Examining the Feasibility, Acceptability, and Effectiveness of Remote Training on Community-Based Participatory Research: Single-Arm Pre-Post Pilot Study

BACKGROUND

Over the past decade, a growing body of scientific evidence has demonstrated that community engagement in research leads to more relevant research, enhances the uptake of research findings, and improves clinical outcomes. Despite the increasing need for the integration of community engagement methodologies into the scientific inquiry, doctoral and master's level competencies in the field of psychiatry often lack dedicated training or coursework on community engagement methodologies.

OBJECTIVE

A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months.

METHODS

A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months.

RESULTS

The pilot study demonstrated that a 3-month remote training on community-based participatory research ("Partnership Academy") was deemed feasible and acceptable by service users, peer support specialists, caregivers of people with mental health challenges, and scientists. Improvements were found in research engagement and the quality of partnership. A marked increase in distrust in the medical system was also found. Groups submitted 4 grant applications and published 1 peer-reviewed journal at a 3-month follow-up.

CONCLUSIONS

This pre- and postpilot study demonstrated it is possible to train groups of service users, peer support specialists, caregivers of people with mental health challenges, and scientists in community-based participatory research. These findings provide preliminary evidence that a 3-month remote training on community-based participatory research ("Partnership Academy") is feasible, acceptable, and potentially associated with improvements in research engagement as well as the quality of partnership and output, such as manuscripts and grant applications.

Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

OBJECTIVE

The objectives of this study were to a) evaluate associations between social isolation and change in cognition over a 3-year period, and b) evaluate whether physical activity mediates the association between social isolation and cognition change.

METHODS

Using baseline and follow-up 1 data from the Canadian Longitudinal Study on Aging, latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of social isolation on cognitive change through physical activity. Multigroup models were constructed based on age group (45-65 versus 65+ years) and sex to allow for varying estimates across age and sex. The final analytic sample included 51,338 participants.

RESULTS

Indirect effects of social isolation on cognition through physical activity were evident in men and women 65+ years old for memory change ( = -0.005 [99.9% confidence interval = -0.007 to -0.002], p < .001 in both groups) and in male adults 65+ years old for executive function change ( = -0.01 [99.9% confidence interval = -0.02 to -0.006], p < .001). Statistically significant indirect effects were not observed for adults between 45 and 65 years old.

CONCLUSIONS

Social isolation is associated with diminished physical activity, and in turn, diminished physical activity is associated with decline in memory in older women and men, with larger declines in executive function in older men. Public health initiatives to promote physical activity-perhaps incorporating social interaction-among older adults experiencing social isolation could be one way to mitigate the negative impact of social isolation on cognitive health.

Neuroimaging and machine learning for studying the pathways from mild cognitive impairment to alzheimer's disease: a systematic review

BACKGROUND

This systematic review synthesizes the most recent neuroimaging procedures and machine learning approaches for the prediction of conversion from mild cognitive impairment to Alzheimer's disease dementia.

METHODS

We systematically searched PubMed, SCOPUS, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review guidelines.

RESULTS

Our search returned 2572 articles, 56 of which met the criteria for inclusion in the final selection. The multimodality framework and deep learning techniques showed potential for predicting the conversion of MCI to AD dementia.

CONCLUSION

Findings of this systematic review identified that the possibility of using neuroimaging data processed by advanced learning algorithms is promising for the prediction of AD progression. We also provided a detailed description of the challenges that researchers are faced along with future research directions. The protocol has been registered in the International Prospective Register of Systematic Reviews- CRD42019133402 and published in the Systematic Reviews journal.

Worsened Ability to Engage in Social and Physical Activity During the COVID-19 Pandemic and Older Adults' Mental Health: Longitudinal Analysis From the Canadian Longitudinal Study on Aging

Background and Objectives

Restrictions implemented to mitigate the transmission of coronavirus disease 2019 (COVID-19) affected older adults' ability to engage in social and physical activities. We examined mental health outcomes of older adults reporting worsened ability to be socially and physically active during the pandemic.

Research Design and Methods

Using logistic regression, we examined the relationship between positive screen for depression (10-item Center for Epidemiological Studies-Depression Scale) or anxiety (7-item Generalized Anxiety Scale) at the end of 2020 and worsened ability to engage in social and physical activity during the first 6-9 months of the pandemic among older adults in Canada. Interactions between ability to participate in social and physical activity and social participation pre-COVID (2015-2018) and physical activity were also examined. We analyzed data collected before and during the COVID pandemic from the Canadian Longitudinal Study on Aging, a nationally representative longitudinal cohort: pre-pandemic (2015-2018), COVID-Baseline survey (April to May 2020), and COVID-Exit survey (September to December 2020).

Results

Of the 24,108 participants who completed the COVID-Exit survey, 21.96% (n = 5,219) screened positively for depression and 5.04% (n = 1,132) for anxiety. Worsened ability to participate in social and physical activity was associated with depression (odds ratio [OR] = 1.85 [95% confidence interval {CI} 1.67-2.04]; OR = 2.46 [95% CI 2.25-2.69]), respectively, and anxiety (OR = 1.66 [95% CI 1.37-2.02] and OR = 1.96 [95% CI 1.68-2.30]). Fully adjusted interaction models identified a buffering effect of social participation and the ability to participate in physical activity on depression (χ2 [1] = 8.86, p = .003 for interaction term).

Discussion and Implications

Older adults reporting worsened ability to participate in social and physical activities during the COVID-19 pandemic had poorer mental health outcomes than those whose ability remained the same or improved. These findings highlight the importance of fostering social and physical activity resources to mitigate the negative mental health impacts of future pandemics or other major life stressors that may affect the mental health of older adults.

Contributors to mental health resilience in middle-aged and older adults: an analysis of the Canadian Longitudinal Study on Aging

OBJECTIVES

Identifying the correlates of mental health resilience (MHR)-defined as the discrepancy between one's reported current mental health and one's predicted mental health based on their physical performance-may lead to strategies to alleviate the burden of poor mental health in aging adults. Socioeconomic factors, such as income and education, may promote MHR via modifiable factors, such as physical activity and social networks.

DESIGN

A cross-sectional study was conducted. Multivariable generalized additive models characterized the associations between socioeconomic and modifiable factors with MHR.

SETTING

Data were taken from the population-based Canadian Longitudinal Study on Aging (CLSA), which collected data at various data collection sites across Canada.

PARTICIPANTS

Approximately 31,000 women and men between the ages of 45 and 85 years from the comprehensive cohort of the CLSA.

MEASUREMENTS

Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance was measured objectively using a composite of grip strength, sit-to-stand, and balance performance. Socioeconomic and modifiable factors were measured by self-report questionnaires.

RESULTS

Household income, and to a lesser extent, education were associated with greater MHR. Individuals reporting more physical activity and larger social networks had greater MHR. Physical activity accounted for 6% (95% CI: 4 to 11%) and social network accounted for 16% (95% CI: 11 to 23%) of the association between household income and MHR.

CONCLUSIONS

The burden of poor mental health in aging adults may be alleviated through targeted interventions involving physical activity and social connectedness for individuals with lower socioeconomic resources.

Internet use and life satisfaction among Chinese older adults: the mediating effects of social interaction

Internet use has been suggested to have a crucial effect on older adults' quality of life; however, few studies have investigated the underlying mechanisms in the relationship between internet use and life satisfaction among older adults. Employing multiple linear regression models and mediation analysis with 2019 Chinese Social Survey (CSS) data, this study analyzed the associations between the internet use and life satisfaction of Chinese older adults. Additionally, it explored the mediating role of social interaction, including online and offline social interactions. The results showed that internet use was positively associated with older adults' life satisfaction, and offline social interaction significantly mediated internet use. Our findings indicate that internet use could improve older adults' quality of life by promoting offline social interaction. Therefore, the government, communities, and families should create conditions for older adults to integrate into online society and participate in offline social interaction.

The Intersection of Business Innovation and Scientific Exploration to Address Early Mortality in People With Serious Mental Illness

This Viewpoint describes how open innovation has been used by communities to support individual and community health and discusses how scientists and clinicians could apply this idea- and resource-sharing strategy to generate breakthrough advances that may extend the life span of people with serious mental illness (SMI).

Multimorbidity, COVID-19 and Mental Health: Canadian Longitudinal Study on Aging (CLSA) Longitudinal Analyses

OBJECTIVES

This paper examines the longitudinal effects of the COVID-19 pandemic on older adults (65+) with multimorbidity on levels of depression, anxiety, and perceived global impact on their lives.

METHODS

Baseline (2011-2015) and Follow-up 1 (2015-2018) data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit waves of the CLSA COVID-19 study (April-December, 2020) (n = 18,099). Multimorbidity was measured using: a) an additive scale of chronic conditions; and b) six chronic disease clusters. Linear Mixed Models were employed to test hypotheses.

RESULTS

Number of chronic conditions pre-pandemic was associated with pandemic levels of depression (estimate = 0.40, 95% CI: [0.37,0.44]); anxiety (estimate = 0.20, 95% CI: [0.18, 0.23]); and perceived negative impact of the pandemic (OR = 1.04, 95% CI: [1.02, 1.06]). The associations between multimorbidity and anxiety decreased during the period of the COVID-19 surveys (estimate = -0.02, 95% CI: [-0.05, -0.01]); whereas the multimorbidity association with perceived impact increased (OR = 1.03, 95% CI: [1.01, 1.05]).

CONCLUSIONS

This study demonstrates that pre-pandemic multimorbidity conditions are associated with worsening mental health.

CLINICAL IMPLICATIONS

Clinicians treating mental health of older adults need to consider the joint effects of multimorbidity conditions and pandemic experiences to tailor counseling and other treatment protocols.

An analysis of dynamic, bidirectional associations between memory and verbal fluency with depressive symptoms in middle- and older-aged adults: A cohort study

OBJECTIVES

This study compared two approaches to analyzing bidirectional associations between aspects of cognition-specifically, verbal memory and fluency-and depression using multi-wave longitudinal data. The cross-lagged panel model (CLPM) does not distinguish between- versus within-person variation, whereas the random-intercepts CLPM (RI-CLPM) partitions variation into a stable, trait-like component that varies across individuals and a wave-specific deviation that varies within individuals.

METHODS

Observational study of 47,719 adults ages 45 to 95 from the Survey of Health, Ageing, and Retirement in Europe (mean age = 63 years, SD = 9 years at first assessment; 57 % female). Participants completed at least four of 8 biennial waves of data collection from 2004 and 2020. Depressive symptoms were assessed by the EURO-D. Cognition was assessed by animal fluency, and immediate and delayed word recall. Multi-group CLPMs and RI-CLPMs were fit on middle-aged (45-65 year) and older (65+ years) males and females.

RESULTS

The estimates from the CLPMs indicated bidirectionality in the associations between cognition and depression, whereas the RI-CLPMs provided clearer evidence that changes in depression may produce subsequent changes in cognition, rather than vice versa. Prospective associations were small and consistent across age, sex and cognitive measure.

LIMITATIONS

Measures of executive function-a domain of cognition affected by aging and related to mood-were not available.

CONCLUSIONS

CLPMs and RI-CLPMs address conceptually distinct questions about how verbal memory and fluency may be dynamically related to depression, and therefore, produce different inferences from the same data about how these aspects of cognition and depression are related.

Guidelines to Establish an Equitable Mobile Health Ecosystem

Mobile health (mHealth)-that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care-is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeducation (i.e., information about mental health conditions), and delivering evidence-based practices. However, some groups may fail to benefit from mHealth despite a high need for mental health services, including people from racially and ethnically disadvantaged groups, rural residents, individuals who are socioeconomically disadvantaged, and people with disabilities. A well-designed mHealth ecosystem that considers multiple elements of design, development, and implementation can afford disadvantaged populations the opportunity to address inequities and facilitate access to and uptake of mHealth. This article proposes inclusion of the following principles and standards in the development of an mHealth ecosystem of equity: use a human-centered design, reduce bias in machine-learning analytical techniques, promote inclusivity via mHealth design features, facilitate informed decision making in technology selection, embrace adaptive technology, promote digital literacy through mHealth by teaching patients how to use the technology, and facilitate access to mHealth to improve health outcomes.

Exercise interventions for stress reduction in older adult populations: a systematic review of randomized controlled trials

Background and Objectives

To assess which forms of supervised exercise are effective in reducing psychological stress in older adults.

Research Design

Systematic Review.

Methods

Four electronic databases (PubMed, Web of Science, PsycInfo, and SportDiscus) were searched in February of 2021. Randomised controlled trials (RCTs) investigating supervised exercise interventions for psychological stress reduction in adults aged 50 + were included in this review. Data on type, intensity, and duration of the intervention were also extracted.

Results

854 studies were identified by the search strategy. Twelve RCTs met inclusion criteria. Trials involving low-intensity qigong and trials combining aerobic and anaerobic or aerobic and nutrition/diet education demonstrated the strongest evidence for stress reduction.

Discussion and Implications

Exercise may reduce stress in older adults. Suitable duration of programme ranges from 3 months to 1 year. Light to moderate activity is recommended for best results, with qigong being the most consistent and common exercise.

Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials

One in five older adults experience symptoms of depression and anxiety. Digital mental health interventions are promising in their ability to provide researchers, mental health professionals, clinicians, and patients with personalised tools for assessing their behaviour and seeking consultation, treatment, and peer support. This systematic review looks at existing randomised controlled trial studies on digital mental health interventions for older adults. Four factors have been found that contributed to the success of digital mental health interventions: (1) ease of use; (2) opportunities for social interactions; (3) having human support; and (4) having the digital mental health interventions tailored to the participants' needs. The findings also resulted in methodological considerations for future randomised controlled trials on digital mental health interventions: (1) having a healthy control group and an intervention group with clinical diagnoses of mental illness; (2) collecting data on the support given throughout the duration of the interventions; (3) obtaining qualitative and quantitative data to measure the success of the interventions; and (4) conducting follow-up interviews and surveys up to 1 year post-intervention to determine the long-term outcomes. The factors that were identified in this systematic review can provide future digital mental health interventions researchers, health professionals, clinicians, and patients with the tools to design, develop, and use successful interventions for older users.

Quantifying Physical Resilience in Ageing Using Measurement Instruments: A Scoping Review

Purpose: The capacity to recover motor function with pathology or age-related decline is termed physical resilience. It is unknown what outcome domains are captured with existing measurement instruments. Thus, this scoping review aimed to identify measurement instruments for physical resilience, identify research gaps, and make recommendations for future research. Methods: Articles were included from the search when their subject matter included the term resilience in relation to the physical health of older adults. Data on physical resilience measurement instruments were extracted using the outcome domains: body function or structure, activity and participation, and societal impact. Results: The majority of the 33 included articles involved older adults with fractures, cardiac conditions, and cancer. Many measurement instruments quantified body function or structure, and some instruments captured activity and participation, and societal impact of physical resilience. Measurement instruments were pooled into 4 categories: psychological, physiological, motor function, and psychosocial scales. No studies combined all areas of measurement. Conclusions: A potential gap of a measurement instrument capturing social aspects of physical resilience was identified. Comprehensive measurement could identify which outcome domains could be targeted to foster resilience. This knowledge might be useful across many health disciplines and contribute to therapeutic decision-making and rehabilitation strategies.

Help-Seeking Behaviors Among Older Adults: A Scoping Review

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

Multimorbidity resilience and COVID-19 pandemic self-reported impact and worry among older adults: a study based on the Canadian Longitudinal Study on Aging (CLSA)

Background

The Coronavirus Disease-2019 (COVID-19) pandemic has created a spectrum of adversities that have affected older adults disproportionately. This paper examines older adults with multimorbidity using longitudinal data to ascertain why some of these vulnerable individuals coped with pandemic-induced risk and stressors better than others – termed multimorbidity resilience. We investigate pre-pandemic levels of functional, social and psychological forms of resilience among this sub-population of at-risk individuals on two outcomes – self-reported comprehensive pandemic impact and personal worry.

Methods

This study was conducted using Follow-up 1 data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit COVID-19 study, conducted between April and December in 2020. A final sub-group of 9211 older adults with two or more chronic health conditions were selected for analyses. Logistic regression and Generalized Linear Mixed Models were employed to test hypotheses between a multimorbidity resilience index and its three sub-indices measured using pre-pandemic Follow-up 1 data and the outcomes, including covariates.

Results

The multimorbidity resilience index was inversely associated with pandemic comprehensive impact at both COVID-19 Baseline wave (OR = 0.83, p < 0.001, 95% CI: [0.80,0.86]), and Exit wave (OR = 0.84, p < 0.001, 95% CI: [0.81,0.87]); and for personal worry at Exit (OR = 0.89, p < 0.001, 95% CI: [0.86,0.93]), in the final models with all covariates. The full index was also associated with comprehensive impact between the COVID waves (estimate = − 0.19, p < 0.001, 95% CI: [− 0.22, − 0.16]). Only the psychological resilience sub-index was inversely associated with comprehensive impact at both Baseline (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]) and Exit waves (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]), in the final model; and between these COVID waves (estimate = − 0.11, p < 0.001, 95% CI: [− 0.13, − 0.10]). The social resilience sub-index exhibited a weak positive association (OR = 1.04, p < 0.05, 95% CI: [1.01,1.07]) with personal worry, and the functional resilience measure was not associated with either outcome.

Conclusions

The findings show that psychological resilience is most pronounced in protecting against pandemic comprehensive impact and personal worry. In addition, several covariates were also associated with the outcomes. The findings are discussed in terms of developing or retrofitting innovative approaches to proactive coping among multimorbid older adults during both pre-pandemic and peri-pandemic periods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02769-2.

Overcoming Barriers for Older Adults to Maintain Virtual Community and Social Connections during the COVID-19 Pandemic

OBJECTIVES

We describe the evaluation of remote training, an innovative use of technology to maintain older adults' virtual connection with their community and socialization, which were disrupted by the pandemic. Remote training was conducted via telephone using principles of cognitive rehabilitation and delivered by trained clinicians.

METHODS

We thematically analyzed trainer reflection notes and interviews with older adult participants.

RESULTS

The main facilitators were technology training with exposure, and the main barrier was fear of technology.

CONCLUSIONS

We describe how telephone-based training grounded in principles of cognitive rehabilitation can be used to remotely train older adults to use new technology and to help them maintain their community-based connections and engage in socialization.

CLINICAL IMPLICATIONS

Fear of technology during the pandemic can cause significant impairment in social functioning for older adults, at least when the only method for socialization is technology mediated such as during the COVID-19 pandemic. Empathically delivered remote training in an understanding manner can reduce fear and increase social and community connections in the era of physical distancing.

Age and sex trends in depressive symptoms across middle and older adulthood: Comparison of the Canadian Longitudinal Study on Aging to American and European cohorts

BACKGROUND

The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear.

METHODS

Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort.

RESULTS

Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60.

LIMITATIONS

Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts.

CONCLUSIONS

Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources.

Decreasing Social Isolation to Enhance Mental Health among Older Adults in China: A Mediation Analysis of Aging Attitude

A large body of literature has examined the relationship between social isolation and mental health in older adults. However, only a few studies have examined the mediating effects of aging attitudes on this relationship. This study investigated the impact of objective isolation (family isolation, friend isolation, and community isolation), and subjective social isolation (perceived isolation) on the mental health of Chinese older adults, and the mediating effect of aging attitudes. Mental health was assessed through depressive symptoms, using the Epidemiological Studies Depression Scale. The research sample comprising 7,024 elderly adults (60 years old), was obtained from the nationally representative 2014 Chinese Longitudinal Aging Social Survey. The regression analysis indicated that objective social isolation and subjective social isolation are independently related to mental health among older adults. Furthermore, in the mediation analysis, aging attitude was found to play a significant mediating role between social isolation and mental health. Our study concludes that though, objective and subjective social isolation are issues affecting mental health in older people, however, aging attitude also needs to be factored in that relationship as we have shown that there is a significant mediating effect.

Barriers in health and social care access and navigation for elder orphans: a scoping review protocol

INTRODUCTION

Family members have traditionally been relied on to provide informal care to older adults. However, social and demographic changes are resulting in rising numbers of kinless and isolated elderly who are unable to rely on familial caregiving and are without assistance in navigating complex systems of health and social services. Research examining this vulnerable subset of the elderly population, identified as elder orphans, is limited, particularly within the context of health and social care access. The aim of this scoping review is to map and report the evidence available in identifying barriers and facilitating factors in health and social care access and system navigation by elder orphans.

METHODS AND ANALYSIS

Arksey and O'Malley's six-staged methodology framework will guide the conduct of this scoping review. The primary author will conduct a systematic search and an initial screen of titles and abstracts from six electronic databases (CINAHL Complete, ASSIA, Pubmed, Scopus, Web of Science and PsycINFO) from January 2005 to the date of commencement, to identify English language peer reviewed studies of various methodologies. Subsequently, two reviewers will independently screen a shorter list of studies for inclusion. We will also search the reference lists of eligible studies. Data from the selected studies will be extracted and charted by two independent reviewers. Findings will be summarised in a tabulated format and accompanied by a narrative synthesis.

ETHICS AND DISSEMINATION

As the scoping review methodology aims to synthesise information from publicly available materials, this study does not require ethical approval. The finalised scoping review will be submitted for publication to a scientific journal.

REGISTRATION

The present protocol has been registered with the Open Science Framework platform (registration ID: https://osf.io/7vjty/).

COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22

One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first groups to experience restrictions on face-to-face contact. Although reducing viral transmission is critical, physical distancing is associated with negative psychosocial implications, such as increased rates of depression and anxiety. Promising evidence suggests that participatory digital co-design, defined as the combination of user-centered design and community engagement models, is associated with increased levels of engagement with mobile technologies among individuals with mental health conditions. The COVID-19 pandemic has highlighted shortcomings of existing technologies and challenges in their uptake and usage; however, strategies such as co-design may be leveraged to address these challenges both in the adaptation of existing technologies and the development of new technologies. By incorporating these strategies, it is hoped that we can offset some of the negative mental health implications for older adults in the context of physical distancing both during and beyond the current pandemic.

What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review

BACKGROUND AND AIM

The aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients.

METHODS

Medline, Embase, Web of Science and the grey literature were searched for papers from inception to 10 September 2020; the search was re-run in Medline up until the 9 December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively.

RESULTS

A total of 2,286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. In total, 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association.

CONCLUSIONS

Whilst the majority of studies have shown a positive association between COVID-19-related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness.

Exposure to multiple childhood social risk factors and adult body mass index trajectories from ages 20 to 64 years

BACKGROUND

While childhood social risk factors appear to be associated with adult obesity, it is unclear whether exposure to multiple childhood social risk factors is associated with accelerated weight gain during adulthood.

METHODS

We used the Medical Research Council National Survey of Health and Development, a British population-based birth cohort study of participants born in 1946, height and weight were measured by nurses at ages 36, 43, 53 and 60-64 and self-reported at 20 and 26 years. The 9 childhood socioeconomic risk factors and 8 binary childhood psychosocial risk factors were measured, with 13 prospectively measured at age 4 years (or at 7 or 11 years if missing) and 3 were recalled when participants were age 43. Multilevel modelling was used to examine the association between the number of childhood social risk factors and changes in body mass index (BMI) with age.

RESULTS

Increasing exposure to a higher number of childhood socioeconomic risk factors was associated with higher mean BMI across adulthood for both sexes and with a faster increase in BMI from 20 to 64 years, among women but not men. Associations remained after adjustment for adult social class. There was no evidence of an association between exposure to childhood psychosocial risk factors and mean BMI in either sex at any age.

CONCLUSIONS

Strategies for the prevention and management of weight gain across adulthood may need to tailor interventions in consideration of past exposure to multiple socioeconomic disadvantages experienced during childhood.

A systematic review of the latent structure of the Center for Epidemiologic Studies Depression Scale (CES-D) amongst adolescents

BACKGROUND

The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents.

METHODS

We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data.

RESULTS

Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia.

LIMITATIONS

Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure.

CONCLUSIONS

A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.

Spinal cord injury and aging: an exploration of the interrelatedness between key psychosocial factors contributing to the process of resilience

CONTEXT

Extant literature highlights how many individuals display resilient trajectories following spinal cord injury (SCI), exhibiting positive psychological adjustment. In the absence of a universal definition, it is agreed that resilience is demonstrated when individuals have better-than-projected outcomes when considering the level of adversity experienced. Previous research has focused on traits connected to vulnerability and maladaptive trajectories following SCI rather than the psychosocial factors that contribute to resilience, which can be cultivated over the lifetime. Individuals living with SCI are now aging and have lifespans paralleling that of the broader older adult population. Aging with SCI can result in a sequela of concomitant pathophysiologic conditions and social challenges, which can undermine resiliency.

OBJECTIVE

The purpose of the current commentary is to explore some of the psychosocial factors contributing to resilience within the context of aging with SCI.

METHODS

Commentary.

FINDINGS

Psychosocial factors contributing to resilience within the SCI population include self-efficacy, social supports, and spirituality. However, these factors are complex and their interconnectedness is not well-understood at the intersection of SCI and aging.

CONCLUSION

Understanding the complexities of the contributing psychosocial factors can allow for the development of targeted and innovative multi-pronged rehabilitative strategies that can support resilient trajectories across the lifetime. Future research should move towards the inclusion of additional psychosocial factors, adopting longitudinal research designs, and prudently selecting methods.

Digital Interventions for Depression and Anxiety in Older Adults: Protocol for a Systematic Review

Background

There is a high prevalence of older adults experiencing depression and anxiety. In response to heightened demands for mental health interventions that are accessible and affordable, there has been a recent rise in the number of digital mental health interventions (DMHIs) that have been developed and incorporated into mental health treatments. Digital interventions are promising in their ability to provide researchers, medical practitioners, and patients with personalized tools for assessing behavior, consultation, treatment, and care that can be used remotely. Reviews and meta-analyses have shown the benefits of DMHIs for the treatment and prevention of depression, anxiety, and other mental illnesses, but there is still a lack of studies that focus on the benefits and use of DMHIs in the older population.

Objective

The aim of this systematic review is to investigate the current evidence for the effect of technology-delivered interventions, such as smartphone/tablet applications, remote monitoring and tracking devices, and wearable technology, for the treatment and prevention of depression and anxiety in adults older than 50 years.

Methods

The academic databases SCOPUS, PsycINFO, AgeLine (EBSCO), and Medline (PubMed) will be searched from January 1, 2010, to the date of search commencement to provide a review of existing randomized controlled trial studies. The search will include 3 key concepts: “older adults,” “digital intervention,” and “depression/anxiety.” A set of inclusion criteria will be followed during screening by two reviewers. Data will be extracted to address aims and objectives of the review. The risk of bias for each study will be determined using appropriate tools. If possible, a random-effects meta-analysis will be performed, and the heterogeneity of effect sizes will be calculated.

Results

Preliminary searches were conducted in September 2020. The review is anticipated to be completed by April 2021.

Conclusions

The data accumulated in this systematic review will demonstrate the potential benefits of technology-delivered interventions for the treatment of depression and anxiety disorders in older adults. This review will also identify any gaps in current studies of aging and mental health interventions, thereby navigating a way to move forward and paving the path to more accessible and user-friendly digital health interventions for the diverse population of older adults.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020192532; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192532

International Registered Report Identifier (IRRID)

PRR1-10.2196/22738

Associations Between Physical Fitness and Brain Structure in Young Adulthood

A comprehensive analysis of associations between physical fitness and brain structure in young adulthood is lacking, and further, it is unclear the degree to which associations between physical fitness and brain health can be attributed to a common genetic pathway or to environmental factors that jointly influences physical fitness and brain health. This study examined genotype-confirmed monozygotic and dizygotic twins, along with non-twin full-siblings to estimate the contribution of genetic and environmental factors to variation within, and covariation between, physical fitness and brain structure. Participants were 1,065 young adults between the ages of 22 and 36 from open-access Young Adult Human Connectome Project (YA-HCP). Physical fitness was assessed by submaximal endurance (2-min walk test), grip strength, and body mass index. Brain structure was assessed using magnetic resonance imaging on a Siemens 3T customized 'Connectome Skyra' at Washington University in St. Louis, using a 32-channel Siemens head coil. Acquired T1-weighted images provided measures of cortical surface area and thickness, and subcortical volume following processing by the YA-HCP structural FreeSurfer pipeline. Diffusion weighted imaging was acquired to assess white matter tract integrity, as measured by fractional anisotropy, following processing by the YA-HCP diffusion pipeline and tensor fit. Following correction for multiple testing, body mass index was negatively associated with fractional anisotropy in various white matter regions of interest (all | z| statistics > 3.9) and positively associated with cortical thickness within the right superior parietal lobe (z statistic = 4.6). Performance-based measures of fitness (i.e., endurance and grip strength) were not associated with any structural neuroimaging markers. Behavioral genetic analysis suggested that heritability of white matter integrity varied by region, but consistently explained >50% of the phenotypic variation. Heritability of right superior parietal thickness was large (∼75% variation). Heritability of body mass index was also fairly large (∼60% variation). Generally, 1 2 to 2 3 of the correlation between brain structure and body mass index could be attributed to heritability effects. Overall, this study suggests that greater body mass index is associated with lower white matter integrity, which may be due to common genetic effects that impact body composition and white matter integrity.

Evidence-based umbrella review of 162 peripheral biomarkers for major mental disorders

The literature on non-genetic peripheral biomarkers for major mental disorders is broad, with conflicting results. An umbrella review of meta-analyses of non-genetic peripheral biomarkers for Alzheimer's disease, autism spectrum disorder, bipolar disorder (BD), major depressive disorder, and schizophrenia, including first-episode psychosis. We included meta-analyses that compared alterations in peripheral biomarkers between participants with mental disorders to controls (i.e., between-group meta-analyses) and that assessed biomarkers after treatment (i.e., within-group meta-analyses). Evidence for association was hierarchically graded using a priori defined criteria against several biases. The Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to investigate study quality. 1161 references were screened. 110 met inclusion criteria, relating to 359 meta-analytic estimates and 733,316 measurements, on 162 different biomarkers. Only two estimates met a priori defined criteria for convincing evidence (elevated awakening cortisol levels in euthymic BD participants relative to controls and decreased pyridoxal levels in participants with schizophrenia relative to controls). Of 42 estimates which met criteria for highly suggestive evidence only five biomarker aberrations occurred in more than one disorder. Only 15 meta-analyses had a power >0.8 to detect a small effect size, and most (81.9%) meta-analyses had high heterogeneity. Although some associations met criteria for either convincing or highly suggestive evidence, overall the vast literature of peripheral biomarkers for major mental disorders is affected by bias and is underpowered. No convincing evidence supported the existence of a trans-diagnostic biomarker. Adequately powered and methodologically sound future large collaborative studies are warranted.

A protocol for co-creating research project lay summaries with stakeholders: guideline development for Canada's AGE-WELL network

BACKGROUND

Funding bodies increasingly require researchers to write lay summaries to communicate projects' real-world relevance to the public in an accessible way. However, research proposals and findings are generally not easily readable or understandable by non-specialist readers. Many researchers find writing lay summaries difficult because they typically write for fellow subject specialists or academics rather than the general public or a non-specialist audience. The primary objective of our project is to develop guidelines for researchers in Canada's AGE-WELL Network of Centres of Excellence, and ultimately various other disciplines, sectors, and institutions, to co-create lay summaries of research projects with stakeholders. To begin, we produced a protocol for co-creating a lay summary based on workshops we organized and facilitated for an AGE-WELL researcher. This paper presents the lay summary co-creation protocol that AGE-WELL researchers will be invited to use.

METHODS

Eligible participants in this project will be 24 AgeTech project researchers who are funded by the AGE-WELL network in its Core Research Program 2020. If they agree to participate in this project, we will invite them to use our protocol to co-produce a lay summary of their respective projects with stakeholders. The protocol comprises six steps: Investigate principles of writing a good lay summary, identify the target readership, identify stakeholders to collaborate with, recruit the identified stakeholders to work on a lay summary, prepare for workshop sessions, and execute the sessions. To help participants through the process, we will provide them with a guide to developing an accessible, readable research lay summary, help them make decisions, and host, and facilitate if needed, their lay summary co-creation workshops.

DISCUSSION

Public-facing research outputs, including lay summaries, are increasingly important knowledge translation strategies to promote the impact of research on real-world issues. To produce lay summaries that include information that will interest a non-specialist readership and that are written in accessible language, stakeholder engagement is key. Furthermore, both researchers and stakeholders benefit by participating in the co-creation process. We hope the protocol helps researchers collaborate with stakeholders effectively to co-produce lay summaries that meet the needs of both the public and project funders.

Latent structure of the Centre for Epidemiologic Studies Depression Scale (CES-D) in older adult populations: a systematic review

Objective: The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item, self-report metric intended to measure depression. Despite being one of the most popular depression scales, the psychometric properties, specifically the underlying factor structure of the scale, have come under scrutiny. The latent structure of a scale is a key indicator of its construct validity, i.e. the degree to which the intended variable is captured. To date, a comprehensive review of the latent structure of the CES-D in older adult populations (≥65 years old) has not been conducted. We aimed to examine the latent structure of the CES-D in samples of older adults to assess its ability to capture depressive symptoms.Methods: A systematic review across Scopus, Web of Science, and PsycINFO databases was conducted. Original studies conducting latent variable analysis of the 20-item CES-D in samples aged ≥65 years old were included.Results: Included studies (n = 6) were primarily conducted with community-dwelling older adults in the United States. Studies that conducted exploratory and confirmatory factor analysis (n = 2) revealed two latent factors, whereas those conducting confirmatory factor analysis of previously identified structures (n = 4) revealed four-factor structures in line with the original four-factor structure.Conclusions: A general alignment with the original four-factor structure of the CES-D provides tentative support for continued use amongst older adults; however, further research is required to provide conclusive evidence for these psychometric properties.

Neuroimaging and analytical methods for studying the pathways from mild cognitive impairment to Alzheimer's disease: protocol for a rapid systematic review

BACKGROUND

Alzheimer's disease (AD) is a neurodegenerative disorder commonly associated with deficits of cognition and changes in behavior. Mild cognitive impairment (MCI) is the prodromal stage of AD that is defined by slight cognitive decline. Not all with MCI progress to AD dementia. Thus, the accurate prediction of progression to Alzheimer's, particularly in the stage of MCI could potentially offer developing treatments to delay or prevent the transition process. The objective of the present study is to investigate the most recent neuroimaging procedures in the domain of prediction of transition from MCI to AD dementia for clinical applications and to systematically discuss the machine learning techniques used for the prediction of MCI conversion.

METHODS

Electronic databases including PubMed, SCOPUS, and Web of Science will be searched from January 1, 2017, to the date of search commencement to provide a rapid review of the most recent studies that have investigated the prediction of conversion from MCI to Alzheimer's using neuroimaging modalities in randomized trial or observational studies. Two reviewers will screen full texts of included papers using predefined eligibility criteria. Studies will be included if addressed research on AD dementia and MCI, explained the results in a way that would be able to report the performance measures such as the accuracy, sensitivity, and specificity. Only studies addressed Alzheimer's type of dementia and its early-stage MCI using neuroimaging modalities will be included. We will exclude other forms of dementia such as vascular dementia, frontotemporal dementia, and Parkinson's disease. The risk of bias in individual studies will be appraised using an appropriate tool. If feasible, we will conduct a random effects meta-analysis. Sensitivity analyses will be conducted to explore the potential sources of heterogeneity.

DISCUSSION

The information gathered in our study will establish the extent of the evidence underlying the prediction of conversion to AD dementia from its early stage and will provide a rigorous and updated synthesis of neuroimaging modalities allied with the data analysis techniques used to measure the brain changes during the conversion process.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO,CRD42019133402.

A Future Research Agenda for Digital Geriatric Mental Healthcare

The proliferation of mobile, online, and remote monitoring technologies in digital geriatric mental health has the potential to lead to the next major breakthrough in mental health treatments. Unlike traditional mental health services, digital geriatric mental health has the benefit of serving a large number of older adults, and in many instances, does not rely on mental health clinics to offer real-time interventions. As technology increasingly becomes essential in the everyday lives of older adults with mental health conditions, these technologies will provide a fundamental service delivery strategy to support older adults' mental health recovery. Although ample research on digital geriatric mental health is available, fundamental gaps in the scientific literature still exist. To begin to address these gaps, we propose the following recommendations for a future research agenda: 1) additional proof-of-concept studies are needed; 2) integrating engineering principles in methodologically rigorous research may help science keep pace with technology; 3) studies are needed that identify implementation issues; 4) inclusivity of people with a lived experience of a mental health condition can offer valuable perspectives and new insights; and 5) formation of a workgroup specific for digital geriatric mental health to set standards and principles for research and practice. We propose prioritizing the advancement of digital geriatric mental health research in several areas that are of great public health significance, including 1) simultaneous and integrated treatment of physical health and mental health conditions; 2) effectiveness studies that explore diagnostics and treatment of social determinants of health such as "social isolation" and "loneliness;" and 3) tailoring the development and testing of innovative strategies to minority older adult populations.

Secular Trends in Dementia Prevalence and Incidence Worldwide: A Systematic Review

BACKGROUND

Time trends for dementia prevalence and incidence rates have been reported over the past seven decades in different countries and some have reported a decline.

OBJECTIVE

To undertake a systematic review to critically appraise and provide an evidence-based summary of the magnitude and direction of the global changes in dementia prevalence and incidence across time.

METHODS

Medline, EMBASE, and PsychINFO were searched for studies focused on secular trends in dementia prevalence and/or incidence until 18 December 2017. In total, 10,992 articles were identified and 43 retained.

RESULTS

Overall, prevalence rates are largely increasing (evidence primarily from record-based surveys and cohort studies in Japan, Canada, and France) or have remained stable (evidence primarily from cohort studies in Sweden, Spain and China). A significant decline in prevalence has however been reported in more recent studies (i.e., from 2010 onwards) from Europe (e.g., UK and Sweden) and the USA. Incidence rates have generally remained stable or decreased in China, Canada, France, Germany, Denmark, Sweden, the Netherlands, UK, and USA. An increase has only been reported in five countries: Italy, Japan, Wales, Germany, and the Netherlands. Only one study reported findings (stability in incidence) from a low and middle-income country using data from Nigeria.

CONCLUSIONS

The evidence on secular trends in the prevalence and incidence of dementia is mixed including contradictory findings using different (and in some cases the same) datasets in some countries (e.g., the USA, UK, and Sweden). This making it difficult to draw concrete conclusions. However, declining trends recently observed in some high-income Western countries in the most recent two decades including the UK, USA, and Sweden are encouraging. Updated dementia prevalence and incidence estimates will inform public health and financial planning as well as development of prevention strategies.

Conceptualising and operationalising resilience in older adults

Context: As a result of increases in life expectancy and decreases in fertility, the proportion of the population entering later life has increased dramatically in recent decades. When faced with age-related challenges, some older adults respond more positively to adversity than would be expected given the level of adversity that they have experienced, demonstrating 'resilience'. Objectives: Having a clear conceptual framework for resilience is a prerequisite to operationalising resilience in a research context. Methods: Here we compare and contrast several approaches to the operationalisation of resilience: psychometric-driven and data-driven (variable-centred and individual-centred) methods. Results: Psychometric-driven methods involve the administration of established questionnaires aimed at quantifying resilience. Data-driven techniques use statistical procedures to examine and/or operationalise resilience and can be broadly categorised into variable-centred methods, i.e. interaction and residuals, and individual-centred methods, i.e. categorical and latent class. Conclusions: The specific question(s) driving the research and the nature of the variables a researcher intends to use in their adversity-outcome dyad will largely dictate which methods are more (or less) appropriate in that circumstance. A measured approach to the ways in which resilience is investigated is warranted in order to facilitate the most useful application of this burgeoning field of research.

Factors across life associated with remaining free from functional limitations despite lifelong exposure to socioeconomic adversity

BACKGROUND

There are substantial socioeconomic inequalities in functional limitations in old age. Resilience may offer new insights into these inequalities by identifying constellations of factors that protect some individuals from developing functional limitations despite socioeconomic adversity.

METHODS

Data from 1973 participants in the Medical Research Council National Survey of Health and Development (Great Britain), followed from birth until age 60-64, were used. Functional limitations were defined as reporting difficulty with at least 1 of 16 activities at age 60-64. Lifetime socioeconomic adversity was based on socioeconomic trajectories, categorised into three adversity levels. Analysis of covariance and regression models were used to compare psychosocial factors and health-related behaviours between a 'Resilient' group (high adversity but no functional limitations) and five groups with other combinations of adversity and limitations.

RESULTS

Prevalence of functional limitations in high, intermediate and low adversity groups was 44%, 30% and 23% in men, and 61%, 55% and 49% in women, respectively. Compared with the other high adversity group, the resilient group had a lower prevalence of childhood illness (12% vs 19%) and obesity throughout ages 43-64 (70% vs 55%). Partially adjusted models also showed higher adolescent self-management, lower neuroticism, higher prevalence of volunteer work and physical activity (age 60-64) and lower prevalence of smoking (age 43) in the resilient. Marital status and contact frequency were not associated with resilience.

CONCLUSION

Results suggest protection against childhood illness, health-behavioural factors and self-regulation as targets for interventions across life that may particularly benefit those with long-term exposure to socioeconomic adversity.

Mobilizing mHealth Data Collection in Older Adults: Challenges and Opportunities

Worldwide, there is an unprecedented and ongoing expansion of both the proportion of older adults in society and innovations in digital technology. This rapidly increasing number of older adults is placing unprecedented demands on health care systems, warranting the development of new solutions. Although advancements in smart devices and wearables present novel methods for monitoring and improving the health of aging populations, older adults are currently the least likely age group to engage with such technologies. In this commentary, we critically examine the potential for technology-driven data collection and analysis mechanisms to improve our capacity to research, understand, and address the implications of an aging population. Alongside unprecedented opportunities to harness these technologies, there are equally unprecedented challenges. Notably, older adults may experience the first-level digital divide, that is, lack of access to technologies, and/or the second-level digital divide, that is, lack of use/skill, alongside issues with data input and analysis. To harness the benefits of these innovative approaches, we must first engage older adults in a meaningful manner and adjust the framework of smart devices to accommodate the unique physiological and psychological characteristics of the aging populace. Through an informed approach to the development of technologies with older adults, the field can leverage innovation to increase the quality and quantity of life for the expanding population of older adults.

Measurement instruments for quantifying physical resilience in aging: a scoping review protocol

BACKGROUND

Physical resilience is the ability to optimize or recover motor function in the face of disease, injury, or aging-related decline. Greater knowledge of how some individuals regain or maintain function despite pathology may help identify protective factors and approaches that promote healthy aging. To date, a scoping review on physical resilience has not been conducted. The aims are to (1) identify measurement instruments for physical resilience, (2) synthesize and map the key concepts of physical resilience, and (3) identify gaps and make recommendations for future research.

METHODS

A scoping review of Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Medline Ovid, PsycINFO, and AgeLine databases will take place using the search strategy "resilience" AND (aging OR elderly OR older adult). The initial electronic search will be supplemented by hand searching the reference lists and review articles to identify any missing studies. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. To meet study inclusion criteria, the term "resilience" must be applied in relation to the physical health of older adults. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Physical resilience information to be extracted are measurement instruments that describe the core domains of (1) body function or structure (signs or symptoms, etc.), (2) activity and participation (quality of life, etc.), and (3) societal impact. Tables and/or charts will map the data with distribution of studies by core domains. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results.

DISCUSSION

The information gleaned in this scoping review will be essential to understand how physical resilience is currently measured and identify gaps for further research.

Early-life adversity, later-life mental health, and resilience resources: a longitudinal population-based birth cohort analysis

ABSTRACTBackground:Robust and persistent links between early-life adversities and later-life mental distress have previously been observed. Individual and social resources are associated with greater mental health and resilience. This study aimed to test these resources as moderators and mediators of the association between childhood psychosocial adversity and later-life mental distress.

METHODS

Participant data came from the Medical Research Council National Survey of Health and Development, a nationally-representative birth cohort study. The General Health Questionnaire-28 (GHQ-28) captured mental distress at ages 53, 60-64, and 68-69. An eight-item cumulative psychosocial adversity score was created (0, 1, 2, ≥3 adversities). Individual (i.e., education, occupational status, physical activity) and social (i.e., social support, neighborhood cohesion) resources were examined as mediators and moderators of CPA and GHQ-28 in longitudinal multilevel models.

FINDINGS

Greater adversity was associated with an average GHQ-28 score increase of 0.017, per unit adversity (β = 0·017, p < 0·001, 95% CI 0·011, 0·022). Lower mental distress was associated with higher levels of physical activity, occupational status, education, social support, and neighborhood cohesion. There was no evidence that resources moderated the relationship between GHQ-28 and adversity. All resources, save for physical activity and occupational status, partly mediated this relationship.

CONCLUSIONS

Individual and social resources were associated with lower mental distress. They did not modify, but partly mediated the association between childhood adversity and adult mental distress. Social support was the most important mediator, suggesting that interventions to promote greater social support may offset psychosocial adversities experienced in childhood to foster better mental health in older adults.

Smartphones, Sensors, and Machine Learning to Advance Real-Time Prediction and Interventions for Suicide Prevention: a Review of Current Progress and Next Steps

PURPOSE OF REVIEW

As rates of suicide continue to rise, there is urgent need for innovative approaches to better understand, predict, and care for those at high risk of suicide. Numerous mobile and sensor technology solutions have already been proposed, are in development, or are already available today. This review seeks to assess their clinical evidence and help the reader understand the current state of the field.

RECENT FINDINGS

Advances in smartphone sensing, machine learning methods, and mobile apps directed towards reducing suicide offer promising evidence; however, most of these innovative approaches are still nascent. Further replication and validation of preliminary results is needed. Whereas numerous promising mobile and sensor technology based solutions for real time understanding, predicting, and caring for those at highest risk of suicide are being studied today, their clinical utility remains largely unproven. However, given both the rapid pace and vast scale of current research efforts, we expect clinicians will soon see useful and impactful digital tools for this space within the next 2 to 5 years.

Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions

PURPOSE OF REVIEW

This review aims to provide a comprehensive overview of the efficacy, limitations, and future of e-health treatments for anxiety. Within this, we provide detail on "first-generation" e-health approaches, such as computerized therapies. Additionally, we assess the emergence and early efficacy of newer methods of treatment delivery, including smartphone apps and virtual reality interventions, discussing the potential and pitfalls for each.

RECENT FINDINGS

There is now substantial clinical research demonstrating the efficacy of internet-delivered cognitive behavioral therapy in the treatment of anxiety. However, the ability of these interventions for engaging patients in "real-world" settings is unclear. Recently, smartphone apps for anxiety have presented a more popular and ubiquitous method of intervention delivery, although the evidence base supporting these newer approaches drastically falls behind the extensive marketing and commercialization efforts currently driving their development. Meanwhile, the increasing availability of novel technologies, such as "virtual reality" (VR), introduces further potential of e-health treatments for generalized anxiety and anxiety-related disorders such as phobias and obsessive compulsive disorder, while also creating additional challenges for research. Although still in its infancy, e-health research is already presenting several promising avenues for delivering effective and scalable treatments for anxiety. Nonetheless, several important steps must be taken in order for academic research to keep pace with continued technological advances.

Intergenerational social mobility and leisure-time physical activity in adulthood: a systematic review

Aim

To systematically review the association between intergenerational social mobility and leisure-time physical activity (LTPA) in adulthood, in order to assess all published evidence relating to the hypothesis that adults socially mobile between childhood and adulthood will have different levels of LTPA than those in the same socioeconomic group across life.

Methods

A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified by searching databases (MEDLINE, Embase, PsycINFO) and reference lists. Eligible studies examined associations between any indicator of social mobility, based on at least one measure of parental socioeconomic position (SEP) and one measure of own adult SEP, and LTPA in adulthood.

Results

13 studies comprising a total of 44 000 participants from the UK, Finland, Sweden, Australia, USA and Brazil were included. Participants were aged 16–70 years and were from population-based surveys, occupational cohorts and primary care registries. Most studies (n=9) used occupational class measures to identify social mobility; education (n=4) and income (n=1) were also used. There was consistent evidence in nine of the 13 studies that stable high socioeconomic groups tended to report the highest levels of participation in LTPA and stable low socioeconomic groups the lowest. Upward and downwardly mobile groups participated in LTPA at levels between these stable groups.

Conclusions

Cumulative exposure to higher SEP in childhood and adulthood was associated with higher LTPA in adulthood. Thus, a potential outcome of policies and interventions which aim to minimise exposure to socioeconomic adversity may be increased LTPA among adults.

Trial registration number

CRD42016036538.

A population study of the association between sleep disturbance and suicidal behaviour in people with mental illness

Limited representative research has considered the relationship between sleep disturbance and suicidal behaviour among people with mental illness. We investigated the relationship between sleep disturbance and suicidal behaviour across Part II interview of the National Comorbidity Survey Replication (NCSR). The associations between sleep disturbance and suicidal behaviour (thoughts, plans and attempts) were investigated using logistic and multinomial logistic regressions and stratified across six mental disorder groups (depression, anxiety, substance use disorders (SUD), eating disorders (ED), bipolar disorders (BD) and early life disorders). From 5701 participants (mean age 43.4 years 58% women), people with any mental disorder experiencing sleep disturbance were at increased odds of suicidal thoughts (odds ratio (OR): 2.5; 95% CI: 1.7, 3.6) and suicidal plans and attempts (OR: 5.7; 95% CI: 2.7, 11.9) adjusting for age, sex and income. People with BD (OR: 8.9; 95 CI: 2.1, 38.1), early life disorders (OR 6.98, 95% ci 2.48, 19.67), depression (OR 1.88, 95% CI 1.14, 3.11), anxiety (OR 1.90, 95% CI 1.28, 2.85) and SUD (2.60, 95% CI 1.23, 5.49) but not ED, were at increased odds of suicidal thoughts in the presence of sleep disturbance. Adjusting for anti-depressant intake attenuated the effect sizes by up to 20% but the associations remained significant. In conclusion, sleep disturbance is a potential risk factor for suicidal behaviours in people with mental illness. Monitoring and management of sleep disturbance in clinical practice might be an important strategy to mitigate suicidal behaviours in people with mental illness.

Operationalising resilience in longitudinal studies: a systematic review of methodological approaches

Over the life course, we are invariably faced with some form of adversity. The process of positively adapting to adverse events is known as ‘resilience’. Despite the acknowledgement of 2 common components of resilience, that is, adversity and positive adaptation, no consensus operational definition has been agreed. Resilience operationalisations have been reviewed in a cross-sectional context; however, a review of longitudinal methods of operationalising resilience has not been conducted. The present study conducts a systematic review across Scopus and Web of Science capturing studies of ageing that posited operational definitions of resilience in longitudinal studies of ageing. Thirty-six studies met inclusion criteria. Non-acute events, for example, cancer, were the most common form of adversity identified and psychological components, for example, the absence of depression, the most common forms of positive adaptation. Of the included studies, 4 used psychometrically driven methods, that is, repeated administration of established resilience metrics, 9 used definition-driven methods, that is, a priori establishment of resilience components and criteria, and 23 used data-driven methods, that is, techniques that identify resilient individuals using latent variable models. Acknowledging the strengths and limitations of each operationalisation is integral to the appropriate application of these methods to life course and longitudinal resilience research.