Baltes' SOC model of successful ageing as a potential framework for stroke rehabilitation

Identifying emotional contributors to participation post-stroke

BACKGROUND

Participation in daily activities is the ultimate goal of stroke rehabilitation. Emotional factors have been considered as contributors to participation, but associations between emotional factors and participation post-stroke have not been fully explored.

OBJECTIVE

To investigate the extent to which emotional factors contribute to participation post-stroke.

METHODS

73 participants were included. Three participation outcomes were used as dependent variables in three models: (1) Stroke Impact Scale (SIS) Participation/Role Function, (2) Activity Card Sort (ACS), and (3) Reintegration to Normal Living (RNL). Main independent variables were six emotional factors: SIS Emotion Function (General emotion), Visual Analog Mood Scale energetic and happy subscales, Patient Health Questionnaire-9 (Depression), State-Trait Anxiety Inventory-Trait Anxiety Scale, and Apathy Evaluation Scale. Covariates of stroke severity and social support were included.

RESULTS

Model 1 showed stroke severity (β = -0.300) and depression (β = -0.268) were significant contributors to SIS Participation/Role Function (R² = 0.368, p < .05). Model 2 indicated that happiness (β = 0.284) and apathy (β = -0.330) significantly contributed to ACS total activity retention (R² = 0.247, p < .05). Model 3 revealed that anxiety (β = -0.348), apathy (β = -0.303), stroke severity (β = -0.184), and social support (β = 0.185) were significant contributors to RNL total score (R² = 0.583, p < .05).

CONCLUSIONS

Results suggested that emotional measures of apathy, depression, anxiety, and happiness, but not general emotion, were important contributors to participation post-stroke. These findings suggest that rehabilitation professionals should address individual emotional contributors to facilitate participation post-stroke.

Health information behavior and related factors among Estonians aged ≥ 50 years during the COVID-19 pandemic

Purpose

The purpose of the article is to introduce the outcomes of a study analyzing the relationships between willingness to use technology for health purposes, health information behavior (HIB), health behavior (HB) choices, readiness for COVID-19 vaccination, socioeconomic indicators and self-reported health among older adults aged = 50 years living in Estonia.

Design/methodology/approach

A cross-sectional survey was conducted among 501 people aged = 50 in Estonia in 2020, a month after the end of lockdown.

Findings

The results of the study indicate that the more recurrent the need for HI was (rho = 0.11, p < 0.05) and the more regularly one searched for it (rho = 0.14, p < 0.01), the more willing a person was to get vaccinated. Also, interest in digital applications corresponded to vaccination readiness (rho = 0.25, p < 0.001). However, this relationship did not emerge in the case of other HBs such as healthy eating and exercise. Differences in HIB should be taken into account when developing effective means of health communication designed especially for crisis situations.

Originality/value

Estonia is known as one of the digital front runners in the world. However, social welfare and the well-being of disadvantaged groups among the population (e.g. older people) have not yet caught up with the more developed Western countries. Thus, learning more about the health-related information behavior of older adults, e.g. the kind of health information they are seeking and using in Estonia, allows policymakers, health information providers and libraries in Estonia to plan and carry out more effective interventions and help them to improve the existing systems so as to furnish older adults with relevant information.

The Utility of Solution-Oriented Strategies to Support Grandparents Raising Grandchildren

Objectives: The purpose of this article is to evaluate the effectiveness of a psychosocial intervention program to improve the health and social psychological outcomes for grandparents raising grandchildren using the theory of Selection, Optimization, and Compensation (Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). Cambridge University Press. doi:10.1017/CBO9780511665684.003). Methods: Fifty-two grandparents were randomly assigned either to a 6-session solution-oriented goal-setting program or to a waiting list control condition who subsequently received the intervention. Results: Grandparents in the intervention group, in comparison to the waiting list control group, reduced their level of depression, improved their parental efficacy, overall psychosocial adjustment, and increased their ability to choose effective goals. For the most part, findings were replicated in the waiting list control analyses. Discussion: While these findings are consistent with previous studies using psychosocial interventions with parents and grandparent caregivers, they also provide support for strength-based proactive behavioral approaches to improve the quality of life of grandparent caregivers.

Rehabilitation for participation in life after spinal cord injury - clinician responses to a preliminary conceptual framework

PURPOSE

To explore face validity of a preliminary conceptual framework for rehabilitation (the HEAR Framework), which is grounded in the narratives of people with spinal cord injury.

METHODS

Using a quantitative online survey, experienced spinal cord injury rehabilitation practitioners were asked to compare the overall Framework, and its three components and nine elements, against usual practice. Participants rated the helpfulness and ease of implementation of each component. Perceived training needs, to support the implementation of the Framework were also explored. Respondents were given the opportunity to provide qualitative feedback about the Framework.

RESULTS

Thirty-four participants completed the survey. Median rating of congruence of the Framework with usual practice was 6 (out of 10). The Help component of the Framework was rated as more like usual practice than the Encourage and Accept components. Median rating of the potential helpfulness to practice, of all the elements of the Framework was 5 (out of 5). Participants rated the elements within the Help component of the Framework as easiest to implement. Teaching assertiveness, promoting flexible thinking and fostering responsive communication were the highest rated training topics related to implementation of the Framework.

CONCLUSIONS

Face validity testing suggests the preliminary HEAR Framework is promising as a basis for spinal cord injury rehabilitation theory. Broad-based testing is required to progress the promise of the Framework.IMPLICATIONS FOR REHABILITATIONSpinal cord injury rehabilitation lacks conceptual frameworks to guide practice.This validity study suggests moderate alignment between the preliminary HEAR Framework and usual practice (based on the perceptions of professionals in a spinal cord injury service).The Framework may be useful to individual rehabilitation practitioners as a basis for clinical reflection.The Framework may be useful as a practice development tool for teams of rehabilitation practitioners.

Predictors of Vascular Cognitive Impairment Poststroke in a Middle Eastern (Bahrain) Cohort: A Proposed Case-Control Comparison

BACKGROUND

Poststroke dementia and cognitive impairment are associated with poor long-term outcomes after stroke. The contribution of genetic factors such as the presence of apolipoprotein (ApoE) ɛ4 allele and its association with cognitive impairment poststroke remains inconclusive, particularly in Middle Eastern regions.

OBJECTIVE

The aim of this study is to examine all correlates and potential predictors of cognitive impairment including self-awareness and regulation deficits in stroke patients and compare these functions with healthy older adults from a Middle Eastern population.

METHODS

A prospective stroke sample of 200 patients (case group) and 100 healthy aging individuals (control group) will be recruited from the largest medical complex in Bahrain. A neuropsychological battery of cognitive assessments (global, executive, and metacognition) will be conducted on all participants. Participants will be categorized into 4 subgroups (nonvascular cognitive impairment, vascular cognitive impairment with no dementia, vascular dementia, and mixed dementia) using standardized cognitive assessment scores and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, dementia criteria. Biomarkers will include ApoE genotype, soluble form of receptor for advanced glycation end products, neprilysin, beta-secretase 1, biochemistry, and hematology measurements.

RESULTS

The primary study outcome is to determine early risk factors for cognitive impairment after stroke in a Bahraini cohort. The study has received full ethical approval from the Bahrain Ministry of Health and from the affiliated university.

CONCLUSIONS

With increasing stroke incidence rates in the Middle East, this research study will provide useful biological and epidemiological data for future development and planning of health policies and guidelines for stroke care within the Gulf region.

Hearing, Cognition, and Healthy Aging: Social and Public Health Implications of the Links between Age-Related Declines in Hearing and Cognition

Sensory input provides the signals used by the brain when listeners understand speech and participate in social activities with other people in a range of everyday situations. When sensory inputs are diminished, there can be short-term consequences to brain functioning, and long-term deprivation can affect brain neuroplasticity. Indeed, the association between hearing loss and cognitive declines in older adults is supported by experimental and epidemiologic evidence, although the causal mechanisms remain unknown. These interactions of auditory and cognitive aging play out in the challenges confronted by people with age-related hearing problems when understanding speech and engaging in social interactions. In the present article, we use the World Health Organization's International Classification of Functioning, Disability and Health and the Selective Optimization with Compensation models to highlight the importance of adopting a healthy aging perspective that focuses on facilitating active social participation by older adults. First, we examine epidemiologic evidence linking ARHL to cognitive declines and other health issues. Next, we examine how social factors influence and are influenced by auditory and cognitive aging and if they may provide a possible explanation for the association between ARHL and cognitive decline. Finally, we outline how audiologists could reposition hearing health care within the broader context of healthy aging.

Association Between Metacognition and Mood Symptoms Poststroke

INTRODUCTION

The link between metacognition and mood has been well established, particularly in other conditions with psychological comorbidity, however, there is no evidence regarding this association in the area of stroke.

AIM

The aim of this study was to examine the association between metacognition, based on the Self-Regulatory Executive Function model, and mood symptoms in the acute phase after stroke.

METHODS

One hundred thirty patients were recruited to a prospective stroke study in Bahrain, and n = 64 were assessed for mood and cognition. A neuropsychological battery of cognitive assessments included the following measures: the Mini-Mental State Examination, the Trail Making Test (A+B), and the Metacognition Questionnaire 30 (MCQ-30) for metacognition. The Hospital Anxiety and Depression Scale assessed mood symptoms, and stroke severity was measured using the National Institute of Health Stroke Severity Scale.

RESULTS

Total MCQ-30 scores were significantly associated with both anxiety (r = .47, P = .001) and depression (r = .54, P <. 0001). The MCQ-30 subscales' cognitive confidence, cognitive self-consciousness, and uncontrollability/danger were the specific factors to be associated with mood symptoms (P < .01). Global cognition (r =.32, P < .01), but not executive function, was significantly associated with depression only. Metacognition remained a statistically significant correlate with depression (β = .42, P < .0001) and anxiety (β = .51, P < .0001) after adjusting for education and global cognition.

DISCUSSION

Metacognition is a better determinant of mood symptoms after stroke, especially in regions where illiteracy levels are high in older populations, in comparison to executive function and global cognition.

Metacognitive function poststroke: a review of definition and assessment

Metacognition is the conscious knowledge individuals have about their own cognitive capacities and the regulation of these activities through self-monitoring. The aim of this review was to identify the definitions and assessment tools used to examine metacognition in relation to stroke studies. A computer database search was conducted using MEDLINE, CINAHL, PsycINFO, Cochrane Reviews, Scopus and Web of Science. A total of 1412 publications were retrieved from the initial database search. Following the removal of unrelated articles, 34 articles remained eligible. 5 studies examined metacognition in relation to cognitive and/or emotional functioning, 4 examined the concept in relation to memory, while others investigated its relationship to driving, employment or restrictions in daily living. 12 studies examined metacognitive function exclusively in stroke. Only 1 study examined metacognition in the acute phase of stroke. 7 studies adhered to the standard definition of metacognition in line with the neuropsychological literature. The main assessment tools utilised included the Self-Regulation and Skills Interview (SRSI), the Self-Awareness of Deficits Interview (SADI), the Awareness Questionnaire (AQ) and the Patient Competency Rating Scale (PCRS). Assessment of metacognition has tended to focus on traumatic and other acquired brain injury in comparison to stroke. The majority of the studies that examined metacognition in stroke did not assess patients in the acute phase. The heterogeneity of assessment tools was in keeping with the variation in the definition of metacognition. The emergence of a standard metacognitive assessment tool may have important implications for future rehabilitative programmes.

Older people with incurable cancer: Existential meaning-making from a life-span perspective

OBJECTIVE

An increasing number of older people in Western countries are living with incurable cancer, receiving palliative care from specialized healthcare contexts. The aim of our article was to understand how they experience the existential meaning-making function in daily living from a life-span perspective.

METHOD

Some 21 participants (12 men and 9 women), aged 70-88, were interviewed in a semistructured framework. They were recruited from somatic hospitals in southeastern Norway. We applied the model of selective optimization with compensation (SOC) from life-span developmental psychology in a deductive manner to explore the participants' life-oriented adaptive strategies. A meaning component was added to the SOC model.

RESULTS

The participants experienced the existential meaning-making function on two levels. On a superordinate level, it was an important component for interpreting and coordinating the adaptive strategies of SOC for reaching the most important goals in daily living. The existential meaning-making framework provided for a comprehensive understanding of resilience, allowing for both restoration and growth components to be identified. The second level was related to strategy, in that the existential meaning-making function was involved in a complex interaction with behavioral resources and resilience, leading to continuation of goals and more realistic goal adjustments. A few experienced existential meaning-making dysfunction.

SIGNIFICANCE OF RESULTS

The modified SOC model was seen as applicable for palliative care in specialized healthcare contexts. Employing the existential meaning-making framework with its complementary understanding of resilience as growth potential to the SOC model's restoration potential can help older people to identify how they make meaning and how this influences their adaptation process to being incurably sick.