A Profile of Social Participation in a Nationally Representative Sample of Canadian Older Adults: Findings from the Canadian Longitudinal Study on Aging.

Social participation has tremendous implications for the physical and mental health of older adults. A growing body of Canadian literature has examined social participation among older adults, including frequency of participation; gender, age, and regional differences in participation; and associations with self-perceived health, loneliness, and life dissatisfaction. The current study adds to this important body of research, using a large, nationally representative sample of adults 45-85 years of age (Canadian Longitudinal Study on Aging [CLSA] baseline data [n = 51,338]), to examine nuanced characteristics associated with social participation (socio-demographics, social support, cognitive ability, mental health, physical conditions), frequency of participation, and the relationship between the aforementioned characteristics and frequency of participation. Findings indicated that compared with those who reported infrequent/no participation, more frequent participation was associated with greater social support, higher cognitive abilities, increased satisfaction with life, fewer depressive symptoms, reduced odds of self-reported mood and anxiety disorders, and fewer self-reported physical conditions. Findings highlight the importance of active social participation, and have important implications for the development and implementation of accessible community programs across Canada.

Caregiver identity in care partners of persons living with mild cognitive impairment.

Research on caregiver identity in the context of memory impairment has focused primarily on more advanced stages of the cognitive impairment trajectory (e.g., dementia caregivers), failing to capture the complex dynamics of early caregiver identity development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was to develop a nuanced understanding of how caregiver identity develops in family and friends of persons living with MCI. Using constructivist grounded theory (ConGT), this study explored caregiver identity development from 18 in-depth interviews with spouses (n = 13), children (n = 3), and friends (n = 2) of persons recently diagnosed with MCI. The overarching themes influencing MCI caregiver identity development included MCI changes, care-related experiences, "caregiver" interpretation, and approach/avoidance coping. These themes influenced how participants primarily identified, represented as I am a caregiver, I am not a caregiver, or liminality (i.e., between their previous identity and a caregiver identity). Irrespective of their current self-identification, all conveyed thinking about their "future self," as providing more intensive care. MCI caregiver identity development in family and friends is a fluid and evolving process. Nearly all participants had taken on care tasks, yet the majority of these individuals did not clearly identify as caregivers. Irrespective of how participants identified, they were engaging in care, and would likely benefit from support with navigating these changes and their new, ambiguous, and evolving roles.

Choice, coercion, and/or muddling through: Older adults' experiences in seeking psychological treatment.

Help-seeking related to mental health concerns has been found to decrease as age increases . Despite extensive literature devoted to barriers to accessing mental health services, the reasons why older adults are especially unlikely to seek treatment are not well understood. The present study had two objectives concerning the experiences of older adults accessing outpatient psychological treatment: 1) classifying pathways into treatment using the Network Episode Model (NEM; Pescosolido et al., 1998), and 2) critically examining whether these pathways effectively captured the process of seeking treatment for older adults. Utilizing secondary qualitative data from three studies (N = 35), we met our first objective of classifying pathways according to the NEM with directed content analysis. The majority (n = 21, 60%) of older adults willingly accessed treatment (choice) and 42.9% of those involved 'others' in their help-seeking by way of referrals or support. The remaining participants' (n = 14, 40%) pathways into treatment reflected a process of muddling through (being unsure of their need for mental health services and where to access support, or bouncing around the treatment system). No participants' pathways were categorized as coercive. To meet our second objective, we used conventional content analysis to explore how best to categorize pathways to treatment. Findings demonstrated that a minority of participants (n = 10, 28.6%) had a help-seeking journey that represented only one of the three pathways. Instead, most participants described a lengthy period of muddling through, eventually followed by a willingness to seek help. These findings highlight the complex process of seeking treatment, and suggest a need to implement more direct mental health literacy interventions to reduce the amount of time spent muddling through, while improving the experience of mental health help-seeking for older adults.

Older Adults' Narratives of Seeking Mental Health Treatment: Making Sense of Mental Health Challenges and "Muddling Through" to Care.

Older adults who experience challenges related to mental health are unlikely to seek professional help. The voices of older adults who have navigated through mental health issues and systems of care to arrive at psychological treatment are less well understood. We conducted individual interviews with 15 adults aged 61 to 86 who sought psychological treatment. Interviews were audio-recorded, transcribed, and analyzed using narrative methods. We identified several main storylines that describe the meaning-making and treatment-seeking journeys of older adults: resistance to being labeled with mental health problems (telling stories of resistance, defining mental health issues in mysterious and uncontrollable terms, and experiencing internal role conflict); muddling through the help-seeking process (manifestations of chaos and system-level barriers); and emotional reactions to psychological treatment (hope, fear, and mistrust). Findings add to the literature base in the area of narrative gerontology, and highlight the complex experiences that older adults face when seeking psychological treatment.

Efficacy of a parent-youth teamwork intervention to promote adherence in pediatric asthma.

OBJECTIVE: To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS: We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS: TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS: Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.

Development and psychometric evaluation of the reasons for living--older adults scale: a suicide risk assessment inventory.

PURPOSE: The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide. DESIGN AND METHODS: Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in one's life, and current mental status and physical functioning. RESULTS: Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach's alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior. IMPLICATIONS: These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.

Manejo de los problemas de comportamiento asociados a la demencia / Management of behavior problems associated with dementia

Se espera que la proporción de personas de la tercera edad aumente en Europa del 20 por ciento al 35 por ciento en los próximos 50 años. Esto se concretará en que uno dé cada tres individuo tenga 60 añoso más. Se espero que España tenga la población más anciana, con una media de edad de 55 años. Un número importante de adultos desarrollará demencia conforme lleguen a la tercera edad. Cerca de medio millón de individuos padecen actualmente demencia en España. la demencia se acompaña a menudo dé problemas de comportamiento que tienen que ser controlados por la medicación y/o individuos debidamente entrenados. Menos del 3 por ciento de los sujetos con demencia en España se encuentran en instituciones donde se proporciona ese cuidado. La mayoría de los individuos con demencia son cuidados por miembros de la familia con escasas habilidades para manejar los comportamientos problema asociados a la demencia. A muchas de estas familias se les puede enseñar a actuar con eficacia sobre esos comportamientos problema de los miembros de la familia que padecen demencia. La idea del presente artículo es familiarizar al lector con las demencias y con los problemas asociados a ella y también ofrecer una breve discusión de los enfoques conductual que se han encontrado eficaces para majerar estos comportamientos problema. Se enfatiza el papel de la familia como cuidadores y participantes en el proceso de evaluación e intervención (AU)