Validity and reliability of a shorter version of the Geriatric Depression Scale in institutionalized older Portuguese adults

Association Between Depressive Symptoms, Cognitive Status, and the Dual-Task Performance Index in Older Adults: A Cross-Sectional Study

The Performance Index (P-Index) is a measure for evaluating mobility-related dual-task performance in older adults. The identification of specific clinicodemographic factors predictive of P-Index scores, however, remains unclear. This cross-sectional study analyzed data from 120 community-dwelling older adults (average age 71.3 ± 11.23 years) to explore clinicodemographic variables that influence P-Index scores during the instrumented timed up and go test. Unadjusted analyses suggested several factors, including age, gender, body mass index, Mini-Mental Status Examination scores, functional reach test performance, history of falls, ethnicity, Geriatric Depression Scale scores, alcohol consumption, and educational levels, as potential predictors of P-Index. However, adjusted multinomial multiple regression analysis revealed Geriatric Depression Scale and Mini-Mental Status Examination scores as the exclusive independent predictors of P-Index classifications, segmented into high, intermediate, or low (percentiles ≤ 25, 26-74, or ≥ 75, respectively). A significant association was observed between the manifestation of depressive symptoms, lower Mini-Mental Status Examination scores, and reduced cognitive-motor performance. The findings implicate depressive symptoms and low cognitive performance as substantial impediments to optimal dual-task mobility within this cohort. Further studies are warranted to examine the efficacy of cognitive stimulation and antidepressant therapy, in augmenting mobility-related dual-task performance among older adults.

Mini-ACE: Validation Study Among Older People in Long-Term Care

Background

The Mini-Addenbrooke's Cognitive Examination (M-ACE) is a valid and reliable tool that accurately differentiates various types of cognitive impairment from Normal-cognition assessed in multiple settings. However, its validity among older individuals in long-term care (LTC) was not yet established. Therefore, we sought to assess the Portuguese M-ACE's validity, reliability, and accuracy in detecting cognitive impairment no-dementia (CIND) in LTC users.

Methods

A comprehensive assessment was performed on 196 LTC Portuguese users aged ≥ 60 years, among whom 71 had Normal-cognition, and 125 had CIND.

Results

The M-ACE was found to be reliable (McDonald's ω = .86, Cronbach's α = .85) and consistent over time (r = .72; ICC = .83) and between raters (k = .92). Strong correlations with related measures supported construct validity (both r = .67). The M-ACE accurately distinguished CIND from Normal-cognition with a cut-off of 17 points (AUC = 0.81, Sensitivity = 81.7%, Specificity = 74.4%).

Conclusion

Our findings suggest that the Portuguese M-ACE is a valid and reliable cognitive assessment tool for LTC users, allowing for accurate differentiation between CIND and Normal-cognition. Thus, the M-ACE's use could contribute to the early detection and intervention of cognitive disorders, especially among older adults in LTC.

Emotion dysregulation in older people: validity and reliability of an 8-item version of the Difficulties in Emotion Regulation Scale

OBJECTIVES

The abbreviated 16-item version of the Difficulties with Emotion Regulation Scale (DERS-16) is widely used to assess individuals' perceived challenges in regulating their emotions, a central aspect of psychological symptoms commonly experienced in old age. However, its psychometric properties have yet to be tested in this population. Furthermore, a shorter version of the DERS-16 could further minimize the assessment burden on older individuals. Thus, we aimed to test the DERS-16's psychometric performance and determine if any items were redundant to develop a psychometrically sound shorter version.

METHODS

We enrolled 302 Portuguese older adults (Mage = 75.22; SD = 8.99 years) in a cross-sectional study.

RESULTS

Exploratory factor analyses indicated a one-factor structure and a four-factor solution with eight items (69.3%-81.9% of the variance observed). The four-factor-8-item solution presented an interpretable structure and demonstrated good reliability values (> 0.70) and construct validity with the Twenty-Item Toronto Alexithymia Scale, Eight-Item Geriatric Depression Scale, and Geriatric Anxiety Inventory (r = 0.66, 0.40, 0.52; p < 0.001).

CONCLUSION

The robust psychometric properties of DERS-8 make it a valuable tool for clinical and longitudinal studies, facilitating targeted interventions in older adults and allowing for precise emotion dysregulation screening.

Does emotional dysregulation mediate the relationship between disability and depressive symptoms in older people?

BACKGROUND

Emotion dysregulation has been consistently linked to psychopathology, and the relationship between disability and depressive symptomatology in old age is well-known.

OBJECTIVE

To examine the mediational role of emotional dysregulation in the relationship between perceived disability and depressive symptomatology in older adults.

METHODS

Two hundred eighty-three participants, aged 60-96 years (M±SD=74.22±8.69; 62.9% women; 29.0% with long-term care support [LTC-S] and 71.0% community residents without LTC-S), were assessed with the Geriatric Depression Scale-8 (GDS-8), the World Health Organization Disability Assessment Schedule-2 (WHODAS-2), and the Difficulties in Emotion Regulation Scale-16 (DERS-16).

RESULTS

A mediation model was established, which revealed: (1) a moderate association between WHODAS-2 and GDS-8 (β=0.20; p<.001); (2) DERS-16 partially and weakly mediated the relationship between WHODAS-2 and GDS-8 (β=0.003; p<.01). The model explained 31.9% of the variance of depressive symptoms. An inconsistent mediation model was obtained in the LTC-S group.

CONCLUSIONS

Globally, our findings indicate that disability has an indirect relationship with depressive symptomatology through emotional dysregulation (except for those in the LTC-S). Accordingly, we present suggestions for the treatment of depressive symptoms and for the inclusion of other emotion regulation variables in the study of the disability-depressive symptom link in future studies with older people in the LTC-S.

The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study

The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.

Validation of the geriatric sleep questionnaire

OBJECTIVE

Assessing sleep in later life is essential for diagnosing and treating sleep problems and their consequences. We aimed to test a short questionnaire specifically designed to assess the subjective sleep quality in older people, the Geriatric Sleep Questionnaire (GSQ).

METHOD

The GSQ was validated in a Portuguese sample of older people (N = 443; 65-100 years; M = 80.02; SD = 6.95). We analyzed reliability, factor validity, convergent validity with other theoretical similar constructs, discriminant validity with a theoretically divergent measure, and predictive power to detect sleep problems (ROC analysis).

RESULTS

A six-item version was obtained with good reliability (Cronbach's α = 0.79), and adequate convergent and divergent validity (p < 0.01). ROC analysis revealed a sensitivity of 80.0% and a specificity of 66.7% in detecting sleep problems with a cutoff point of 16 (AUC = 0.72). Older people in social care, low education, and living in rural areas reported worse sleep quality.

CONCLUSION

The GSQ-6 is a brief instrument with good psychometric characteristics to assess the subjective sleep quality in older people. The GSQ-6 seems to be a valuable tool for future investigations on the relationship of sleep quality with mental health and well-being in older people.

The Relationship between Nutritional Status and Functional Capacity: A Contribution Study in Institutionalised Portuguese Older Adults

Demographic aging of the population allied with the new family structures and societal dynamics is generating an increasing demand for institutions for older adults. Nutritional status is a key health determinant that impacts the quality of life among older adults. Hence, the aim of the present study was to evaluate the relationship between nutritional status and nutritional risk, functional capacity, and cognition in institutionalised Portuguese older adults by a cross-sectional study in 15 institutions. Nutritional status (body mass index (BMI), waist circumference (WC), nutritional risk (mini nutritional assessment (MNA)), degree of functional independence (Barthel index (BI)), and cognitive ability (mini mental state examination (MMSE)) were assessed. Of the 214 older adults evaluated, 28.0% were at risk of malnutrition, 69.6% were mildly functional dependent, and 39.3% presented minor cognitive impairment. The risk of malnutrition increased functional dependence and cognitive impairment. The MNA score, but not the BMI or WC, was related to disability and deficits in cognition. A differential interdependence was found between nutritional, cognitive, and functional status. Strategies to improve self-care and well-being in nursing homes should consider a correct diet and a closer evaluation of nutritional risk to preserve cognition, independence, and autonomy.