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Kaye AD, Kweon J, Hashim A, Elwaraky MM, Shehata IM, Luther PM, Shekoohi S. Evolving Concepts of Pain Management in Elderly Patients. Curr Pain Headache Rep 2024; 28:999-1005. [PMID: 38967713 DOI: 10.1007/s11916-024-01291-x] [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] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE OF REVIEW The elderly population typically suffer from a variety of diseases that mostly reflect the degenerative changes linked with the aging process. These diseases may be exacerbated by acute pain or by an abrupt aggravation of previously stable chronic pain. RECENT FINDINGS Physical and psychological changes associated with aging may influence one's experience of pain and, as a result, the severity of pain. Pain treatment in the elderly can be complex and is often a budgetary burden on the nation's health care system. These difficulties arise, in part, because of unanticipated pharmacodynamics, changed pharmacokinetics, and polypharmacy interactions. Therefore, it is critical to integrate a multidisciplinary team to develop a management strategy that incorporates medical, psychological, and surgical methods to control persistent pain conditions. It is in this critical process that pain prediction models can be of great use. The purpose of pain prediction models for the elderly is the use of mathematical models to predict the occurrence and intensity of pain and pain-related conditions. These mathematical models employ a vast quantity of data to ascertain the many risk factors for the development of pain problems in the elderly, whether said risks are adjustable or not. These models will pave the way for more informed medical decision making that are based on the findings of thousands of patients who have previously experienced the same illness and related pain conditions. However, future additional research needs to be undertaken to build prediction models that are not constrained by substantial legal or methodological limitations.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
- Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Jaeyeon Kweon
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, 70112, USA
| | - Ahmed Hashim
- School of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Patrick M Luther
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
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Low F, Earleywine M. Psychedelic Experiences After Bereavement Improve Symptoms of Grief: The Influence of Emotional Breakthroughs and Challenging Experiences. J Psychoactive Drugs 2024; 56:316-323. [PMID: 37343940 DOI: 10.1080/02791072.2023.2228303] [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] [Received: 02/16/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
Grief, a common reaction to loss, can frequently become problematic or impairing. Available treatments for prolonged grief disorder are promising but leave room for considerable improvement. Qualitative accounts of psychedelic experiences after bereavement reveal themes that parallel core components of prolonged grief disorder therapy. However, few studies have investigated the therapeutic potential of psychedelics for symptoms of grief. The present study surveyed recreational psychedelic users (N = 363) who had suffered a bereavement event. They reported retrospective grief symptoms before and after the psychedelic experience as well as subjective reactions to the psychedelic, including emotional breakthroughs and challenging experiences. Results indicate improvements in grief symptoms after a psychedelic experience, with a large effect size (Cohen's d = 0.83). The occurrence of emotional breakthroughs was positively associated with improvements in symptoms of grief, while the converse relation was observed for challenging experiences. Findings provide preliminary evidence that support the development of a psychedelic-assisted therapy protocol to target symptoms of grief. Psychedelic-assisted therapy might offer an alternative to current grief treatment options.
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Affiliation(s)
- Fiona Low
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Mitch Earleywine
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
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Frumkin MR, Robinaugh DJ, LeBlanc NJ, Ahmad Z, Bui E, Nock MK, Simon NM, McNally RJ. The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults. J Clin Psychol 2021; 77:254-267. [PMID: 32662088 PMCID: PMC7725983 DOI: 10.1002/jclp.23024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/15/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. METHOD Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. RESULTS Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. CONCLUSIONS Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.
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Affiliation(s)
- Madelyn R. Frumkin
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Nicole J. LeBlanc
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Zeba Ahmad
- The Graduate Center and Hunter College, City University of New York
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | | | - Naomi M. Simon
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine
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Ghesquiere A, Bagaajav A, Ito M, Sakaguchi Y, Miyashita M. Investigating associations between pain and complicated grief symptoms in bereaved Japanese older adults. Aging Ment Health 2020; 24:1472-1478. [PMID: 31002011 DOI: 10.1080/13607863.2019.1594166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: About 10% of those who lose a loved one in hospice or palliative care settings will experience a mental health condition characterized by severe, prolonged grief responses. Criteria for this condition have evolved; we refer to this condition as Complicated Grief (CG) because it is one of the more common names. While there are some indications of associations between CG and poor physical health, explorations of the association between CG and pain is limited. The main objective of this study was to explore whether pain levels are higher in those with CG than those without, using a large population-based samples of Japanese older adults.Method: The study analyzed data from the Japan HOspice and Palliative care Evaluation (J-HOPE) study, a cross sectional study conducted in 2008 that examined the experiences and outcomes among adults throughout Japan who had lost a loved one within a palliative department or hospice setting, via self-report survey. We examined a subsample sample of 324 individuals aged 50 and above who completed a measure of CG.Results: Family members with high pain group had statistically significantly higher CG symptoms than those with low pain group (M = 66.95 vs. M = 52.05), an association which remained when controlling for demographic and loss-related factors.Conclusion: We found preliminary evidence of an association between CG symptoms and pain, which should be explored in additional samples. Should this finding be replicated, the mechanism of this association could be explored and treatment could potentially address both CG and pain.
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Affiliation(s)
- Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Ariunsanaa Bagaajav
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Masaya Ito
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Yukihiro Sakaguchi
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
| | - Mitsunori Miyashita
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, New York, USA
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Cederbom S, Bjerk M, Bergland A. A qualitative study exploring physical therapists' views on the Otago Exercise Programme for fall prevention: a stepping stone to "age in place" and to give faith in the future. Physiother Theory Pract 2020; 38:132-140. [PMID: 32090667 DOI: 10.1080/09593985.2020.1731895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: One of the most effective interventions to prevent falls is exercise. A commonly used program that prevents falls is the Otago Exercise Programme (OEP). Despite this, user-based knowledge of its applicability in real-world settings for older adults who are dependent on formal care in their homes is lacking. Purposes: To explore how physical therapists (PTs) experience the applicability of the OEP in clinical practice for home-dwelling older adults who are dependent on formal home care and to determine their beliefs regarding the benefits of the OEP for living longer at home. Methods: Semi-structured interviews were conducted with 17 physical therapists. Data were analyzed using qualitative thematic analysis. Results: The OEP was described by PTs to be applicable in clinical practice. Their experience was that the OEP seemed to be meaningful and to have a strong relationship with everyday activities. The OEP improved physical function, mood, self-efficacy, and participation in social activities in older adults, as well as provided faith in the future. Conclusion: The OEP is suitable for use in a primary care setting, and according to the perceptions of physical therapists, the OEP contributes to older adults' capability to live longer at home.
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Affiliation(s)
- Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Maria Bjerk
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Chen MA, Lewis MR, Chirinos DA, Murdock KW, Fagundes C. Differential psychological reactions to grief: The role of childhood adversity for depression symptoms among bereaved and non-bereaved adults. DEATH STUDIES 2019; 44:778-786. [PMID: 31094661 PMCID: PMC6858533 DOI: 10.1080/07481187.2019.1614107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Childhood maltreatment dysregulates an individual's physiological response to stress, increasing reactivity to stressors across the lifespan. Given the prevalence and impact of bereavement, we examined whether the association between childhood maltreatment and depression was exacerbated by spousal bereavement. We identified an interaction between childhood maltreatment and bereavement using linear regression analysis (B = 0.79, p < .001). A simple slopes test indicated a positive association between childhood maltreatment and depressive symptoms among those who were bereaved (B = 0.86, p < .001), but such association did not emerge among those who were not bereaved (B = 0.06, p = .60).
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Affiliation(s)
- Michelle. A. Chen
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
| | - Megan R. Lewis
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
- Department of Medicine, Dell Medical School, 1501 Red River Street, Austin, TX 78712
| | - Diana A. Chirinos
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL 60611
| | - Kyle W. Murdock
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802
| | - Christopher Fagundes
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030
- Department of Psychiatry, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030
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Cederbom S, Nortvedt L, Lillekroken D. The perceptions of older adults living with chronic musculoskeletal pain about participating in an intervention based on a behavioral medicine approach to physical therapy. Physiother Theory Pract 2019; 36:1118-1129. [PMID: 30727810 DOI: 10.1080/09593985.2019.1572846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: There is evidence that interventions based on a behavioral medicine approach to physical therapy (BMPI) are beneficial for older adults living with chronic pain; however, knowledge of the perceptions of older people regarding their participation in BMPI is lacking. Aim: The aim of this study was to describe the perceptions of older people about being participants in a home-based BMPI. Methods: Semi-structured interviews were conducted with 12 older adults living with chronic pain and participating in a BMPI. Data were analyzed using qualitative content analysis. Results: The respondents highlighted the importance of the home-based and individualized nature of the intervention. They perceived the support from the physical therapist (PT) as significant for their motivation and goal attainment. The benefits of the intervention were described in physical, psychological, social, and functional terms and as enabling participants to live at home for longer. Conclusion: The results show that participation in a BMPI was perceived as a positive and meaningful experience. Support from a PT is crucial to encouraging behavioral changes. Finally, participation in a BMPI may contribute to the ability of participants to "age in place" for longer.
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Affiliation(s)
- Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University , Oslo, Norway
| | - Line Nortvedt
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University , Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University , Oslo, Norway
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Impaired mental health and low-grade inflammation among fatigued bereaved individuals. J Psychosom Res 2018; 112:40-46. [PMID: 30097134 DOI: 10.1016/j.jpsychores.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fatigue is a common symptom in stressed individuals. Bereavement is a major life event that has been associated with impaired mental health. Little research has investigated the prevalence of fatigue and its inflammatory correlates in bereaved individuals. OBJECTIVES To assess fatigue prevalence and its relationship with mental health outcomes and markers of inflammation, as indexed by C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) in bereaved individuals. METHODS Seventy-eight-bereaved adults were examined for fatigue (SF-36 energy/vitality scale), perceived stress (PSS), depression (CES-D), sleep quality (PSQI), pain (SF-36 pain scale), and general health (SF-36 general), and their serum levels of CRP, IL-6 and TNF-α were measured. Group differences between fatigued versus non-fatigued individuals were estimated using analysis of covariance (ANCOVA), with adjustment for body mass index (BMI). RESULTS Fatigued bereaved individuals (33%; SF-36 energy/vitality score 0-45) had significantly higher CRP levels (p < .05) as compared to non-fatigued bereaved individuals and reported higher levels of pain (p < .001), greater stress (p < .001), depression (p < .001), and sleeping problems (p < .001), as well as poorer social functioning (p < .001) and general health (p < .001) than those in the non-fatigued group. No group differences were found for IL-6 and TNF-α. CONCLUSIONS Fatigued bereaved individuals showed elevated systemic inflammation as measured by CRP in comparison to non-fatigued bereaved individuals. They were also more likely to report mental health problems that co-occur with fatigue in the context of immune activation. Continued research is needed to help clarify the involvement of inflammatory markers in the development of fatigue in a larger sample of bereaved adults.
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Bernfort L, Gerdle B, Husberg M, Levin LÅ. People in states worse than dead according to the EQ-5D UK value set: would they rather be dead? Qual Life Res 2018; 27:1827-1833. [PMID: 29616427 PMCID: PMC5997722 DOI: 10.1007/s11136-018-1848-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/22/2022]
Abstract
Purpose Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Methods Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. Results SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Conclusions Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.
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Affiliation(s)
- Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 58183, Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Husberg
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 58183, Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 58183, Linköping, Sweden
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Musalek C, Kirchengast S. Grip Strength as an Indicator of Health-Related Quality of Life in Old Age-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121447. [PMID: 29186762 PMCID: PMC5750866 DOI: 10.3390/ijerph14121447] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 01/08/2023]
Abstract
Over the last century life expectancy has increased dramatically nearly all over the world. This dramatic absolute and relative increase of the old aged people component of the population has influenced not only population structure but also has dramatic implications for the individuals and public health services. The aim of the present pilot study was to examine the impact of physical well-being assessed by hand grip strength and social factors estimated by social contact frequency on health-related quality of life among 22 men and 41 women ranging in age between 60 and 94 years. Physical well-being was estimated by hand grip strength, data concerning subjective wellbeing and health related quality of life were collected by personal interviews based on the WHOQOL-BREF questionnaires. Number of offspring and intergenerational contacts were not related significantly to health-related quality of life, while social contacts with non-relatives and hand grip strength in contrast had a significant positive impact on health related quality of life among old aged men and women. Physical well-being and in particular muscle strength—estimated by grip strength—may increase health-related quality of life and is therefore an important source for well-being during old age. Grip strength may be used as an indicator of health-related quality of life.
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Hulla R, Gatchel RJ, Liegey-Dougall A. Biopsychosocial Measures Related to Chronic Low Back Pain Postural Control in Older Adults. Healthcare (Basel) 2017; 5:E74. [PMID: 29036904 PMCID: PMC5746708 DOI: 10.3390/healthcare5040074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
This study examined the biopsychosocial measures related to postural control in the growing population of older adults (i.e., 60 years and older). The sample of the study consisted of 129 older adults (M = 74.45, SD = 6.95), with 34 males and 95 females; 36 were classified with chronic low-back pain (CLBP), and 93 without chronic low-back pain (NCLBP). Physical and psychosocial constructs were analyzed as predictors for postural control measures. Additionally, gender and classification of low-back pain were examined as moderators for all physical and psychosocial measures. Results demonstrated that physical and psychosocial measures were able to significantly predict composite, visual, and vestibular balance measures, but not somatosensory or preference balance measures. The chair-stand test, modified sit-and-reach test, sleep disturbance, and balance efficacy were all identified as individually significant predictors. Gender and CLBP did not moderate the utility of any predictor variables. Results of the current study re-confirm the importance of utilizing the biopsychosocial approach for future research examining postural control in older adults.
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Affiliation(s)
- Ryan Hulla
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Robert J Gatchel
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Angela Liegey-Dougall
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
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Cederbom S, Denison E, Bergland A. A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain: protocol for a randomized controlled trial. J Pain Res 2017; 10:845-853. [PMID: 28435321 PMCID: PMC5391824 DOI: 10.2147/jpr.s129648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is a major health problem among older adults, particularly those who live alone and/or those who are dependent on formal care. Chronic pain is associated with mobility problems, falls, fear of falling, catastrophizing thoughts, and a lower quality of life. Research shows that physical therapy interventions based on behavioral medicine approaches are beneficial for middle-aged adults with chronic pain. However, there appears to be no previous randomized controlled trials (RCTs) based on this theoretical framework that have examined the effect on older adults with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The aim of the planned study is to evaluate the effect of an individually tailored integrated physical therapy intervention based on a behavioral medicine approach compared with the effect of standard care. METHODS/DESIGN The planned study is an RCT that will include one intervention and one control group involving a total of 150 adults aged ≥75 years with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The intervention will involve a 12-week home-based individually tailored intervention that will be designed to enhance the participants' ability to perform everyday activities by improving physical function and reducing pain-related disability and beliefs. The control group will be given standard care, including general advice about physical activity. The participants will be assessed at baseline and at 3 and 6 months after baseline. The primary outcome will be pain-related disability and physical performance. DISCUSSION The intervention, if effective, will have the potential to be the basis of the first evidence-based guidelines for physical therapists who work with older adults with chronic musculoskeletal pain.
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Affiliation(s)
- Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Eva Denison
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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13
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Canaway A, Al-Janabi H, Kinghorn P, Bailey C, Coast J. Development of a measure (ICECAP-Close Person Measure) through qualitative methods to capture the benefits of end-of-life care to those close to the dying for use in economic evaluation. Palliat Med 2017; 31:53-62. [PMID: 27260168 DOI: 10.1177/0269216316650616] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-of-life care affects both the patient and those close to them. Typically, those close to the patient are not considered within economic evaluation, which may lead to the omission of important benefits resulting from end-of-life care. AIM To develop an outcome measure suitable for use in economic evaluation that captures the benefits of end-of-life care to those close to the dying. DESIGN To develop the descriptive system for the outcome measure, in-depth qualitative interviews were conducted with the participants and constant comparative analysis methods were used to develop a descriptive system for the measure. PARTICIPANTS Twenty-seven individuals bereaved within the last 2 years or with a close-person currently receiving end-of-life care were purposively recruited into the study. Participants were recruited through newsletters, adverts, snowball sampling and a local hospice. RESULTS Twenty-seven individuals were recruited. A measure of capability with six attributes, each with five levels, was developed based on themes arising from the analysis. Attributes comprise the following: good communication with services, privacy and space to be with the loved one, emotional support, practical support, being able to prepare and cope and being free from emotional distress related to the condition of the decedent. CONCLUSION This measure is designed to capture the benefits of end-of-life care to close-persons for use in economic evaluation. Further research should value the measure and develop methods for incorporating outcomes for close-persons into economic evaluation.
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Affiliation(s)
- Alastair Canaway
- 1 Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hareth Al-Janabi
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Philip Kinghorn
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- 2 Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
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Hulla R, Moomey M, Garner T, Ray C, Gatchel RJ. Biopsychosocial Characteristics, Using a New Functional Measure of Balance, of an Elderly Population with CLBP. Healthcare (Basel) 2016; 4:healthcare4030059. [PMID: 27563929 PMCID: PMC5041060 DOI: 10.3390/healthcare4030059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/03/2016] [Accepted: 08/01/2016] [Indexed: 01/04/2023] Open
Abstract
This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the common problem of slips and falls in the elderly) was part of this biopsychosocial evaluation. Also, the National Institutes of Health (NIH)-developed Patient-Reported Outcome Measurement Information System (PROMIS) was also part of this comprehensive evaluation. Two demographically-matched groups of elderly participants were evaluated: one with CLBP (n = 24); and the other without (NCLBP, n = 24). Results revealed significant differences in most of these measures between the two groups, further confirming the importance of using a biopsychosocial approach for future studies of pain and postural control in the elderly.
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Affiliation(s)
- Ryan Hulla
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Michael Moomey
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Tyler Garner
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Christopher Ray
- College of Health Sciences, Texas Woman's University, Denton, TX 76204, USA.
| | - Robert J Gatchel
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
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Williams BR, Baker PS, Allman RM. Nonspousal Family Loss among Community-Dwelling Older Adults. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/bubq-j0vp-evpw-v95v] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We examined the prevalence and correlates of recent nonspousal family loss among older adults using data from the University of Alabama at Birmingham Study of Aging, a stratified random sample of community-dwelling older adults living in central Alabama. Twenty-three percent of participants reported a recent nonspousal family loss. African American ethnicity, education <12th grade, functional difficulty, restricted life-space mobility, depressive symptomology, pain and other somatic symptoms were associated with recent nonspousal family loss. Compared to non-widowed participants, widows with family loss reported a higher proportion of mental health and activity-limiting physical problems as well as restricted life-space. Programs to improve physical function and enhance health and wellbeing in older bereaved spouses should be expanded to include older adults with nonspousal family loss, particularly targeting the mental health needs of previously widowed persons who lose another family member.
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Ghesquiere AR, Bazelais KN, Berman J, Greenberg RL, Kaplan D, Bruce ML. Associations Between Recent Bereavement and Psychological and Financial Burden in Homebound Older Adults. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.1177/0030222815590709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Bereavement is common in older adults, but it remains unknown whether bereavement contributes to poor outcomes in the vulnerable population of older adults receiving home-based services. We examine whether recent bereavement was associated with worse physical or mental health, presence of abuse or neglect, and financial strain. Research Design Cross-sectional analyses of an assessment of functional and social vulnerabilities collected by the New York City Department for the Aging (DFTA), the largest Area Agency on Aging in New York. Assessments were completed on 5,576 New York City Department for the Aging long-term care program, recipients aged ≥60 who received services in 2012. Assessment also collected data on partner or child death in the last year. Results Logistic regression indicated that the recently bereaved were more likely than the nonbereaved to report both depression symptoms and financial strain. Conclusion Enhanced efforts to identify and address mental health and financial concerns in bereaved homebound older adults may be warranted.
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Affiliation(s)
- Angela R. Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, NY, USA
| | - Kisha N. Bazelais
- University of Miami, Student Counseling Center, Coral Gables, FL, USA
| | | | | | - Daniel Kaplan
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Martha L. Bruce
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
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Validation of the Italian version Inventory of Complicated Grief (ICG): a study comparing CG patients versus bipolar disorder, PTSD and healthy controls. Compr Psychiatry 2014; 55:1322-9. [PMID: 24721191 DOI: 10.1016/j.comppsych.2014.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/11/2014] [Accepted: 03/12/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A minority (9%-20%) of bereaved individuals experience symptoms of persistent intense grief associated with significant distress and impairment. This recently identified distinct post-loss syndrome has been variously named complicated grief, prolonged grief disorder, traumatic grief and persistent complex bereavement disorder. The Inventory of Complicated Grief (ICG) is a self-report instrument used to reliably identify this syndrome. We undertook a study to: 1) validate the Italian version of the ICG; 2) examine its performance in a clinical of bereaved individuals with complicated grief, post-traumatic stress disorder, bipolar disorder and healthy controls. METHODS Study participants included 171 bereaved individuals clinically diagnosed with complicated grief (n=64); post-traumatic stress disorder (n=72); bipolar disorder (n=35) and 58 bereaved healthy controls. Assessments included the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I/P) and the Italian version of the ICG. RESULTS The mean total ICG score was significantly different among the study groups [F(3.228)=94.19, p<.001]. Post-hoc Games-Howell comparisons indicated significantly higher scores in complicated grief patients with respect to the other three groups and significantly lower scores in healthy controls compared to all other participants. The scale demonstrated a high level of internal consistency: Cronbach's alpha value for the whole sample was 0.947. Factor analyses demonstrated a single-factor solution. CONCLUSIONS This study provides evidence of the validation of the Italian version of the ICG, tested in a large and well-characterized clinical help-seeking population. These data further support the existence of a unique grief-related syndrome different from bipolar and post-traumatic stress disorders.
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Cederbom S, Wågert PVH, Söderlund A, Söderbäck M. The importance of a daily rhythm in a supportive environment – promoting ability in activities in everyday life among older women living alone with chronic pain. Disabil Rehabil 2014; 36:2050-8. [PMID: 24517866 DOI: 10.3109/09638288.2014.887795] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara Cederbom
- School of Health, Care and Social Welfare, Mälardalens University , Västerås , Sweden and
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Holland JM, Rozalski V, Thompson KL, Tiongson RJ, Schatzberg AF, O'Hara R, Gallagher-Thompson D. The unique impact of late-life bereavement and prolonged grief on diurnal cortisol. J Gerontol B Psychol Sci Soc Sci 2014; 69:4-11. [PMID: 23740094 PMCID: PMC3894130 DOI: 10.1093/geronb/gbt051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/04/2013] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study expands on previous research by examining the effects of prolonged grief disorder (PGD) symptoms and bereavement on diurnal cortisol patterns above and beyond depressive symptomatology. METHODS Drawing on information from 56 depressed older adults, 3 groups were compared: (1) a depressed nonbereaved group, (2) a depressed bereaved without elevated PGD symptoms group, and (3) a depressed bereaved with elevated PGD symptoms group. Multilevel modeling was used to examine differences in diurnal cortisol profiles between these 3 groups, controlling for demographic factors and depressive symptoms. RESULTS Results revealed that those who were bereaved had more dysregulated cortisol patterns, but PGD symptomatology seemed to have little effect. Subsidiary analysis with just the bereaved participants suggests that those who were recently widowed may have had greater cortisol dysregulation compared with other bereaved individuals in the sample. DISCUSSION These findings suggest that the circumstance of being bereaved may be associated with more dysregulated cortisol, regardless of PGD symptomatology. This pattern of results might reflect greater disturbance in daily routines among bereaved individuals and acute stress in the case of those experiencing the recent loss of a spouse, which leads to disruption in circadian rhythms and the diurnal cycle of cortisol.
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Affiliation(s)
- Jason M Holland
- Correspondence should be addressed to Jason M. Holland, Department of Psychology, University of Nevada, Las Vegas, 4505 South Maryland Parkway, Box 455030, Las Vegas, NV 89154-5030. E-mail:
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Choi KH, Vasunilashorn S. Widowhood, age heterogamy, and health: the role of selection, marital quality, and health behaviors. J Gerontol B Psychol Sci Soc Sci 2013; 69:123-34. [PMID: 24128991 DOI: 10.1093/geronb/gbt104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Although the impact of widowhood on the surviving spouse's health has been widely documented, there is little empirical research examining whether certain spousal choice decisions and marital sorting patterns predispose individuals to be more vulnerable to the adverse consequences of widowhood for health. DESIGN AND METHOD We use data from the Wisconsin Longitudinal Study and employ ordinary least squares models to (a) document variations in mental and physical health between married and widowed persons, (b) determine whether widowed persons in age heterogamous unions are especially vulnerable to the adverse consequences of widowhood, and (c) investigate to what extent differential selection, marital quality, and health practices account for health disparities by marital status and the spousal age gap. RESULTS Widowed persons, especially those in age heterogamous unions, have worse mental health than married persons, but they do not seem to be more disadvantaged in terms of physical health. Differential selection, marital quality, and health behaviors partly account for some of the health disparities by marital status and spousal age gap. DISCUSSION Our findings suggest that marrying a spouse who is very dissimilar in age may enhance one's vulnerability to the adverse consequences of widowhood for health.
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Affiliation(s)
- Kate H Choi
- Correspondence should be addressed to Kate H. Choi, Department of Sociology, Social Science Centre Room 5306, University of Western Ontario, London, Ontario N6A5C2, Canada. E-mail:
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Asgeirsdóttir HG, Valdimarsdóttir U, Fürst CJ, Steineck G, Hauksdóttir A. Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4-5 years later-a population-based study. Psychooncology 2013; 22:2763-70. [PMID: 23839720 DOI: 10.1002/pon.3345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/18/2013] [Accepted: 05/27/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The focus of this study was on the impact of spousal loss on the development of chronic pain thereafter. More specifically, the aim was to investigate the effect of experiencing low preparedness before a wife's death and the widower's chronic pain 4-5 years after loss. METHODS In a population-based study in the years 2004-2005, anonymous questionnaires were sent out to 907 men in Sweden who had lost a wife to cancer in 2000 and 2001. The questionnaires contained questions on the man's preparedness for his wife's death and his physical and psychological health at follow-up. RESULTS Altogether, 691 out of 907 questionnaires were retrieved (76%). Younger widowers (38-61 years old) with a low degree of preparedness for their wife's death had an increased risk of experiencing symptoms of chronic pain (odds ratio 6.67; 2.49-17.82) 4-5 years after loss. The same results did not apply for older widowers (62-80 years old) (odds ratio 0.81; 0.32-2.05). Widowers who experienced chronic pain were at an increased risk for psychological morbidity, depression (relative risk [RR] 2.21; 1.31-3.74), anxiety (RR 2.11; 1.33-3.37), and sleep disorders (RR 2.19; 1.30-3.69). CONCLUSION Our data suggest that low preparedness for a wife's death may increase risk of chronic pain among younger widowers 4-5 years after loss. In addition, we found comorbidity between psychological symptoms and chronic pain among widowers. These findings call for studies on possible mechanisms in the association between low preparedness and morbidity and on how to increase preparedness for a wife's death to cancer.
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Song JI, Shin DW, Choi JY, Kang J, Baek YJ, Mo HN, Seo MJ, Hwang YH, Lim YK, Lee OK. Quality of life and mental health in the bereaved family members of patients with terminal cancer. Psychooncology 2011; 21:1158-66. [DOI: 10.1002/pon.2027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 12/22/2022]
Affiliation(s)
- Jong Im Song
- Department of Family Medicine; Kangwon National University Hospital; Korea
| | - Dong Wook Shin
- Department of Family Medicine and Health Promotion Center; Seoul National University Hospital; Korea
| | - Jin-Young Choi
- National Cancer Control Institute; National Cancer Center; Korea
| | - Jina Kang
- National Cancer Control Institute; National Cancer Center; Korea
| | - Young-Ji Baek
- National Cancer Control Institute; National Cancer Center; Korea
| | - Ha-Na Mo
- National Cancer Control Institute; National Cancer Center; Korea
| | - Min-Jeong Seo
- Gangnam St. Mary Hospital; The Catholic University of Korea; Korea
| | | | | | - Ok Kyoung Lee
- St. Vincent's Hospital; The Catholic University of Korea; Korea
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Docking RE, Fleming J, Brayne C, Zhao J, Macfarlane GJ, Jones GT. Epidemiology of back pain in older adults: prevalence and risk factors for back pain onset. Rheumatology (Oxford) 2011; 50:1645-53. [DOI: 10.1093/rheumatology/ker175] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pokela N, Simon Bell J, Lihavainen K, Sulkava R, Hartikainen S. Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study. ACTA ACUST UNITED AC 2010; 8:233-44. [DOI: 10.1016/j.amjopharm.2010.05.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2010] [Indexed: 11/25/2022]
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Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, Raphael B, Marwit SJ, Wortman C, Neimeyer RA, Bonanno GA, Bonanno G, Block SD, Kissane D, Boelen P, Maercker A, Litz BT, Johnson JG, First MB, Maciejewski PK. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 2009; 6:e1000121. [PMID: 19652695 PMCID: PMC2711304 DOI: 10.1371/journal.pmed.1000121] [Citation(s) in RCA: 1062] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 06/25/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. METHODS AND FINDINGS A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. CONCLUSIONS The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.
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Affiliation(s)
- Holly G Prigerson
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
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Lunde LH, Nordhus IH, Pallesen S. The effectiveness of cognitive and behavioural treatment of chronic pain in the elderly: a quantitative review. J Clin Psychol Med Settings 2009; 16:254-62. [PMID: 19424781 DOI: 10.1007/s10880-009-9162-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
Abstract
This study provides a meta-analytic review of cognitive and behavioural interventions for chronic pain in the elderly, focusing on treatment effectiveness. Included in the analysis are studies in which a comparison was made either to a control condition or to pre-treatment. A total of 12 outcome studies published or reported between January 1975 and March 2008, were identified involving participants 60 years and above and providing 16 separate treatment interventions. The analysis indicated that cognitive and behavioural interventions were effective on self-reported pain experience, yielding an overall effect size of 0.47. However, there were no significant effects of cognitive and behavioural treatment on symptoms of depression, physical functioning and medication use. Methodological issues concerning design, outcome measures and treatment are discussed and recommendations for future studies are outlined.
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Kirchengast S, Haslinger B. Gender differences in health-related quality of life among healthy aged and old-aged Austrians: cross-sectional analysis. ACTA ACUST UNITED AC 2009; 5:270-8. [PMID: 18727993 DOI: 10.1016/j.genm.2008.07.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although they experience lower mortality rates and lower rates of several chronic diseases than do their male counterparts, aging women are more likely to experience functional impairment in mobility and a general diminished health-related quality of life (HRQoL). The determinants of these gender differences have been the subject of controversy. OBJECTIVE This study analyzed gender differences in HRQoL in relation to social and biomedical factors such as age, marital status, educational level, and living arrangements. METHODS Participants were recruited via snowball sampling. All were healthy and lived independently in private homes. Data were obtained from personal interviews, based on a 30-item questionnaire, in the private homes of the participants. Additionally, HRQoL was assessed by means of the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) 26-item questionnaire, which contains 1 general health item, 1 general QoL item, and 24 specific items covering 4 broad domains: physical (DOM I), psychological (DOM II), social (DOM III), and environmental (DOM IV). RESULTS The participants (98 women, 62 men) enrolled in the study ranged in age from 57 to 95 years (mean [SD] age: 71.8 [8.6] years). The younger age group (aged 57-70 years) comprised 54 women and 25 men, and the older age group (aged >70 years) comprised 44 women and 37 men. Women aged < or =70 years rated their health and QoL significantly higher than did men in the same age group (P = 0.02). These women rated physical capacity (DOM I), social relationships (DOM III), and environment (DOM IV) higher, but not statistically significantly different, than did same-aged men. Women and men exhibited nearly identical psychological health (DOM II) values. Physical capacity (DOM I) differed significantly between women and men aged >70 years (P = 0.03). Women aged >70 years rated their QoL lower than their male counterparts did, although not significantly so. These women depended more on medical treatment, felt significantly less safe in everyday life (P = 0.03), and were less satisfied with themselves. The results of the multiple regression analyses suggest that gender may have a significant impact on general QoL for both age groups (P < 0.01 for the younger age group; P > 0.04 for the older age group). In these analyses, gender also had a significant impact on 2 domains, physical capacity and social relationships (P < 0.02 for both domains), among the participants of the younger age group. CONCLUSION Depending on the age group (< or =70 vs >70 years) in this small sample of Austrian women and men, gender influenced HRQoL.
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Abstract
In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.
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Affiliation(s)
- Margaret Stroebe
- Research Institute for Psychology and Health, Utrecht University, Utrecht, Netherlands.
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Sawyer P, Bodner EV, Ritchie CS, Allman RM. Pain and pain medication use in community-dwelling older adults. ACTA ACUST UNITED AC 2007; 4:316-24. [PMID: 17296537 DOI: 10.1016/j.amjopharm.2006.12.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pain is a common symptom and significant problem for older adults; up to one half of community-dwelling older adults have pain that interferes with normal function. OBJECTIVE The goal of this study was to investigate the prevalence of pain among a racially and gender-balanced sample of community-dwelling older adults and evaluate sociodemographic factors associated with the reporting of pain. Both nonprescription (over-the-counter [OTC]) and prescription pain medications used by the participants and the sociodemographic factors associated with having medication prescribed were considered. METHOD This was a population-based, prospective, observational study. Subjects were participants in the University of Alabama at Birmingham (UAB) Study of Aging, a stratified random sample of Medicare beneficiaries who completed in-home interviews (1999-2001). Assessments included sociodemographic factors and pain; interviewers listed all prescription and OTC pain medications used. Pain medications were coded as NSAIDs, opiates, and miscellaneous pain medications. A composite ordinal measure reflecting pain severity and frequency ranged from 0 = no pain to 4 = dreadful or agonizing pain > or =4 times per week. RESULTS There were 1000 participants in the UAB Study of Aging (mean [SD] age, 75.3 [6.7] years; 50% black; 50% male; 51% rural residence). Seventy-four percent of the subjects reported pain; among these, 52% had daily pain, with 26% reporting dreadful or agonizing pain. Logistic regression controlling for other sociodemographic factors (age, gender, race, education, income, and marital status) found that rural residence (odds ratio [OR], 1.42; 95% CI, 1.1-1.9; P = 0.02) was significantly associated with the reporting of pain. Prescription pain medications were used by 35% of persons with pain and by 17% without pain (P < 0.001); OTC pain medications were used by 52% of persons with pain and by 45% of persons without pain (P = 0.06). Of persons reporting pain, 28% were taking neither prescription nor OTC pain medications; 16% took both and 20% took only prescription pain medications. Logistic regression found that factors associated with taking a prescription pain medication were: unmarried status (OR, 1.56; 95% CI, 1.1-2.2) and pain frequency/severity (OR, 1.39; 95% CI, 1.3-1.6). Taking an OTC pain medication was associated with lower odds of taking a prescription pain medication (OR, 0.50; 95% CI, 0.4-0.7). Age, gender, race, education, rural residence, transportation difficulty, income, and being on Medicaid were not associated with prescription pain medication use. CONCLUSIONS Prescription pain medication use was associated with pain frequency/severity after adjusting for sociodemographics and OTC pain medications in this study of community-dwelling older adults, suggesting that even with medications, individuals remained in pain.
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Affiliation(s)
- Patricia Sawyer
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA.
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