A growing number of studies are emphasizing the importance of positive and negative appraisals of caregiving and the utilization of social resources to buffer the negative effects of caring for persons with dementia. By assessing the roles of unmet needs and formal support, this study tested a hypothesized model for Korean family caregivers’ satisfaction and burden in providing care for persons with dementia.

The stress process model and a two-factor model were used as the conceptual framework for this study. Data for 320 family caregivers from a large cross-sectional survey, the Seoul Dementia Management study, were analyzed using structural equation modeling. In the hypothesized model, the exogenous variables were patient symptoms, including cognitive impairment, behavioral problems, and dependency on others to help with activities of daily living and with instrumental activities of daily living. The endogenous variables were the caregiver's perception of the unmet needs of the patient, formal support, caregiving satisfaction, and caregiving burden.

The adjusted model explained the mediating effect of unmet needs on the relationship between patient symptoms or formal support and caregiving satisfaction. Formal support also had a mediating effect on the relationship between patient symptoms and unmet needs. Patient symptoms and caregiving satisfaction had a significant direct effect on caregiving burden.

The level of unmet needs of persons with dementia and their family caregivers must be considered in the development of support programs focused on improving caregiving satisfaction.

Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD.

This was a cross-sectional study using data from a Norwegian national registry of memory clinics. From a total sample of 4,571 patients, we included those with MCI or AD (MCI 817, mild AD 883, moderate–severe AD 441). To compare variables across groups ANOVA or χ2-test was applied. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items to identify subgroups of NPS.

The frequency of any NPS was 87.2% (AD 91.2%, MCI 79.5%; p < 0.001) and increased with increasing severity of cognitive decline. The most frequent NPS in MCI was depression. Apathy was the most frequent NPS in AD across different stages of severity. The factor analysis identified three subgroups in MCI and mild AD, and a fourth one in moderate–severe AD. We labelled the subgroups “depression,” “agitation,” “psychosis,” and “elation.”

The frequency of NPS is high in MCI and AD and increases with the severity of cognitive decline. The subgroups of NPS were relatively consistent from MCI to moderate-severe AD. The subgroup elation appeared only in moderate-severe AD.

The study aims to assess the relationship between oral discomfort and subjective well-being (SWB) in older people.

A quantitative cross-sectional study was conducted in four Reference Centers for Social Welfare in Fortaleza, Northeastern Brazil. A census was held and individual interviews were carried out with all the older people (n = 246) enrolled in the centers. A questionnaire addressing sociodemographic data (age, gender, marital status, income, and education) and oral discomfort (dry mouth, difficulty in chewing and swallowing food, problems with the taste of food, burning mouth sensation, pain for no apparent reason, and mouth swelling) and the 62-item SWB scale were used.

Participants were 246 people aged 60–89 years (mean of 69 ± 6.9 years). The majority were women (n = 199; 80.9%), had incomplete primary education (n = 161; 65.4%), had an income of up to one minimum wage (n = 182; 74%), were retired (n = 169; 68.7%), were white (n = 100; 40.7%), and had no partner (n = 177; 72%). The mean SWB score (subscale 1) was associated with age (p = 0.010), gender (p = 0.019), health in the previous year (p = 0.027), systemic diseases (p = 0.007), speech problems (p = 0.016), vision problems (p = 0.006), number of teeth (p = 0.010), and dry mouth (p = 0.044). SWB (subscale 2) was associated with gender (p = 0.029), skin color (p = 0.023), general health (p < 0.001), health in the previous year (p < 0.001), systemic diseases (p = 0.001), drinking (p = 0.022), soft tissue problems (p = 0.001), and pain for no apparent reason (p = 0.025).

The relationship between oral discomfort and SWB reveals that older people's poor oral health leads to physical, psychological, and/or social problems that directly interfere with their well-being.

Pharmacological interventions for Lewy body dementia (LBD), especially for its non-cognitive symptoms, are limited in their efficacy and tolerability. Clinicians are often uncertain about non-pharmacological interventions and their efficacy in managing cognitive and non-cognitive symptoms of LBD. Therefore, we aimed to systematically review the existing literature on non-pharmacological interventions for people with LBD.

We carried out a systematic search using six databases. All human studies examining impact of any non-pharmacological intervention on LBD were assessed for cognitive, physical, psychiatric, and quality-of-life outcomes. Study quality was assessed by Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the CARE criteria checklist.

Prevailing evidence supporting the efficacy of non-pharmacological interventions is weak. We screened 1,647 papers. Fifteen studies (n = 61) including 11 case reports were found eligible for this systematic review. Interventions and reported outcomes were heterogeneous. Deep brain stimulation of the nucleus basalis of Meynert reportedly conferred cognitive benefit. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have been reported to ameliorate depressive symptoms. Transcranial direct current stimulation was observed to improve attention. Exercise-based interventions reportedly improve various clinically important outcomes. Spaced retrieval memory training and environmental intervention for “mirror sign” have also been reported.

Several non-pharmacological interventions have been studied in LBD. Although evidence supporting their efficacy is not robust, prevailing preliminary evidence and limitations of available pharmacological interventions indicate the need to consider appropriate non-pharmacological interventions, while planning comprehensive care of LBD patients. Larger trials evaluating the efficacy of non-pharmacological interventions for LBD are needed.

The purpose of this study was to examine whether a perceived person-centered nursing home environment has a direct relationship with nursing home adjustment and life satisfaction, and whether a perceived person-centered nursing home environment has an indirect relationship with life satisfaction through improved nursing home adjustment.

203 nursing home residents who were able to read and speak English and were physically and cognitively able to respond to questionnaires were included in this study. Data were collected from six nursing homes in the Midwestern US.

Higher levels of a perceived person-centered nursing home environment had a significantly direct relationship with increased life satisfaction of residents (β = 0.35), and this relationship was mediated by residents’ improved nursing home adjustment (β = 0.10). In-depth exploration using sub-domains of the main variables demonstrated that “safety” and “everydayness” of a person-centered nursing home environment were directly related to higher levels of life satisfaction (β = 0.15 and β = 0.16, respectively); and “everydayness” was related to three sub-domains of nursing home adjustment: better “relationship development,” “acceptance of the new residence” (β = 0.32 and β = 0.24, respectively), and lower “depressed mood” (β = 0.05). The positive relationship between “everydayness” and life satisfaction was partially mediated by the “relationship development” sub-domain of nursing home adjustment (β = 0.07).

The findings provide new evidence for the positive association between person-centered care and nursing home adjustment. The findings also provide insights into the mechanism through which the specific sub-domains of person-centered care and nursing home adjustment operate in the path model.

Several methods have been developed to evaluate activities of daily living (ADLs) in mild cognitive impairment (MCI) and mild dementia. This study evaluated the convergent and concurrent validity between (1) two report-based methods (the advanced (a)- and instrumental (i)-ADL tools) and (2) a performance-based method (the Naturalistic Action Test (NAT)) to check if their ability to differentiate between cognitively healthy comparisons (HCs), persons with MCI, and persons with mild Alzheimer's disease (AD) are comparable to each other.

This was a cross-sectional study, undertaken in a geriatric day hospital. The participants comprised community-dwelling HCs (n = 21, median age 78.0 years, 61.9% female), MCI (n = 20, median age 79.5 years, 55.0% female), and AD (n = 20, median age 80.0 years, 85.0% female) adults. A diagnostic procedure for neurocognitive disorders was employed. In addition, the a- and i-ADL tools and the NAT were administered separately by blinded raters.

The NAT and both the a- and i-ADL tools showed significant differences between HCs, MCI, and AD participants. Convergent validity showed moderate to strong significant correlations between the NAT, and a- and i-ADL tools (range −0.583 to −0.663; p < 0.01). Concurrent validity showed that the NAT (AUC 0.809–1.000) and the a- and i-ADL tools (AUC 0.739–0.964) presented comparable discriminatory accuracy (p = 0.0588).

In contrast to prior studies comparing report-based and performance-based methods of assessing ADL, this study indicates that the NAT and the a- and i-ADL tools have strong convergent and concurrent validity, and appear to have similar discriminatory power in differentiating between HCs, MCI, and AD.

Cognitive decline is an important complication of joint replacement surgeries in senior people.

We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD).

The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001).

In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.

The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people.

To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France.

The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years).

Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11–6.16 and aOR≥10 drugs 2.69, 95% CI 1.06–6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04–6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94–5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28–4.12).

This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.

Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP.

This was a qualitative study using face-to-face interviews with 30 residents (age range 66–94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis.

Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents’ concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives.

ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.

Elderly drivers are an increasing group in society. Previous research has found that functional and cognitive abilities are more important for driving abilities than biological age. In an attempt to conserve independent mobility for elderly drivers, many researchers have focused on elderly drivers diagnosed with cognitive decline (mild cognitive impairment or mild Dementia). This study is the first to focus on elderly drivers with cognitive complaints or suspected of diminished fitness to drive by an (in)formal caregiver as an at-risk group.

The main objective of this study was to develop a fitness to drive screening tool for elderly drivers to be used in a doctor's office. Furthermore, this study investigated the additional value of driving simulator tests in the assessment of fitness to drive. Both screenings (functional abilities and driving simulator test) were benchmarked against the official Belgian fitness to drive licensing procedure.

One-hundred thirty-six elderly drivers participated in a functional abilities screening, a driving simulator assessment and an on-road driving test. Sixty-five percent of the sample was considered fit to drive. Visual acuity, physical flexibility, and knowledge of road signs were found to be the best predictive set of tests for the on-road fitness to drive outcome. A performance based driving simulator assessment increased predictive accuracy significantly.

The proposed screening procedure saves part of the at-risk elderly driver population from stressful and costly on-road driving evaluations. This procedure provides more information of an individual driver's specific driving parameters. This opens doors for personalized older driver training to maintain independent mobility in later life.

Physical frailty and depression are common comorbid conditions that have important impact on older adults. Few studies however have examined their co-occurrence in centenarians. This paper explores the relationship between the two conditions and the most characteristic depressive symptoms associated with the frailty syndrome.

Data come from two Portuguese Centenarian Studies. Frailty was measured using Fried's phenotype, which includes at least three clinical signs: exhaustion, weight loss, weakness, slowness, and low physical activity level; the Geriatric Depression Scale was used to assess depression. Descriptive comparison and binary logistic regression models were used for data analysis.

The final sample comprised 91 centenarians (mean age = 101.0, SD = 1.3; 85.7% female). From these, 5.5% were classified as robust, 42.9% as pre-frail, and 51.6% as frail. The prevalence of depression in the whole sample was 35.2% (51.1% in frail centenarians; 21.1% in pre-frail centenarians; 0% in robust centenarians). Frail centenarians presented higher risk of depression (OR = 3.92; 95% CI 1.48–10.4) when compared to pre-frail centenarians. Findings from the multivariable model (gender, living arrangements, education, cognition, subjective health, current illness, and functionality) revealed that only subjective health remained significant.

It seems that depression is a comorbid clinical independent condition that is frequent in frail and pre-frail centenarians.

Low- and middle-income countries such as Vietnam are home to a majority of the world's population with dementia, yet little is known regarding how individuals in these countries perceive memory problems that might be indicative of cognitive impairment. This study examined the prevalence and correlates of subjective memory complaints (SMCs) in Vietnamese adults in Da Nang, Vietnam.

A stratified sample of 600 adults (aged ≥ 55 years) living in Da Nang, Vietnam, and surrounding areas were recruited to participate in a cross-sectional study. Students and faculty from the National Technical Medical College Number 2 administered questionnaires in participants’ homes regarding socio-demographic characteristics, functional health, social support, cognitive and mental health, and SMCs. Descriptive and stepwise regression analyses examined the prevalence and correlates of SMCs.

Approximately 64% of the sample reported at least poor memory and 39% said that memory interfered with their daily life at least somewhat. Multivariate regression analyses (adjusted for all covariates) showed that depressive symptoms, cognitive impairment, self-rated health and pain, and material hardship were associated with SMCs.

Prevalence of SMCs as well as depressive symptoms was high in this Vietnamese population. Although future research using more detailed measures of subjective memory and which include longitudinal data are required, the need for physicians to routinely assess Vietnamese patients for depression, SMCs, and cognitive impairment may be warranted.

Research reviews highlight methodological limitations and gaps in the evidence base for the arts in dementia care. In response, we developed a 12-week visual art program and evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation.

One hundred and twenty-five people living with mild to severe dementia were recruited across three research settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on quality of life (QoL), communication and perceptions of the program were obtained through interviews and self-reports with participants and their carers. Eight domains of well-being were measured using a standardized observation tool, and data compared to an alternative activity with no art.

Across all sites, scores for the well-being domains of interest, attention, pleasure, self-esteem, negative affect, and sadness were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. This was contrasted by their qualitative accounts, which described a stimulating experience important for social connectedness, well-being, and inner-strength. Communication deteriorated between baseline and follow-up in the hospital setting, but improved in the residential care setting.

The findings highlight the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment. We encourage dementia care providers and arts and cultural services to work toward embedding art activities within routine care provision.

Memory strategies help seniors remember information that is essential for the performance of their daily activities and contribute to their independence in the context of declining memory skills. This study aimed to analyze the categories, the diversity, and relevance of memory strategies known by seniors, and to identify individual characteristics that correlated with these variables.

The sample consisted of 294 participants aged 60 and over who decided to take part in a cognitive vitality promotion program. An adapted version of the memory situation questionnaire (Troyer, 2001) was administered to identify the memory strategies that seniors would use in five daily life situations. A scoring grid, also adapted from the questionnaire's original version (Troyer, 2001), was used to quantify the relevance of the strategies that were reported by participants.

All participants mentioned at least once that they would use a strategy from the physical category of memory strategies. Out of a possible range of 26 strategies, participants answered an average of 6.14 (SD = 1.7) different answers across the five situations. Based on expert consensus, 67.7% of the mentioned memory strategies were relevant. Diversity and relevance were significantly higher when trying to remember appointments, things to bring or phone numbers (p ≤ 0.05). The level of education, cognitive skills, and participation in leisure activities were related to diversity and relevance of reported strategies.

Seniors know various and relevant memory strategies to perform daily activities. The advantages of integrating strategies that they already know in cognitive health promotion programs should be considered in further studies.

A cognitive behavioral model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people.

In a cross-sectional design, 160 community-dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analyzed via mediation analysis using a bootstrapping approach.

Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (0.003, 0.021) and an effect size of κ2 = 0.035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal.

Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls.

With a rise in the aging population and a consequential rise in persons diagnosed with dementia comes an increase in the number of informal caregivers who are caring for a loved one. The objective of the proposed study was to assess the neurocognitive and psychological effects of caring for a person with dementia or a related neurodegenerative disease in a sample of Canadian informal caregivers.

Fifty-seven informal caregivers of a person with dementia or a related neurodegenerative disease (mean age = 66.26, SD = 7.55) and 97 non-caregivers (mean age = 69.16, SD = 4.84) were recruited. Neuropsychological measures of attention, cognitive flexibility, verbal learning, delayed recall, and verbal fluency were examined, and questionnaires related to perceived stress, quality of life, mood, and self-esteem were administered.

Caregivers made more errors on a measure of cognitive flexibility (p = 0.02), generated fewer words on measures of phonemic fluency (p < 0.01) and semantic fluency (p < 0.001), and learned significantly fewer words on a list-learning task (p < 0.01). Caregivers also reported experiencing significantly more perceived stress (p < 0.001), lower quality of life (p < 0.001), and were more likely to meet the cut-off for clinically significant depressive symptoms on a self-report scale (p < 0.001).

These data contribute to a growing body of literature that consistently points to the need for immediate action to improve the welfare of caregivers.