[Effects of psychosomatic treatment for the elderly on cognition and quality of life : Naturalistic study at the psychosomatic day care hospital for the elderly in Nuremberg]

BACKGROUND AND OBJECTIVE

In 2006 the psychosomatic day care hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of the study was to determine treatment effectiveness regarding quality of life and cognition.

MATERIAL AND METHODS

Designed as a naturalistic study of a population sample of 116 patients, the cognitive capacity (memory performance and cognitive speed) and the subjective quality of life were measured by the Nuremberg aging inventory (NAI) and the World Health Organization quality of life for elderly persons (WHOQOL-OLD). The patients were surveyed at four points in time including at 8‑month follow-up. A 5-week waiting time before admission to the 5‑week therapy was implemented as a control condition.

RESULTS

In comparison with the waiting time, after treatment significant improvement (<0.05) was found in cognitive capacity and quality of life. Effect sizes were partly small and mostly moderate (ES 0.2-1.0) with larger effect sizes in the quality of life than in the cognitive domain. Improvements of cognition and quality of life remained stable at follow-up (admission to follow-up ES 0.1-1.0). No correlation was found between cognitive improvement and reduction of depressive symptoms.

CONCLUSION

The results indicate that the psychosomatic day care hospital treatment of the elderly improves subjective quality of life and cognitive capacity.

Resilience, stressful life events, and depressive symptomatology among older Chinese adults

OBJECTIVE

The association between exposure to stressful life events (SLEs) and late-life depression is well-documented. However, the role of resilience as a buffer against the adverse mental health effects of SLEs in late life has not been convincingly demonstrated. In this paper, the moderating effect of resilience in the relationship between SLEs and depressive symptomatology in older Chinese adults is investigated.

METHOD

A population sample of 385 community-dwelling older Chinese adults aged ≥60 years responded to questionnaires on resilience (Connor-Davidson resilience scale), depressive symptomatology (Geriatric Depression Scale, GDS-15) and SLEs.

RESULTS

Increased numbers of SLEs (β = 0.343, p < .001) and lower levels of resilience (β = -0.137, p < 0.001) were significantly associated with higher levels of depressive symptomatology. There was a significant interaction of resilience and number of SLEs on depressive symptomatology (p = 0.003). The sense of personal competence and optimism was the principal underlying resilience dimension moderating the relationship for both the young-old (aged 60-69) and the old-old (aged 70 and above).

CONCLUSION

The finding of significant interaction supported the role of resilience in moderating the adverse effect of SLEs in terms of depressive symptoms among older Chinese adults.

Effectiveness of a psychosomatic day hospital treatment for the elderly: a naturalistic longitudinal study with waiting time before treatment as control condition

OBJECTIVE

In 2006 the psychosomatic day hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of this study was to determine treatment effectiveness and identify possible effects on health care utilization.

METHODS

Designed as a naturalistic study with waiting time before admission as a control condition, the primary outcome was the level of depressive symptoms as measured by the hospital anxiety and depression scale. Secondary outcomes were depressive and somatoform symptoms and syndromes as measured with the patient health questionnaire, patient perception of interpersonal problems and health care use before and after treatment.

RESULTS

After treatment significant improvement (p<0.01) with moderate effect sizes (ES) was found in all variables from admission to discharge (ES from 0.3 to 0.8) and also to follow-up (ES from 0.2 to 0.6). Improvement remained stable at follow-up. Furthermore, after psychosomatic treatment a reduction in medical service usage was visible. Number of consultations (pre: 13, post: 9), number and length of hospital stays (pre: 1, 7 weeks, post: 0, 3 weeks) were both significantly (p<0.001) reduced six months after treatment as compared to the period six months prior to treatment.

CONCLUSION

Results indicate that the psychosomatic day hospital treatment of the elderly is successful. Reduced usage of health care and the lower costs for day hospital treatment compared to inpatient treatment point to a positive cost-effect-ratio. Expanding this psychosomatic intervention would be useful in reducing the current gap in mental health care for the elderly.

Examination of important life experiences of the oldest-old: cross-cultural comparisons of U.S. and Japanese centenarians

The purpose of this study was to compare the most important life events reported by U.S. and Japanese centenarians. This study included a population-based sample of 239 U.S. centenarians from the Georgia Centenarian Study and 304 Japanese centenarians from the Tokyo Centenarian Study. Two open-ended life events questions were categorized and grouped into different life event domains. Several cross-tabulations were computed to investigate culture and gender differences in most important life event domains. Next, four configural frequency analyses were conducted using Neuroticism, Extraversion, and the first most often mentioned life event domain for each sample (i.e., marriage and historical life events). Results suggest that events related to marriage were the most frequent important event domains mentioned by U.S. centenarians. The Japanese sample was more likely to report historical events. Men from the U.S. were more likely to report events related to work and retirement compared to U.S. women, and U.S. women reported events related to family as the most important life events when compared to U.S. men. Japanese women considered events related to marriage, death and grief as the most important life events when compared to Japanese men. In addition, Japanese men reported events related to work and retirement as the most important life events. A cross-cultural difference was found in life events: U.S. centenarians were more likely to mention positive experiences related to marriage and children, whereas Japanese centenarians reported mostly negative and traumatic experiences such as historical, death/grief, and work/retirement events.

How does functional disability affect depressive symptoms in late life? The role of perceived social support and psychological resources

This study examines the process whereby functional disability amplifies depressive symptoms through decreasing perceived social support and psychological resources. The study analyzed two waves of panel data (1986 to 1992) of a large sample of older adults from the National Institutes of Aging Established Populations for Epidemiologic Studies of the Elderly. The results of longitudinal change models and path analyses show that the perceived availability of a confidant, satisfaction with support, sense of control, and self-esteem mediate the effects of disability on increments in depressive symptoms in late life. Psychological resources play a dominant role in mediating the effects of functional impairment. Scales of sense of control and self-esteem account for 53 percent of the total effect of baseline disability and 43 percent of the total effect of changes in disability on changes in the CES-D depression scale. Self-esteem appears to be the strongest mediator.

Conceptualizing and Identifying Cumulative Adversity and Protective Resources: Implications for Understanding Health Inequalities

This article focuses on cumulative adversity and protective resources, both social and biological, that interrupt or deflect individuals from optimal life-course trajectories and contribute to widening gaps in health. Under the guiding framework of cumulative adversity and/or advantage, this narrative discusses the theoretical framework of cumulative adversity, presents identified sources of cumulative adversity and protective resources, and highlights the utilization of the life-course approach. Numerous social and biological adverse conditions are identified across multiple domains. Utilizing the life-course perspective in identifying early life determinants and the paucity of information regarding identified protective factors are discussed. Understanding health inequalities requires attention paid to heterogeneity in the impact of social statuses as well as sources of cumulative adversity and protective resources within diverging trajectories across the life course. Intervention implications are discussed, and suggestions for future research are made.

Age, the stress process, and physical distress: the role of distal stressors

OBJECTIVES

This article examines the nature of distal stressors over a 15-year period and the extent to which they contribute to the explanation of additional variation in the life stress model.

METHODS

The study uses data collected from a community sample of adults to test specific hypotheses.

RESULTS

Findings show that (a) distal stressors significantly increase variance explained in physical symptoms and maintain a direct effect on physical symptoms, (b) recent stressors mediate the effects of distal stressors on distress, and (c) social resources have direct and mediating effects on physical distress. Variations exist for different age groups or life stages.

DISCUSSION

The implications of the findings are discussed in the context of life course, theoretical issues of temporality, types of stressors, and the role of social resources. The major conclusion is that there are multiple pathways to distress that differ for different stages in the life course.

Stress in the life course: a life history approach

This article examines the relationship between stress and distress in the life course, emphasizing the time elapsed between the event and measurement of psychological distress. Stressors are conceptualized as either distal or proximal based on how recently they occurred. Distal stressors are further classified as status changes or undesirable life changes. Using a life history calendar approach, we examine stressors occurring over a 15-year-period. We explore whether distal stressors affect current depressive symptomatology above and beyond the effect of more recent stressors and how these stressors vary in frequency and affect over 3 empirically defined age groups. While some events decrease in frequency over age, others occur consistently across age groups. Most important, distal stressors significantly impact current depressive symptomatology, independent of proximal stressors. Types of distal stressors affecting depression vary over age, indicating that the stage of life at which a stressor occurs is a significant determinant of the stressor's effect on depression.

The effects of depression, health status, and stressful life-events on self-reported memory problems among aged blacks

A sample of 1,250 Black elderly individuals was examined to assess the prevalence and correlates of self-reported memory problems. More than 48.3 percent of the sample reported poor memory and forgetfulness as either a very (17.9%) or somewhat (30.4%) serious problem. Multivariate logistic regression was employed to detect the significant predictors of self-reported memory problems. According to our data, those Black elderly individuals who have hearing problems, who report a higher number of stressful life-events, who experience a higher level of depression, and who suffer from poorer health are more likely to complain of memory problems.