Loneliness in mid-life and older adults from ethnic minority communities in England and Wales: measure validation and prevalence estimates.

We investigated the prevalence of loneliness among 1206 adults aged 40 + from six minority communities in England and Wales: Black Caribbean, Black African, Indian, Pakistani, Bangladeshi and Chinese. Replicating the approach from the previous studies, we demonstrate robust acceptability, reliability and validity for both the six-item De Jong Gierveld (DJG) and single-item loneliness scales in our six ethnic groups. The prevalence of loneliness using a single-item question (loneliness reported as often/always) ranges from 5% (Indian) to 14% (Chinese) compared with approximately 5% for the general population aged 40 + in Britain. Levels of loneliness are very much higher using the DJG scale. Using a loneliness threshold score of 5 +, the percentage ranged from 13% (Indian) to 36% (Chinese). We explored the importance of six established loneliness vulnerability factors for our sample using regression modelling. Three factors were not associated with loneliness-number of children, gender and health rating, and three factors were protective: younger age, being married and low financial strain. The addition of ethnicity did not change these relationships or enhance statistical power of our models. Being a member of the African Caribbean group was protective against loneliness but not for the other groups included in our study. We suggest that exposure to loneliness vulnerability factors rather than ethnicity per se or measurement artefact underpins differences in loneliness across ethnic groups.

Health and social care practitioners' understanding of the problems of people with dementia-related visual processing impairment.

It has been highlighted that health and social care staff need a greater awareness of the needs and problems of those people with young onset dementia in the UK. Symptoms of Alzheimer's disease are relatively well known (memory loss, disorientation, language difficulties and behavioural problems). However, there is less awareness of dementia-related visual processing impairments in Alzheimer's disease, Dementia with Lewy Bodies or rarer dementia syndromes such as posterior cortical atrophy (PCA), leading to delayed assessment, diagnosis and management. This qualitative study explored health and social care practitioners' opinions of the needs of people with dementia-related visual processing impairment (such as individuals with PCA) and identify any training that these practitioners might need. Social workers, occupational therapists, care home staff, rehabilitation workers (visual impairment), optometrists and admiral nurses participated in focus groups or one-to-one semi-structured interviews. All participants were shown video clips of people with dementia-related visual impairment to facilitate discussion. Sixty-one participants took part in focus groups or interviews between November 2014 and December 2015. Participants' experiences and understanding of dementia were explored and thematic analysis of the data identified two major themes. Theme 1 explores participants' understanding of dementia-related visual impairments. Theme 2 recounts how participants address and support people with dementia-related visual impairment and their families. Participants discussed, reflected and critically analysed the video clips during data collection. Most considered new perspectives of their own clients' difficulties and those participants working with people with rarer dementias consolidated their experiences. However, some participants seemed hesitant to accept the existence of visual processing impairment arising due to dementia, rationalising novel information to existing understanding of memory loss or behavioural problems. This study highlights that health and social care practitioners want more training and better understanding of less well-recognised symptoms of dementia and rarer syndromes (including PCA) to ensure appropriate, evidence-based assessment and intervention.

'Because my brain isn't as active as it should be, my eyes don't always see': a qualitative exploration of the stress process for those living with posterior cortical atrophy.

OBJECTIVES: To explore the stress process for individuals living with posterior cortical atrophy (PCA) and their families. DESIGN: A qualitative study using in-depth semi-structured dyadic and individual interviews with people living with a diagnosis of PCA and a family carer. Interview transcripts were thematically analysed. SETTING: Participants' homes. PARTICIPANTS: 20 individuals in the mild to moderate stages of PCA and 20 family carers. FINDINGS: Three major themes were identified: (1) the diagnostic journey: mostly an unsettling and convoluted process, owing to the early age of onset, rarity and atypical symptom profile of PCA. (2) Interactions with the physical environment: profound difficulties with functional and leisure activities were usually compensated for with adaptations maximising familiarity or simplicity. (3) Implications within the psychosocial environment: symptoms impacted individuals' sense of independence and identity and required reallocations of roles and responsibilities. Ongoing uncertainties and the progressive nature of PCA caused most dyads to take a 'one day at a time' approach to coping. Relatively well-preserved insight and memory were a benefit and burden, as individuals shared the illness experience with family members and also compared their current situation to pre-diagnosis. The experience was framed by background and contextual factors and understood within an ever-changing temporal context. CONCLUSION: The stress process in PCA is characterised by uncertainty and unpredictability from diagnosis through to ongoing management. The provision of tailored information about cortical visual problems and associated functional difficulties, time-sensitive environmental adaptations to help those with PCA to identify what and where things are and psychosocial interventions for the marital/family unit as a whole would be useful to improve both functional status and psychological well-being. Future research exploring (1) stress and coping in the later stages of PCA and (2) the nature and impact of visual impairment(s) in typical Alzheimer's disease would be worthwhile.

Incubation and Intuition in Creative Problem Solving.

Creative problem solving, in which novel solutions are required, has often been seen as involving a special role for unconscious processes (Unconscious Work) which can lead to sudden intuitive solutions (insights) when a problem is set aside during incubation periods. This notion of Unconscious Work during incubation periods is supported by a review of experimental studies and particularly by studies using the Immediate Incubation paradigm. Other explanations for incubation effects, in terms of Intermittent Work or Beneficial Forgetting are considered. Some recent studies of divergent thinking, using the Alternative Uses task, carried out in my laboratory regarding Immediate vs. Delayed Incubation and the effects of resource competition from interpolated activities are discussed. These studies supported a role for Unconscious Work as against Intermittent Conscious work or Beneficial Forgetting in incubation.

Identifying and enhancing risk thresholds in the detection of elder financial abuse: a signal detection analysis of professionals' decision making.

BACKGROUND: Financial abuse of elders is an under acknowledged problem and professionals' judgements contribute to both the prevalence of abuse and the ability to prevent and intervene. In the absence of a definitive "gold standard" for the judgement, it is desirable to try and bring novice professionals' judgemental risk thresholds to the level of competent professionals as quickly and effectively as possible. This study aimed to test if a training intervention was able to bring novices' risk thresholds for financial abuse in line with expert opinion. METHODS: A signal detection analysis, within a randomised controlled trial of an educational intervention, was undertaken to examine the effect on the ability of novices to efficiently detect financial abuse. Novices (n = 154) and experts (n = 33) judged "certainty of risk" across 43 scenarios; whether a scenario constituted a case of financial abuse or not was a function of expert opinion. Novices (n = 154) were randomised to receive either an on-line educational intervention to improve financial abuse detection (n = 78) or a control group (no on-line educational intervention, n = 76). Both groups examined 28 scenarios of abuse (11 "signal" scenarios of risk and 17 "noise" scenarios of no risk). After the intervention group had received the on-line training, both groups then examined 15 further scenarios (5 "signal" and 10 "noise" scenarios). RESULTS: Experts were more certain than the novices, pre (Mean 70.61 vs. 58.04) and post intervention (Mean 70.84 vs. 63.04); and more consistent. The intervention group (mean 64.64) were more certain of abuse post-intervention than the control group (mean 61.41, p = 0.02). Signal detection analysis of sensitivity (A´) and bias (C) revealed that this was due to the intervention shifting the novices' tendency towards saying "at risk" (C post intervention -.34) and away from their pre intervention levels of bias (C-.12). Receiver operating curves revealed more efficient judgments in the intervention group. CONCLUSION: An educational intervention can improve judgements of financial abuse amongst novice professionals.

Influence of a walking aid on temporal and spatial parameters of gait in healthy adults.

OBJECTIVE: To determine the effect of using a walking aid on temporal and spatial parameters of gait when used for balance versus support on the dominant and nondominant hand side. DESIGN: Repeated measures observational study design. SETTING: University gymnasium. PARTICIPANTS: Twenty-seven healthy male and female adults of mean ± standard deviation age 44.74 ± 10.00 years. METHODS: Five walking conditions (C) were completed by all participants on the GAITRite pressure mat. Normal walking (C1), walking with a cane in the dominant hand (C2) and nondominant hand (C3) as if using for balance, walking with a cane in the dominant hand (C4) and nondominant hand (C5) while allowing approximately 10% of the body weight through the cane. MAIN OUTCOME MEASUREMENTS: Temporal measurements (swing time, stance time, single limb support time, double limb support time) as percentage of a gait cycle and the base of support for the left and the right foot for all 5 walking conditions. RESULTS: A significant difference (P < .001) was observed between C1, C2, and C3 in percentage swing time and percentage stance time of the ipsilateral side, and in percentage single limb support time of the contralateral side. The double limb support time was significantly different (P ≤ .04) for both ipsilateral and contralateral sides. Comparisons among C1, C4, and C5 demonstrated significance (P < .001) for all variables. Post hoc analysis showed significance between C1 and C4, and C1 and C5 for all variables except percentage stance time of the ipsilateral side and percentage single limb support of the contralateral side. CONCLUSIONS: In healthy adults, use of a cane for balance modifies swing and stance parameters of the ipsilateral side and does not affect the base of support formed by the feet. When used for support, the cane alters the swing and stance parameters, and also the base of support formed by the feet.

Factors influencing decision-making by social care and health sector professionals in cases of elder financial abuse.

This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals' certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person's mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person's mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.

Effectiveness of a decision-training aid on referral prioritization capacity: a randomized controlled trial.

BACKGROUND: In the community mental health field, occupational therapy students lack the capacity to prioritize referrals effectively. OBJECTIVE: The purpose of this study was to test the effectiveness of a clinical decision-training aid on referral prioritization capacity. DESIGN: A double-blind, parallel-group, randomized controlled trial was conducted using a judgment analysis approach. SETTING: Each participant used the World Wide Web to prioritize referral sets at baseline, immediate posttest, and 2-wk follow-up. The intervention group was provided with training after baseline testing; control group was purely given instructions to continue with the task. PARTICIPANTS: One hundred sixty-five students were randomly allocated to intervention (n = 87) or control (n = 81). Intervention. Written and graphical descriptions were given of an expert consensus standard explaining how referral information should be used to prioritize referrals. MEASUREMENTS: Participants' prioritization ratings were correlated with the experts' ratings of the same referrals at each stage of testing, as well as to examine the effect on mean group scores, regression weights, and the lens model indices. RESULTS: At baseline, no differences were found between control and intervention on rating capacity or demographic characteristics. Comparison of the difference in mean correlation baseline scores of the control and intervention group compared with immediate posttest showed a statistically significant result that was maintained at 2-wk follow-up. The effect size was classified as large. At immediate posttest and follow-up, the intervention group improved rating capacity, whereas the control group's capacity remained poor. The results of this study indicate that the decision-training aid has a positive effect on referral prioritization capacity. CONCLUSIONS: This freely available, Web-based decision-training aid will be a valuable adjunct to the education of these novice health professionals internationally.

Don't wait to incubate: immediate versus delayed incubation in divergent thinking.

Previous evidence for the effectiveness of immediate incubation in divergent creative tasks has been weak, because earlier studies exhibited a range of methodological problems. This issue is theoretically important, as a demonstration of the effects of immediate incubation would strengthen the case for the involvement of unconscious work in incubation effects. For the present experiment, we used a creative divergent-thinking task (alternative uses) in which separate experimental groups had incubation periods that were either delayed or immediate and that consisted of either spatial or verbal tasks. Control groups were tested without incubation periods, and we carried out checks for intermittent conscious work on the target task during the incubation periods. The results showed significant incubation effects that were stronger for immediate than for delayed incubation. Performance was not different between the verbal and spatial incubation conditions, and we found no evidence for intermittent conscious working during the incubation periods. These results support a role for unconscious work in creative divergent thinking, particularly in the case of immediate incubation.

Creativity and ease of ambiguous figural reversal.

Two studies examined the relationships between self-rated and objectively measured creative ability and ease of perceiving alternative interpretations of the ambiguous Duck-Rabbit figure. The studies found empirical support for what has previously been a largely analogical connection between figural reversal and creativity, using both self-rated trait creativity and objectively scored creative productivity. We discuss the hypothesis that executive functioning is the likely common cognitive factor linking perception of ambiguous figures and creative ability.

Occupational therapists' self-insight into their referral prioritisation policies for clients with mental health needs.

BACKGROUND/AIM: Obtaining valid accounts of professionals' thinking is dependent upon experts' capacity for self-insight. Self-insight has implications for developing professional decision making, facilitating education and promoting agreement among therapists. The aim of this study was to examine occupational therapists' self-insight into their referral prioritisation policies. METHODS: A total of 40 occupational therapists individually rated the importance that differing types of referral content had on their prioritisation of referrals. These subjective policies were then correlated with their objective referral prioritisation policies that had been previously statistically derived. RESULTS: Self-insight was found to be moderate but with wide variation across individuals and across referral information used. Self-insight on cues that were important to the decision was found to be better than on those cues not so important to the decision. CONCLUSIONS: Occupational therapists have similar levels of self-insight to other professional groups. The 'attention hypothesis' may explain why self-insight varied across referral information used.