Mental Health for LGBTQIA+ Older Adults.

LGBTQIA+ older adults share a unique set of risk factors that impact mental health. This article provides an overview of the minority stress and allostatic load models and how they can lead to worse physical and mental health outcomes. The article also describes unique epidemiologic and psychosocial context for various aspects of mental health among LGBTQIA+ older adults. Within each section are suggestions for health care providers when addressing these mental health issues and caring for LGBTQIA+ older adults in all settings.

Celecoxib or naproxen treatment does not benefit depressive symptoms in persons age 70 and older: findings from a randomized controlled trial.

BACKGROUND: Several lines of evidence suggest that inflammatory mechanisms may be involved in the severity and progression of depression. One pathway implicated is the production of prostaglandins via the enzyme cyclooxygenase (COX). Although late-life depression in particular has been associated with inflammation, we know of no published studies using COX inhibitors, such as nonsteroidal anti-inflammatory drugs (NSAIDs), in the treatment of depressive syndromes in this population. OBJECTIVE: To evaluate the effect of the NSAIDs celecoxib and naproxen on depressive symptoms in older adults. METHODS: The Alzheimer's Disease Anti-inflammatory Prevention Trial was a randomized, placebo-controlled, double-masked clinical trial conducted at six U.S. memory clinics. Cognitively normal volunteers age 70 and older with a family history of Alzheimer-like dementia were randomly assigned to receive celecoxib 200 mg twice daily, naproxen sodium 220 mg twice daily, or placebo. The 30-item version of the Geriatric Depression Scale (GDS) was administered to all participants at enrollment and at yearly follow-up visits. Participants with a GDS score greater than 5 at baseline were classified as depressed. RESULTS: Of 2,528 participants enrolled, 2,312 returned for at least one follow-up visit. Approximately one-fifth had significant depressive symptoms at baseline. Mean GDS score, and the percentage with significant depressive symptoms, remained similar over time across all three treatment groups. Furthermore, there was no treatment effect on GDS scores over time in the subgroup of participants with significant depressive symptoms at baseline. In longitudinal analysis using generalized estimating equations (GEE) regression, higher baseline GDS scores, a prior psychiatric history, older age, time in the study, and lower cognition interacting with time, but not treatment assignment, were associated with significantly higher GDS scores over time. CONCLUSION: Treatment with celecoxib or naproxen did not improve depressive symptoms over time compared with placebo. While inflammation has been implicated in late-life depression, these results do not support the hypothesis that inhibition of the COX pathway with these NSAIDs at these doses alleviates depressive symptoms in older adults.

A study of geriatric forensic evaluees: who are the violent elderly?

The objective of this study was to examine a sample (n = 99) of elderly forensic evaluees to describe the psychiatric, medical, legal, and demographic characteristics of the sample and to examine which of these factors is associated with violent charges. Clinical data were gathered through retrospective chart review of patients aged 60 and over who were referred for criminal responsibility/competency-to-stand-trial evaluations from 1991 to 1998 at William S. Hall Psychiatric Institute in Columbia, South Carolina. Most (67.7%) of the sample was alcohol dependent, nearly one half (44.4%) had dementia, and close to one third (32.3%) had antisocial personality disorder. The majority of patients (60.6%) were facing violent charges and most (80.8%) were recidivists. In multivariate analysis, race, outpatient treatment status, crime location, and paranoia were all associated with violent charges. The implications and limitations of these data as applied to forensic treatment settings are discussed.