Longitudinal effects of ambivalent and guilt feelings on dementia family caregivers' depressive symptoms.

BACKGROUND: The world prevalence of people with dementia is increasing. Most of the care received by people with dementia is provided by family caregivers, and this prolonged activity has a significant impact on caregivers' levels of depression. Stressors and frequency of leisure are known predictors of caregivers' depressive levels. The longitudinal impact of caregivers' ambivalent and guilt feelings is unknown. METHODS: Participants were 177 family caregivers of relatives with dementia who were assessed three times during a 2-year period. In addition to demographic variables, psychological symptoms of the dementias, and frequency of leisure activities, caregivers' ambivalent feelings, guilt, and depressive symptoms were measured. The longitudinal association of changes in these variables with changes in caregivers' depressive symptoms over time was assessed using mixed linear models. RESULTS: Changes over time in the assessed variables predicted 48.05% of variance of changes over time in depressive symptoms. Even when variables strongly associated with increased depressive symptoms were controlled (lower caregivers' age and educational level, higher reaction to BPSD, and lower leisure activities), increases in ambivalence and guilt contributed to an increase of 9.22% of the variance of changes depressive symptoms over a 2-year period. The effects of ambivalent feelings on depression are indirect, mediated by guilt feelings. Cessation of caregiving do not seem to alter these findings. CONCLUSIONS: Caregivers' ambivalent and guilt feelings are significant predictors of caregivers' mental health. Caregivers may significantly benefit from early detection of ambivalent and guilt feelings and preventive strategies targeting triggers associated with ambivalent and guilt symptoms.

Spanish adaptation of the Gender-Related Variables for Health Research (GVHR): Factorial Structure and Relationship with Health Variables.

The aim of the present study was to conduct a preliminary study of the Stanford Gender-Related Variables for Health Research (GVHR) adapted to the Spanish population, testing its factor structure, sex factorial invariance and relationship with health variables. Participants were 438 adults between 19-73 years old (M = 31.90, SD = 12.12) who completed the GVHR and measures of health-related quality of life, psychological health, and health-risk behaviors. The confirmatory factorial analysis of the GVHR indicated an acceptable fit to the 7-factor structure as proposed for the North American population. Emotional intelligence and independence factors had low internal consistency, therefore, a five-factor model was tenable in the Spanish population. Sex scalar invariance was tenable, indicating that the factors latent means can be meaningfully compared across sex. Univariate logistic regressions indicated that women reported worse mental and physical health and more health limitations, but this effect dissipated when gender variables were considered. Caregiver and work strain stood out as the variables related to gender that predicted worse health-related quality of life, psychological health, and health-risk behaviors. In conclusion, factorial structure of the GVHR may differ from one culture to another. Additionally, the variables related to gender in the GVHR give a better account of the differences in health compared to biological sex.

Spanish adaptation of the Gender-Related Variables for Health Research (GVHR): Factorial Structure and Relationship with Health Variables

The aim of the present study was to conduct a preliminary study of the Stanford Gender-Related Variables for Health Research (GVHR) adapted to the Spanish population, testing its factor structure, sex factorial invariance and relationship with health variables. Participants were 438 adults between 19–73 years old (M = 31.90, SD = 12.12) who completed the GVHR and measures of health-related quality of life, psychological health, and health-risk behaviors. The confirmatory factorial analysis of the GVHR indicated an acceptable fit to the 7-factor structure as proposed for the North American population. Emotional intelligence and independence factors had low internal consistency, therefore, a five-factor model was tenable in the Spanish population. Sex scalar invariance was tenable, indicating that the factors latent means can be meaningfully compared across sex. Univariate logistic regressions indicated that women reported worse mental and physical health and more health limitations, but this effect dissipated when gender variables were considered. Caregiver and work strain stood out as the variables related to gender that predicted worse health-related quality of life, psychological health, and health-risk behaviors. In conclusion, factorial structure of the GVHR may differ from one culture to another. Additionally, the variables related to gender in the GVHR give a better account of the differences in health compared to biological sex. (AU)

A meta-analysis of cognitive interventions for patients with recent onset psychosis: are they effective for improving functioning?

The increasing popularity of cognitive interventions for patients with psychosis calls for further exploration on how these interventions may benefit functional outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of cognitive interventions (i.e. Cognitive Remediation, Cognitive Training, Social Cognition, and their combination) on functioning of patients with recent onset psychosis, established as the period within the first five years from the first episode. The following databases were searched: Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus for research published until January 2022. In total, 12 studies were eligible. The total number of participants was 759, of which 32.2% in the intervention and 30.8% in the control group were female. We extracted data to calculate the standardized mean change from pre-test to post-test comparing the intervention with the control conditions. Overall, there was no effect of any of the cognitive intervention types on functioning. None of the examined factors (intervention type, length, and modality; control condition, follow-up time; cognitive functions; medication; symptoms) seemed to moderate these findings. Our results indicate that cognitive interventions as standalone interventions do not appear to improve functioning in patients with recent onset psychosis. Given the small number of eligible studies, further RCTs with larger and more refined samples are needed to test whether these interventions should be applied as single interventions with these patients.

To be happy and behave in a healthier way. A longitudinal study about gender differences in the older population.

INTRODUCTION: Subjective well-being plays a key role in health. The objectives of this study are to analyse the longitudinal associations between subjective well-being dimensions and healthy behaviours, and to examine gender differences. METHOD: A representative sample of 1,190 Spanish non-institutionalised adults aged 50+ were interviewed over a 6-year follow-up period. The Cantril scale was used to measure evaluative well-being. The Day Reconstruction Method measured experienced well-being. The Global Physical Activity Questionnaire was used, whereas fruit and vegetables, tobacco and alcohol consumption, and sleep quality were self-reported. The Generalised Estimating Equation was calculated. RESULTS: Women show significantly worse subjective well-being than men longitudinally. Higher scores in life satisfaction and positive affect were significantly related to a higher level of physical activity and better-quality sleep for both women and men. Associations between a higher life satisfaction and an adequate intake of fruits and vegetables and being a non-smoker was only found in women (OR = 1.05; 95% IC = 1.00, 1.10 and OR = 1.16; 95% IC = 1.09, 1.23, respectively). CONCLUSION: Subjective well-being levels and frequencies in healthy behaviours are different in women and men. Subjective well-being interventions should take into account these differences in the frequency of healthy-unhealthy behaviours.

Medical conditions and depressive symptoms: A study of kinship profiles in dementia caregivers.

OBJECTIVE: To analyze the association between diverse medical conditions and depressive symptoms in different profiles of dementia caregivers based on sex and kinship (wives, husbands, daughters, and sons). METHODS: Individual interviews were conducted with 338 dementia family caregivers. Depressive symptoms were measured with the Spanish version of the Center for Epidemiologic Studies-Depression Scale. Medical conditions encompassed the following physical diseases: high cholesterol, osteoarthritis, hypertension, diabetes, cancer, and cardiovascular, brain, kidney, liver, and stomach diseases.Logistic regression analyses were carried out to identify determinants associated to thepresenceof depressive symptoms. RESULTS: High cholesterol was the most frequent disease among caregivers.Significant differences among groups were found in depressive symptoms: between wives (50.60%) and husbands (28.40%),(p = 0.033), and between daughters (57.00%) and husbands (p = 0.001). Half of the sonsreported thepresenceof depressive symptoms. In daughters, depressive symptomatology was significantly more likely whether they presented a worse reaction to disruptive behaviors, a poor assessment of global deterioration of care recipient, and less perceived health status. Furthermore, daughters were 1.94 times more likely to experience depressive symptoms if they presented medical conditions (p = 0.017). CONCLUSIONS: Daughter caregivers that have depressive and physical diseases may be an especially vulnerable subgroup of caregivers that may not be the ideal population to provide care. Access to high-quality, evidence-based therapies focused on improving caregivers' physical health could have a positiveeffecton thepresenceof depressive symptoms, particularly in the case of daughter caregivers.

Is there a combined effect of depression and cognitive reserve on cognitive function? Findings from a population-based study.

OBJECTIVE: To analyse the combined effect of depression and cognitive reserve (CR) on cognition over a three-year follow-up period; and to explore this relationship specifically in individuals aged 65+ years. DESIGN: Data from the 'Edad con Salud' project were analysed (n = 1,144; 50+ years). MAIN OUTCOME MEASURES: The Composite International Diagnostic Interview was used to evaluate depression. CR was assessed with the Cognitive Reserve Questionnaire. Episodic memory was assessed with the word list memory and recall. Verbal fluency was measured through the animal naming task. Random coefficient regression analyses were performed. RESULTS: Depression was associated with lower scores in episodic memory, whereas increased levels of CR were related with higher scores across all the cognitive tests. Among older-aged individuals, cognition decreased at lower levels of CR regardless of depression, while participants with depression exhibited decreased values in both measures of memory at higher levels of CR. CONCLUSION: Depression and CR were related with cognitive performance. Among older individuals, those with low levels of CR may constitute a vulnerable group with poor cognitive prognosis, whilst a harmful effect of depression on memory performance was observed among individuals with greater CR. Further evidence needs to be gathered to understand these associations.

Instruments to evaluate mental well-being in old age: a systematic review.

OBJECTIVE: The aim of this study is to identify and appraise existing instruments to evaluate mental well-being in old age. METHOD: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell'Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL). CONCLUSION: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.

Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study.

OBJECTIVES: The number of older adults is rapidly rising globally. Loneliness is a common problem that can deteriorate health. The aims of this work were to identify different types of loneliness (transient and chronic) and to assess their association with depression over time. METHODS: A nationally representative sample from the Spanish population comprising 1190 individuals aged 50+ years was interviewed on three evaluations over a 7-year period. The UCLA Loneliness Scale was used to measure loneliness. While chronic loneliness was defined as the presence of loneliness across all three waves, transient loneliness expressed the presence of loneliness in one wave only. A 12-month major depressive episode was assessed at each interview. After confirming the cross-sectional relationship, a multilevel mixed-effects model was used to examine the association between loneliness and depression. RESULTS: Almost a quarter of individuals felt lonely and one out of 10 presented depression at baseline. Of the sample, 22.78% showed transient loneliness, while 6.72% presented the chronic type. People experiencing chronic loneliness were at a higher risk of presenting major depression (OR = 6.11; 95% CI = 2.62, 14.22) than those presenting transient loneliness (OR = 2.22; 95% CI = 1.19, 4.14). This association varied over time and was stronger at the first follow-up than at the second one. CONCLUSIONS: Focusing on loneliness prevention could reduce the risk of depression. Chronic loneliness is a public health problem that should be addressed through the full participation of the political, social, and medical sectors.

Exploring the effect of loneliness on all-cause mortality: Are there differences between older adults and younger and middle-aged adults?

OBJECTIVE: This study aims to investigate the association between loneliness and all-cause mortality over a six-year follow-up period using the overall sample and by age groups (18-59 years and 60+ years). METHOD: Data from a longitudinal, prospective study of a nationally-representative sample of the Spanish non-institutionalized adult population were analysed (n = 4467). Mortality was ascertained via linkage to the National Death Index or obtained during the household visits. The UCLA Loneliness Scale was used to measure loneliness. Sex, age, education, physical activity, tobacco consumption, body mass index, disability, depression, living situation, and social participation were also considered as covariates. Multivariable Cox proportional hazard models were carried out. RESULTS: A higher level of loneliness was not associated with mortality risk in fully covariate-adjusted models over the entire population (HR = 1.02; 95% CI = 0.94, 1.12). The interaction term between loneliness and age groups was significant, indicating that the rate for survival of loneliness varied by age (HR = 1.29; 95% CI = 1.02, 1.63 for young- and middle-aged individuals; HR = 0.96; 95% CI = 0.89, 1.04 for older adults). CONCLUSIONS: The development of interventions aimed at tackling loneliness among young- and middle-aged adults might contribute to a mortality risk reduction. Future research is warranted to test whether our results can be replicated.

Trajectories of Immediate and Delayed Verbal Memory in the Spanish General Population of Middle-aged and Older Adults.

(1) Cognitive decline differs among individuals and cognition function domains. We sought to identify distinct groups of immediate and delayed verbal memory in two age subsamples (50-64, 65+ years), and to analyze associated factors. (2) Latent class mixed models were used to identify verbal memory trajectories in a sample of Spanish community-dwelling individuals over 8 years' follow up. Chi-square and Kruskal-Wallis tests were used to assess differences among trajectories. (3) Different trajectories were identified. In the case of immediate verbal memory, these were: very low/decline (6.3%), low/stable (38.2%), medium/slow decline (43.4%), and high/slow decline (12.2%) in the middle-aged group, and low/decline (20.4%), medium/slow decline (60.4%), and high/slow decline (19.2%) in the older subsample. In delayed verbal memory, more distinct patterns were found: very low/decline (12.4%), low/stable (51.4%), medium/accelerated decline (24.7%), and high/slow increase (11.4%) in the younger group, and low/slow decline (34.4%), medium/decline (52.7%), and high/slow decline (12.9%) in the older group. (4) Overall, low initial performance and decline were associated with older age, lower education, and higher diabetes/stroke prevalence. Differences found suggests heterogeneity in cognitive ageing. The high prevalence of cardiovascular diseases in those with worse cognition suggests that early interventions to prevent those conditions should be targeted in midlife to delay cognitive decline.

Mental well-being among the oldest old: revisiting the model of healthy ageing in a Finnish context.

Purpose: This study aimed to examine how participants aged 80 years old or over describe their mental well-being-exploring the suitability of the model of healthy ageing when outlining the mental well-being concept.Methods: Six structured focus group interviews with 28 participants were conducted in Western Finland in 2017. Qualitative content analysis was performed, where both manifest and latent content was considered in a process involving meaning condensation and coding, followed by categorization.Results: The healthy ageing model constituted a useful framework for the conceptualization of mental well-being, illustrating the links between these two constructs. The analysis resulted in a four-dimensional model of mental well-being in oldest old age, the key components being: Activities-enjoyment and fulfilment; Capability-functioning and independence; Orientation-awareness, shifted perspectives and values; and Connectedness-sense of belonging.Conclusions: Although functional status plays an important role for well-being in general, it is not the principal component of self-reported mental well-being within the heterogeneous group of the oldest old. Further, many persons in this age group do not view themselves as passive or dependent, on the contrary, they underline the importance of empowering attitudes, a positive mindset and actively creating circumstances which support their mental well-being.

The relationship between all-cause mortality and depression in different gender and age groups of the Spanish population.

BACKGROUND: Literature has shown that the effect of depression on all-cause mortality is stronger in men. However, it is less clear whether depression affects older and younger people equally. The present study is aimed to analyze whether depression is associated to all-cause mortality in different age and gender groups. METHODS: We analyzed a nationally representative sample of the Spanish adult population that was followed-up on for a period of 6 years (n = 4583). Unadjusted and adjusted cox proportional hazard regression models were conducted to test whether baseline depression was associated to all-cause mortality in the total sample and in the different gender and age specific groups, separately. RESULTS: Unadjusted analyses revealed that depression was associated with higher likelihood of having a shorter survival and dying, in the total sample and in both groups of men (18-64 and 65+ years). However, adjusted analyses stratified by age groups and gender revealed that depression was only a significant factor for all-cause mortality in 18-64 aged men (HR: 6.11; 95%CI= 2.16,17.23). LIMITATIONS: Cause-specific mortality was not examined. Young adults and middle-aged participants were not analyzed separately. CONCLUSIONS: The depression and all-cause mortality relationship was only found among young and middle-aged men. Further studies should consider whether the significant association between depression and all-cause mortality in young and middle-aged men is due to a behavior of seeking help less, the way depression is shaped in adult men, or to other clinical or health-system related factors.

Relationship between subjective well-being and healthy lifestyle behaviours in older adults: a longitudinal study.

Objectives: People who report better subjective well-being tend to be healthier in their daily behaviours. The objective of this study is to assess whether different components of subjective well-being are prospectively associated with different healthy lifestyle behaviours and to assess whether these associations differ by age.Method: A total of 1,892 participants aged 50+ living in Spain were interviewed in 2011-12 and 2014-15. Life satisfaction was measured with the Cantril Self-Anchoring Striving Scale. Positive and negative affect were assessed using the Day Reconstruction Method. Physical activity was assessed with the Global Physical Activity Questionnaire version 2. The remaining healthy lifestyle behaviours were self-reported. Generalised Estimating Equations (GEE) models were run.Results: Not having a heavy episodic alcohol drinking was the healthy lifestyle behaviour most fulfilled (97.97%), whereas the intake of five or more fruits and vegetables was the least followed (33.12%). GEE models conducted over the 50-64 and the 65+ age groups showed that a higher life satisfaction was significantly related to a higher physical activity in both groups. Relationships between a higher negative affect and presenting a lower level of physical activity, and a higher positive affect and following the right consumption of fruits and vegetables and being a non-daily smoker, were only found in the older group.Conclusion: The relationship between subjective well-being and healthy lifestyle behaviours was found fundamentally in those aged 65+ years. Interventions focused on incrementing subjective well-being would have an impact on keeping a healthy lifestyle and, therefore, on reducing morbidity and mortality.

Differential impact of transient and chronic loneliness on health status. A longitudinal study.

Objective: Loneliness is associated with worse health status outcomes. Yet, the present study is one of the first to identify how patterns of loneliness (transient and chronic) are associated with health over time. Design: A total of 2,390 individuals were interviewed in 2011-2012 and 2014-2015 in a follow-up study conducted over a nationally representative sample of Spain. After confirming a longitudinal relationship between loneliness and health status, a growth curve mixture modeling was used to examine health trajectories. Main outcome measures: The three-item UCLA Loneliness Scale was used to assess loneliness. Health status was measured with self-reported questions regarding ten domains (vision, mobility, and self-care, among others), and seven measured tests (including grip strength, walking speed and immediate and delayed verbal recall). Results: A quarter of participants were lonely at baseline. Both the group of transient and chronic loneliness showed a negative significant relationship with health status at follow-up, (ß = -0.063 and ß = -0.075 respectively, p < 0.001). Nevertheless, the health status did not change across time in any group. Conclusion: People experiencing chronic loneliness had the worst health status. Different patterns of loneliness could benefit from the appropriate interventions.

Fruit and Vegetable Consumption and Potential Moderators Associated with All-Cause Mortality in a Representative Sample of Spanish Older Adults.

This study sought to determine the association between levels of fruit and vegetable consumption and time to death, and to explore potential moderators. We analyzed a nationally-representative sample of 1699 older adults aged 65+ who were followed up for a period of 6 years. Participants were classified into low (≤3 servings day), medium (4), or high (≥5) consumption using tertiles. Unadjusted and adjusted cox proportional hazard regression models (by age, gender, cohabiting, education, multimorbidity, smoking, physical activity, alcohol consumption, and obesity) were calculated. The majority of participants (65.7%) did not meet the recommendation of five servings per day. High fruit and vegetable intake increased by 27% the probability of surviving among older adults with two chronic conditions, compared to those who consumed ≤3 servings per day (HR = 0.38, 95%CI = 0.21-0.69). However, this beneficial effect was not found for people with none, one chronic condition or three or more, indicating that this protective effect might not be sufficient for more severe cases of multimorbidity. Given a common co-occurrence of two non-communicable diseases in the elderly and the low frequency of fruit and vegetable consumption in this population, interventions to promote consuming five or more servings per day could have a significant positive impact on reducing mortality.

Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies.

There is growing evidence that loneliness is associated with mild cognitive impairment (MCI) and dementia. However, the extent of this association remains unclear. A systematic review and meta-analysis of longitudinal studies examining this association was conducted. Six electronic databases were searched from inception to November 15th 2018. A random-effects meta-analysis was performed to obtain pooled estimates and 95% CIs. Studies were also assessed for heterogeneity, methodological quality and publication bias. A total of 4270 hits were retrieved based on the initial search strategy and ten studies met the eligibility criteria involving 37339 individuals (mean age from 64.9 to 83.1 years). Variation between studies was present for the measurement of loneliness as well as for the case ascertainment of MCI and dementia. Loneliness was positively associated with increased risk of dementia (overall RR = 1.26; 95% CI = 1.14, 1.40; n = 8). Due to lack of sufficient data, we could not explore the association between loneliness and risk of MCI through a meta-analysis, but limited evidence suggests a potential effect of loneliness on MCI. A further understanding of the deleterious effects of loneliness on MCI and dementia may assist the design of environmental and psychological interventions to prevent or delay the onset of these neuropsychiatric conditions.

Mediterranean diet and wellbeing: evidence from a nationwide survey.

OBJECTIVE: Although there is some evidence of the association between specific food groups, such as plant foods, and subjective wellbeing, this is the first study to assess the relationship between adherence to the Mediterranean dietary pattern and subjective wellbeing. DESIGN: Data were collected in 2014-2015, within the Edad con Salud project, a follow-up study of a multistage clustered survey on a representative sample of the population of Spain. The final sample comprised 2397 individuals with ages ranging from 21 to 101 years. MAIN OUTCOME MEASURES: Experienced wellbeing (positive and negative affect) was measured using the Day Reconstruction Method, and evaluative wellbeing was assessed with the Cantril Self-Anchoring Striving Scale. RESULTS: A higher adherence to the Mediterranean diet showed a small but statistically significant inverse relationship with negative affect (ß = -0.076, p=.001), and direct with evaluative wellbeing (ß = 0.053, p=.015), whereas it was not related to positive affect. Several components of the Mediterranean diet were independently associated with wellbeing. CONCLUSION: The results suggest that adherence to a dietary pattern such as the Mediterranean diet, and not only the isolated consumption of its components, is associated with a better subjective wellbeing.