Is Use of Psychedelic Drugs a Risk or Protective Factor for Late-Life Cognitive Decline?

Objectives: Common age-related health conditions can lead to poor mental health outcomes and deteriorate cognition. Additionally, commonly prescribed medications for various mental/physical health conditions may cause adverse reactions, especially among older adults. Psychedelic therapy has shown positive impacts on cognition and has been successful in treating various mental health problems without long-lasting adversities. The current study examines the association between psychedelic drug usage and cognitive functions in middle-aged and older adults. Methods: Data were from wave 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used multiple linear regression models examining associations between psychedelic usage and cognitive functions, controlling for covariates of sociodemographic and health factors. Results: We included 2,503 individuals (Mage = 64 ± 11). After controlling for covariates, the finding revealed that psychedelic usage was independently associated with more favorable changes in executive function (ß = .102, SE = 0.047, p = .031) and less depressive symptoms (ß = -.090, SE = 0.021, p < .001). The same effect was not found for episodic memory (ß = .039, SE = 0.066, p = .553). Discussion: Addressing the mental health implications of physical health conditions in older adults are vital for preventing neurocognitive deterioration, prolonging independence, and improving the quality of life. More longitudinal research is essential utilizing psychedelics as an alternative therapy examining late-life cognitive benefits.

Impact of Optimism on Cognitive Performance of People Living in Rural Area: Findings From a 20-Year Study in US Adults.

Objectives: Mid- or early-late-life cognitive function is an indicator for developing late-life dementia. However, it is still unclear whether rural/urban living contexts provide cognitive benefits across adulthood. Further, higher optimism serves as a general protective factor for many health outcomes. The present study examines associations between rurality/urbanicity, optimism, and change in mid/late-life cognitive functions over time. Methods: Data were from waves 1 to 3 (1995-2015) of the Midlife in the United States (MIDUS) study (N = 2,507). Structural equation models examine whether long-term rural living across both waves (1-2) or intermittent rural living at one wave is associated with better cognitive function over 20 years, compared to no rural living, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if optimism mediates the above associations. Results: After controlling for covariates, long-term rural living (waves 1-2) was indirectly (through less optimism) associated with significantly lower levels of cognitive executive function and episodic memory in wave 3. Conclusions: While long-term rural living and cognitive outcomes have no direct association for MIDUS middle-aged and older adults, mediating roles of optimism in these associations were evident. Future investigations could examine mechanisms that underlie these risk/protective factors on late-life cognition.

The Importance of Zero-Deficiency Complaints in Nursing Homes: A Mere Consequence or Serious Concern?

Complaints represent an important metric for assessing the quality of nursing home (NH) care. Using the Automated Survey Processing Environment (ASPEN) Complaints/Incidents Tracking System dataset (2017), we examined the relationships between zero-deficiency complaints (ZDCs) and zero-deficiency substantiated complaints (ZDSCs) and the proportion of residents with dementia. NHs (N = 15,339) were separated into three groups-proportion of residents with dementia in the top, two middle, and the bottom quartiles. Negative binomial regressions assessed zero-deficiency complaint patterns in relation to NHs' proportion of residents with dementia, controlling for facility characteristics, staffing, and racial pattern. We reported average marginal effects (AMEs) and 95% confidence intervals (CIs). NHs in the top quartile yielded higher numbers of both ZDC (AME = .189, 95% CI: .102-.276, p < .001) and ZDSC (AME = .236, 95% CI: .094-.378, p = .001), than NHs in the bottom quartile. Results suggest a need for more uniform investigation processes and staff training to promote a more valid complaint process for residents with dementia.

A Collaborative Approach to Improving Care Outcomes for Residents in Assisted Living.

Purpose: Assisted Living (AL) residents are embedded in "care convoys" comprised of a dynamic network of formal and informal care partners. Using the convoys of care model-a multi-level framework connecting care convoy properties to resident outcomes-we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, and consensus-building for older adults and their convoys. Methods: Data were collected from the longitudinal study, Convoys of Care: Developing Collaborative Care Partnerships in AL. Fifty residents and their care convoy members (N = 169) were followed in eight AL homes in Georgia over 2 years. Original data were analyzed using Grounded Theory Methods of qualitative data, including formal and informal interviewing, participant observation, and record review. Results: The convoys of care model provide an innovative perspective that will assist providers in supporting AL residents and their care partners to achieve better care outcomes. Findings demonstrate the utility of understanding the structure and function of social resources and implications for improving healthcare outcomes. Conclusion: This research informs the work of physicians and mid-level providers with patients in AL by providing strategies to uncover specific social determinants of health. Recommendations for use in patient encounters are enumerated.

Do nursing homes with a higher proportion of residents with dementia have greater or fewer complaints?

Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= -0.07; p < 0.05) and substantiated (AME= -0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities.

Protective roles of meditation practice and self-esteem on cognitive functions over time: findings from the Midlife in the United States study.

BACKGROUND: Cognitive function is an important component of healthy ageing. However, it is unclear whether relaxation/meditation practices provide cognitive benefits, particularly in midlife and early late life. Meditative practices are associated with higher self-esteem, and self-esteem serves as a general protective factor for many health outcomes. The current study examines associations between meditation practice, self-esteem, and change over 10 years in midlife cognitive performance. METHODS: Data were from waves 2 (2003-2004) and 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used structural equation modelling to examine whether persistent meditation practice at both waves or episodic practice at one wave is associated with better cognitive function over 10 years, compared to no meditation practice, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if self-esteem mediates the above associations. RESULTS: We included 2168 individuals (Mage = 65 ± 11). After controlling for covariates, the findings revealed that persistent meditation practice in both waves was associated with significantly less decline in episodic memory; however, no such effects were found for executive function. Further, although participants' higher self-esteem was significantly associated with less decline in executive function and episodic memory, it did not mediate the associations between meditation practice and cognitive functions. CONCLUSIONS: While both persistent meditation practice and self-esteem have associations with cognitive outcomes for middle-aged and older adults in MIDUS, self-esteem as a mediator was not supported. Thus, future investigations should examine mechanisms that underlie these protective factors on cognitive performances across adulthood.

Consumer Complaints in Nursing Homes: Analyzing Substantiated Single-Allegation Complaints to Deficiency Citations.

Complaints provide important information to consumers about nursing homes (NHs), but how substantiated complaints map onto deficiency citations is unknown. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Federally collected NH complaint and inspection records were obtained to identify all single allegation, substantiated complaints for NHs across the U.S. in 2017. Overall, the 369 complaint allegations in our sample resulted in a total of 585 deficiencies at the inspection stage; however, 35.2% of the allegations led to no deficiencies. Nearly two-thirds of the 369 substantiated single allegation complaints were categorized at the intake stage as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Further, 18% of the inspection deficiencies originated with complaint allegations that were prioritized as immediate jeopardy at intake, but of these, 71.4% were determined upon inspection to constitute "no actual harm with potential for more than minimal harm." These results provide evidence that complaints have the potential to provide unique valuable information on NH quality of care and draw regulatory attention to consumers' concerns. Future studies should include qualitative research concerning complaint processes by conducting interviews/surveys of complainants, NH staff/administrators, long-term care ombudsmen, and state officials.

Does Perceived Generativity Mediate the Association Between Optimism and Cognitive Function Over Time? Findings from Midlife in the United States Study.

Cognitive function is a vital component of healthy aging. However, whether a persistently high optimism benefits late-life cognitive function is debatable. The current study examined associations between high optimism status, perceived generativity, and cognitive functions across adulthood. Data were from waves 2 and 3 (2004-14) of the Midlife in the United States study. We used structural equation modeling to examine whether participants' (N = 2,205; Mage = 65 ± 11) persistent high optimism predicts better cognitive functions over time, compared to high optimism at only one time-point or not at all while controlling for covariates; we also examined whether individuals' perceived generativity mediates the above association. The findings revealed that persistent high optimism was significantly associated with better episodic memory and executive function. Further, perceived generativity positively mediated the association between persistent high optimism and episodic memory. Future research should examine mechanisms for potential aspects of high optimism and perceived generativity on late-life cognitive performances.

The Healthy Caregiver? A Positive Impact of Informal Caregiving Status on Cognitive Functions Over Time From the Midlife in the United States Study.

OBJECTIVES: The current study examined whether informal caregivers performed worse, better, or similar to non-caregivers on cognitive tests of executive functioning and episodic memory over 10 years. Methods: Data were from waves 2 (2003-04) and 3 (2013-14) of the Midlife in the United States (MIDUS) study (N = 2086). Multiple linear regression models examined whether caregiving at both waves 2 and 3 predicted better cognitive functioning at wave 3, than caregiving at only one time point or no caregiving (reference) while controlling for baseline covariates (i.e., sociodemographic, health, and functional status). RESULTS: After controlling for covariates, caregiving at both waves was independently associated with better performance in episodic memory (b = .24, SE = .10, p = .013) but not executive function (b = -.06, SE = .05, p = .246). Discussion:The findings partially supported both healthy caregiver and stress process models, indicating caregiving may be associated with better episodic memory but not executive functioning over time among the middle-aged and older adults.

Mind-Body Practice and Family Caregivers' Subjective Well-Being: Findings From the Midlife in the United States (MIDUS) Study.

Objectives: Informal caregiving has been associated with higher stress and lower levels of subjective well-being. Mind-body practices including yoga, tai chi, and Pilates also incorporate stress reducing activities. The current study aimed to examine the association between mind-body practice and subjective well-being among informal family caregivers. Methods: A sample of informal caregivers were identified in the Midlife in the United States study (N = 506, M ± SDage = 56 ± 11, 67% women). We coded mind-body practice into three categories, including regular practice (participating in one or more of them "a lot" or "often"), irregular (participating "sometimes" and "rarely") and no practice ("never"). Subjective well-being was measured using the 5-item global life satisfaction scale and the 9-item mindfulness scale. We used multiple linear regression models to examine associations between mind-body practice and caregivers' subjective well-being, controlling for covariates of sociodemographic factors, health, functional status, and caregiving characteristics. Results: Regular practice was associated with both better mindfulness-related well-being (b = 2.26, p < .05) and better life satisfaction (b = 0.43, p < .05), after controlling for covariates. Discussion: Future research should examine whether there is a selection effect of caregivers with higher well-being being more likely to choose these activities, and/or if mind-body practices are effective non-pharmacological interventions to improve family caregivers' quality of life.

Trends in Nursing Home Complaints: Prevalence and Variation Across Center for Medicare and Medicaid Services Regions.

Resident complaints are vital to understanding nursing home (NH) quality. Using complaints as facility- and resident-level outcomes, this study replicates prior analyses (spanning 1998-2002 and 2007-2012) with 2013-2017 data, the phase prior to NH regulatory changes initiated in November, 2017. Advancing prior papers, we analyze the number of complaints, allegations, and deficiency citations separately. Between 2013-2017, 458,101 total complaints (5.9/NH/year) were identified, containing 949,466 allegations (12.2/NH/year), and resulting in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, results show a steady increase compared to previous years. Furthermore, there are marked differences among the CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. However, the average rate of substantiation of complaint allegations shows a decreasing trend over these years, suggesting that complaints may have increased due to higher care expectations.

Creating age-friendly nursing homes: The time is now.

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Longevity is not an ingredient of successful aging as self-reported by community-dwelling older adults: a scoping review.

OBJECTIVES: There has been a long-standing debate in gerontology about what constitutes successful aging (SA). This scoping review investigated older adults' perspectives on longevity as part of SA to promote developing a standardized conceptual model. METHOD: The current review followed the JBI methodological guidelines and used Rowe & Kahn's SA framework and Baltes' selection, optimization, and compensation model as the foundational theoretical framework. Five electronic databases (PubMed, Scopus, PsycInfo, CINAHL, and Web of Science) were searched using specific inclusion criteria (participants, concept, and context) to identify original studies that evaluated SA. RESULTS: Eighteen studies, including 9,360 individuals (aged 60 years and older), were selected. Main indicators involved six primary domains: Psychological, physical, social, environmental, spiritual, and behavioral. Physical activity, basic aspects of wellbeing, positive outlook, satisfaction with life, interpersonal relationship, participation in meaningful activities, and financial security emerged as the most important factors. The findings suggest that older adults do not consider longevity a primary component of SA. CONCLUSION: We identified multidimensional self-reported SA components without longevity being emphasized, guiding further improvement of older adults' wellbeing. The study outlines an updated conceptual framework that can be applied to real-life scenarios to test how older adults can best adapt to the challenges of aging.

Mind-Body Practice, Personality Traits, and Cognitive Performance: A 10-Years Study in US Adults.

It is widely established that physical activity is associated with better cognitive outcomes, and accumulating evidence suggests that mind-body practice (MBP, e.g., movement therapies such as yoga) may yield similar benefits. Personality is related to both daily activities and cognition, but its role in the association between MBP and cognition is not well understood. Using data from waves 2 and 3 (2004-2014) of the Midlife in the United States (MIDUS) study, the current study examines bidirectional temporal associations between personality traits, MBP, and cognition in healthy adults (N = 2050). We applied a cross-lagged regression analysis to examine bidirectional effects between MBP, Big Five personality traits, and two cognitive domains (episodic memory and executive function) and controlled for relevant variables (sociodemographic factors, health, and functional status) at wave 2. MBP at baseline was independently associated with more favorable change in episodic memory, but not in executive function, both before and after including control variables. Also, episodic memory and executive function at baseline were related to increase in MBP. The findings show that MBP and cognitive function predict each other over time. There is also some evidence for cognition and personality associations over time; however, personality traits are not related to subsequent MBP.

Self-Reported Satisfaction of Older Adult Residents in Nursing Homes: Development of a Conceptual Framework.

BACKGROUND AND OBJECTIVES: Resident satisfaction is an integral part of nursing home (NH) quality of care. However, there is no uniform categorization framework to classify the self-reported satisfaction of older adult residents in NHs. This scoping review systematically investigated the studies reporting data on older residents' satisfaction to evaluate the quality of NH service and to create a conceptual model for older residents' satisfaction. RESEARCH DESIGN AND METHODS: We used Donabedian's structure-process-outcome model as a theoretical framework. In 3 electronic databases (PubMed, Scopus, and CINAHL), potential studies were searched using specific inclusion criteria identifying original studies that investigated older adult residents' satisfaction in NHs. RESULTS: Fifteen studies, including 264,133 residents and 15,577 NHs, were selected for this review. Although a wide variety of resident satisfaction measures were used in the included studies, all these indicators reflect 5 primary domains: psychological, clinical, social, environmental, and spiritual, with the common focus of improving the quality of life of residents. Though technical competence is a fundamental aspect of health care service, we found autonomy, environment, meaningful activities, and interpersonal quality of professionals as the most important predictors for the resident's satisfaction. DISCUSSION AND IMPLICATIONS: The current review has synthesized a broad range of satisfaction measures, which will help future researchers and policymakers provide guidance for further improvement of NH care services and as a heuristic device to spur research. Additional research is needed to apply this conceptual framework for comparisons of self-reported resident satisfaction in other institutional settings across countries.

Person-Centered Care in Nursing Homes: Potential of Complementary and Alternative Approaches and Their Challenges.

A person-centered approach to care shifts the mind-set of care partners from a traditional medical model to a social model in managing chronic conditions. Using a qualitative descriptive approach, this study examines the barriers and facilitators to the implementation of person-centered care (PCC) and how the integration of complementary and alternative approaches (CAA) has the potential to improve residents' quality of life in nursing homes (NHs). Findings indicate that NHs offer a wide range of engagement activities, but these activities are not purposefully integrated into a person-centered plan of care. Factors such as turnover, "working short," supervisor support, and rising resident care needs make it challenging to implement PCC in NHs. This knowledge of the landscape of activities will help us identify and improve strategies for supporting residents at a deeper, more meaningful level. CAA has the potential to be therapeutic for residents if integrated into collaborative approaches to care.

Movement-based mind-body practices and cognitive function in middle-aged and older adults: Findings from the Midlife in the United States (MIDUS) study.

OBJECTIVES: Cognitive function is a key component of healthy aging. While conventional physical activities (walking, jogging, etc.) have been shown to support physical and cognitive health in late-life, it remains unclear whether traditional Eastern movement-based mind-body practices (MBP) have long-term cognitive benefits above and beyond conventional leisure physical activities. This study examines the relationship between movement-based MBP and cognitive function in middle-aged and older adults during a 10-year follow-up period. METHODS: We used data from Waves 2 (2004-05) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. MIDUS initially surveyed a national probability sample of community-living adults aged 24-75 years in 1995 (Wave 1). Tests of cognitive functioning measuring executive function and episodic memory were added in Wave 2 and repeated in Wave 3. We estimated multivariable linear regression models to examine the effect of MBP (Wave 2) on the episodic memory and executive function (Wave 3) while controlling for covariates (sociodemographic factors, health, and cognitive function at Wave 2). RESULTS: A total of 2097 individuals aged 42-92 years (M = 64 ±â€¯11, 56 % women) were included. After controlling for sociodemographic factors, health and functional status, and prior levels of cognitive function, engaging in MBP was independently associated with a smaller decline in episodic memory (b = 0.11, p = .03), but not executive function (b=0.03, p = .34). DISCUSSION: The findings provide the first large population-based evidence supporting the cognitive benefits of MBP over a 10-year period among middle-aged and older adults. Future research should examine whether MBP are effective non-pharmacological intervention to attenuate age-related cognitive decline.

Effects of yoga-related mind-body therapies on cognitive function in older adults: A systematic review with meta-analysis.

OBJECTIVES: Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults. METHODS: Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d). RESULTS: Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported. DISCUSSION: Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.

Mind-body practices in U.S. adults: Prevalence and correlates.

OBJECTIVES: Mind-body practices (MBP), such as Yoga or Tai-Chi, have increased in popularity in the past 25 years in the US. These activities may help promote a less sedentary lifestyle and may have positive effects on health. The objective of the present study is to understand the prevalence and trends of MBP in US adults and the factors associated with their use in a population-based adult lifespan sample. METHODS: We used data from three waves of the Midlife in the United States (MIDUS) survey (1995, 2005, and 2015), a population-based longitudinal study of community-dwelling adults. Only data from participants with valid observations across three waves (N = 2262) aged 24-74 years at baseline (M = 46; SD = 11) were used. We examined the prevalence of MBP, longitudinal patterns, and correlates of MBP use over 20 years. RESULTS: Rates of MBP use were relatively stable over time in this sample, with 20%, 17%, and 18% of participants using MBP at wave 1, 2, and 3, respectively. A number of sociodemographic and health variables were independently related to frequency of MBP use over 20 years: Women, participants with higher levels of education, never married participants, and participants who suffered from multiple chronic health conditions were more likely to use MBP. DISCUSSION: Our findings suggest that MBP may provide an opportunity for physical activity for individuals suffering from chronic health conditions. More research is needed to understand whether this, in turn, results in better health outcomes for these individuals.

Experience of hepatitis C virus seroprevalence and its genomic diversity among transfusion-dependent thalassemia patients in a transfusion center.

INTRODUCTION: One of the most common blood-borne transfusion-transmitted diseases is hepatitis C. Patients with a history of multiple blood transfusions are significantly at a greater risk of infection by contaminated blood and blood products. Beta thalassemia major is one such condition where repeated blood transfusions are required for patient management. MATERIALS AND METHODS: The present study was conducted to investigate the serological prevalence of hepatitis C virus (HCV), its viremia, and genotype distribution with clinical parameters among multitransfused thalassemic individuals. In this study, a total of 300 patients were screened to detect anti-HCV antibody in serum, along with liver function parameters and genotyping. RESULTS: Seventy-five (25%) patients were found to be HCV positive by enzyme-linked immunosorbent assay (ELISA). Among them, 49 (65%) were HCV RNA positive having a significant viral load in their blood and rest 26 (35%) were below detection level, which signify auto clearance of the virus in those patients. According to our study, HCV genotype 3 was the major circulating strain (92.59%) followed by genotype 1. Liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, and total bilirubin, were significantly elevated among HCV seroreactive individuals. CONCLUSIONS: This study clearly indicates that the incidence of transfusion-transmitted hepatitis C is high in thalassemia patients, but actual scenario of HCV viremia can only be found by HCV RNA qualitative and quantitative detection method and not by ELISA, is a major concern for this high-risk group of population.