cardiovascular disease, malignancies, musculoskeletal disorders (particularly osteoporosis), and cognitive and psychiatric illness are the most frequent, and often most devastating, health issues in this growing segment of the population. An understanding of the differences in disease frequencies, presentations, and response to treatments is necessary to provide older adult women with optimal health care.

Quality of end-of-life care of long-term nursing home residents with and without dementia

OBJECTIVES

To describe the longitudinal patterns and the within- and between-facility differences in hospice use and in-hospital deaths between long-term nursing home (NH) residents with and without dementia.

DESIGN

Retrospective analyses of secondary data sets from 2003 to 2007.

SETTING

NHs in the United States.

PARTICIPANTS

A total of 1,261,726 decedents in 16,347 NHs were included in 2003 to 2007 trend analysis and 236,619 decedents in 15,098 NHs in 2007 were included in the within- and between-facility analyses.

MEASUREMENTS

Hospice use in the last 100 days of life and in-hospital deaths were outcome measures. Dementia was defined as having a diagnosis of Alzheimer's disease or other dementia based on Minimum Data Set (MDS) health assessments.

RESULTS

Overall hospice use increased from 25.6% in 2003 to 35.7% in 2007. During this time, hospice use for decedents with dementia increased from 25.1% to 36.5%, compared with an increase from 26.5% to 34.4% for decedents without dementia. The rate of in-hospital deaths remained virtually unchanged. Within the same facility, decedents with dementia were significantly more likely to use hospice (odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.04-1.11) and less likely to die in a hospital (OR = 0.76, 95% CI = 0.74-0.78). Decedents in NHs with higher dementia prevalence, regardless of individual dementia status, were more likely to use hospice (OR = 1.67, 95% CI = 1.22-2.27).

CONCLUSION

NHs appear to provide less-aggressive end-of-life care to decedents with dementia than to those without. Although significantly more residents with dementia now receive hospice care at the end of life, the quality evaluation and monitoring of hospice programs have not been systematically conducted, and additional research in this area is warranted.