This systematic review and meta-analysis aimed to (1) assess the effectiveness of psychological therapies for depression in older people living in long-term care (LTC) settings, and (2) investigate differences in effectiveness between types of psychological treatments.

We included randomised controlled trials (RCTs) with participants aged 65 years and older. Participants were required to present with (a) major depressive disorder (MDD) or (b) symptoms of depression based on a score over a cut-point on a validated depression measure. The study setting was LTC facilities, including nursing homes, assisted-living facilities, and residential aged care facilities, where some level of day-to-day care was provided by staff employed in the facility. Treatments were grouped and classified as cognitive-behavioural therapy, behaviour therapy, or reminiscence therapy.

The literature review identified 19 studies for the qualitative synthesis: 18 were included in a meta-analysis. Results indicated a benefit for psychological treatments on depressive symptoms at end-of-intervention (standardized mean difference (SMD) -1.04, 95% CI -1.49 to -0.58; 18 trials, 644 participants), and at a medium-term follow-up (SMD -0.43, 95% CI -0.81 to -0.06; 8 RCTs, 355 participants), but not in the longer-term (SMD -0.16, 95% CI -0.58 to 0.27; 2 RCTs, 92 participants). There was no difference in outcomes between therapy types.

This systematic review demonstrated positive impacts of psychological therapies on symptoms of depression in older people living in LTC, both immediately after therapy and in the medium term, but longer-term impacts were not demonstrated.

Aphasia is a communication disorder associated with impairments in spoken language, understanding, reading and writing that impacts upon daily activities, participation in society and the quality of life (QoL), and it is common in elderly patients in the context of vascular diseases. We aimed to investigate participation in society and the environmental factors and health-related QoL of elderly people with aphasia.

People with aphasia whose age was above 65 were included in this study. QoL was assessed by the Japanese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) and Life stage Aphasia Quality Of Life scale-11 (LAQOL-11), and the participation in society and the environmental factors as barriers was assessed by the Japanese version of the Community Integration Questionnaire (CIQ) and the Japanese version 2 of the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. We explored predictors such as aphasia severity, communication impairment, cognitive functions, motor paralysis, activities of daily living (ADL).

We included 58 individuals (43 men; mean age 73.2 [SD 5.7] years) with aphasia after the mean 48 (SD 64.9) months of onset (of stroke, cerebral hemorrhage, subarachnoid hemorrhage, brain tumor, traumatic brain injury). The median of the total score of SAQOL-39 and LAQOL-11 was 3.91 (Quartile Deviation 0.47) out of 5 and 85.0 (QD 12.5) out of 110. The QoL was not associated with aphasia severity assessed by the Standard Language Test of Aphasia (SLTA) which is the most frequently used comprehensive aphasia rating scale in Japan, but poor QoL was significantly associated (Spearman correlations) with increased severity of communication impairment assessed by Communication ADL Test (P = 0.01). Moreover, increased QoL was significantly associated with increased participation in society (P = 0.03) and decreased environmental factors (P = 0.01).

Poor communication ADL may have a negative effect on QoL in elderly people with aphasia. Also, we show that QoL is associated with participation in society. For patients with aphasia after retirement, specific rehabilitation of communication ADL might be beneficial and should be explored in future studies.

Diabetes mellitus (DM) is known to be one of the risk factors for cognitive decline and dementia. Neuropsychiatric symptom (NPS) is present not only in dementia, but also mild cognitive impairment (MCI). In this study, we examined NPS of MCI with DM and compared MCI with DM and our MCI database to investigate the characteristics of MCI with DM.

The participants were subjects who were diagnosed as MCI from type 2 DM participants enrolled in Osaka University Hospital. To estimate NPS, we used Neuropsychiatric Inventory (NPI) score.

The number of MCI subjects with DM who were estimated NPS was 19. According to the NPI score, apathy is the most severe symptom in MCI (average score = 2.5±3.3). This result was the same as the score of our database. In the frequency of NPS, there was no difference between the results in NPI of MCI with DM and MCI of our data (n = 225) except for sleep disturbance and appetite/eating disturbance (chi-squared test, P < 0.05). The sleep disturbance was more frequent in MCI with DM than in MCI of our database. On the other hand, the appetite/eating disturbance was less frequent in in MCI with DM than in MCI of our database. Moreover, the appetite/eating disturbance was not observed in MCI with DM.

NPS of MCI with DM is almost the same as MCI of our database except for sleep disturbance and appetite/eating disturbance. This result might be influenced by the disorder of lifestyle habits that is often observed in patients with DM or cognitive impairment of DM.

The limitation of our study is the small number of cases, further investigation is needed.

To explore commonalities and differences in the sociodemographic, health, and neuropsychological characteristics of participants with SCD recruited in two culturally differentiated cohort studies, namely CIMA-Q (Canada; Bellevile et al., 2019) and CompAS (Spain; Juncos et al., 2012).

Older adults with subjective cognitive complaints of the CompAS (N=251; 68.92% women; Control: 30.3%; SCD: 25.9%; MCI: 28.7%) and the CIMA-Q (N=179; 71.5% women; Control:16.1%; SCD: 36.8%; MCI:28.6%) were recruited, respectively, from primary care centers and memory clinics, excluding patients with dementia and other neurological or psychiatric disturbances. Cognitive complaints were assessed considering coincident items of the QAM and MFE questionnaires. Cut-off points for the 5%ile were calculated independently in both samples and according to this, participants were classified as SCD or controls (CompAS: N= 141; CIMA-Q: N=161) considering complaints relevance at baseline (Pereiro et al., 2021). Participants underwent neuropsychological assessment. Participants diagnosed as Mild Cognitive Impairment (MCI) were excluded from the analysis. Between cohort-studies and inter-group (control, SCD) differences were tested in the sociodemographic, health and neuropsychological measures considered. The Holm-Bonferroni correction was applied to reduce the probability of type I error (p<.003).

Identical cut-off points for 5%ile were obtained in both samples though SCD prevalence was slightly higher in CIMA-Q. For both samples, equivalence between Control and SCD participants in sociodemographic, health, functionality, and neuropsychological measures was observed. Only complaints and depressive symptomatology was significantly higher in SCD participants than in controls in both CompAS and CIMA-Q studies.

Participants of the CIMA-Q, Controls and SCD, showed significantly higher age, cognitive reserve proxies, comorbidity, and better attentional performance than the CompAS participants (see Table 1). CompAS participants, Controls and SCD, showed more neuropsychiatric symptomatology than CIMA-Q participants (see Table 1).

Control and SCD participants showed equivalence on sociodemographic, health, functional, and neuropsychological measures in both studies. However, significant between-sample differences in the two groups, particularly in SCD participants, were observed in sociodemographic, health, cognitive reserve, behavioral and attentional measures. Identification of these factors are critical to analyze the transcultural validity of cognitive complaints in predicting progression to AD.

Table 1

Between group (control, SCD) and Between study (CIMA-Q, CompAS) differences in sociodemographic, health, and cognitive measures

Pleasant, meaningful, recreational or other activities are often used in depression treatment in nursing home (NH) residents. Residents may also undertake such activities alongside or without a treatment (informal activities). It is not clear if such informal activities can partially explain treatment effects. Our aim was to explore associations of depressive symptoms and resilience with informal activities in residents.

We calculated product scores of frequency and pleasantness for activities from 18 activity clusters in NH residents (AIM, Activities to Improve Mood inventory, Knippenberg et al., in prep). The Geriatric Depression Scale, 8 items (GDS-8, Jongenelis et al., 2007) and the Brief Resilience Scale (BRSnl, Dutch translation, Leontjevas et al., 2014) were administered when interviewing residents. Professional caregivers filled out the Nijmegen Observer Rated Depression scale (NORD, Leontjevas et al., 2011). Spearman’s rho’s of 0.20 to 0.39 and of 0.40 to 0.60 were regarded as weak and moderate, respectively.

277 Dutch speaking NH residents (male, N=104, 38%), from Flanders Belgium (male, N=137, 49.5%) and the Netherlands participated in the study. We found positive weak associations between the self-reported and observer-rated depression scales (GDS-8 and NORD), and between the AIM total score and resilience (BRSnl). Negative weak associations were found for both depression scales and resilience, and for the depression scales and AIM. Individual AIM clusters showed positive weak to moderate associations between resilience and activities stimulating cognition (e.g. reading, puzzling), activities related to nature (e.g. walking in a park, activities with animals), or doing something meaningful for others (e.g. helping with daily routines or volunteering). Regarding depression, next to the three mentioned clusters, negative weak to moderate associations were also found for craft activities, social activities, and showing a positive mindset (e.g. humour, giving compliments).

The results underscore the value of activities that residents may undertake on their own alongside or without a treatment. More research is needed to understand whether informal activities alongside or without a treatment may explain intervention effects (e.g. placebo effects) on depression or resilience, and how these activities may be used to improve treatment protocols.