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Studying those who have achieved exceptional longevity can provide a model of successful ageing, however current research remains limited. Previous work on centenarians has primarily focused on depression and anxiety; life satisfaction remains understudied.
To compare the psychological profile of near-centenarians (95-99) and centenarians (100+) with and without dementia. To compare the psychological distress and life satisfaction in near-centenarians and centenarians without dementia with younger age groups. To identify the risk and protective factors of psychological distress and life satisfaction in near-centenarians and centenarians without dementia.
The Sydney Centenarian Study (SCS) collected data from 343 participants aged 95 years and older, of whom 119 had dementia. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Life satisfaction was measured using the Satisfaction with Life Scale (SWLS). Persons aged 70-90 years from the Sydney Memory and Ageing Study (MAS) were used as a cross-sectional comparison group, for which dementia was an exclusion. Multiple linear regressions were undertaken to investigate the predictors for psychological distress and life satisfaction in SCS.
There was no significant difference in K10 or SWLS score between SCS participants with and without dementia. SCS participants without dementia reported significantly higher levels of psychological distress (15.3, 13.4, t=3.869, p<0.001) and life satisfaction (6.0, 5.6, t=5.835, p<0.001) compared to cognitively intact younger age groups in MAS. In SCS, a greater number of psychotropic medications and less contact with friends and family were associated with higher psychological distress. Higher scores on the Mini -Mental State Examination and greater contact with friends and family were associated with higher life satisfaction.
Psychological health was similar in near-centenarians and centenarians whether or not they had dementia. Although near-centenarians and centenarians without dementia demonstrated higher levels of psychological distress in the past 4 weeks than younger age groups, their satisfaction with life was higher. Social support and cognition may be protective factors against poor psychological health and promote greater life satisfaction. Factors identified as associated with psychological distress and life satisfaction may be targets for interventions to maintain good psychological health in this vulnerable population.
Use of antipsychotic drugs in long-term aged care (LTC) is prevalent and commonly exceeds the recommended duration, but contributors to this problem are not well understood. The objective of this study is to provide a snapshot of the features of and contributors to prolonged use of antipsychotic medications (>12 weeks) among a sample of LTC residents.
We present retrospective and baseline data collected for the Australian Halting Antipsychotic Use in Long-Term Care (HALT) single-arm longitudinal deprescribing trial.
Twenty-four long-term care facilities in Sydney, Australia.
The HALT study included 146 older people living in 24 Sydney LTC homes who had been prescribed a regular antipsychotic medication for at least 3 months at baseline.
Detailed file audit was conducted to identify the date and indication recorded at initial prescription, consenting practices, longitudinal course of prescribing, and recommendations for review of antipsychotic medication. Behavioural and psychological symptoms of dementia (BPSD) and functional dependence at baseline were assessed via LTC staff interview. Cognition at baseline was assessed in a participant interview (where possible).
Antipsychotics were prescribed for 2.2 years on average despite recommendations by a doctor or pharmacist for review in 62% of cases. Consent for antipsychotic prescription was accessible for only one case and contraindications for use were common. Longer use of antipsychotics was independently associated with higher dose of the antipsychotic drug and greater apathy, but not with other BPSD.
Antipsychotic medications appeared to be prescribed in this sample as a maintenance treatment in the absence of active indicated symptoms and without informed consent. Standard interventions, including recommendations for review, had been insufficient to ensure evidence-based prescribing.
Current research on the psychological health of near-centenarians (95−99 years old) and centenarians remains limited. Existing studies have mainly characterized their physical, cognitive, and social health. Results on the anxiety and depression of near-centenarians and centenarians (more than 95 years old) have been mixed with some studies, finding higher rates of anxiety and depression among those older than 95 years and others reporting no difference in rates compared with younger age groups. This study aims to synthesize the existing literature on the prevalence and predictors of anxiety and depression in near-centenarians and centenarians.
A systematic review was conducted using Ovid Medline, Embase, PsycINFO, CINAHL, SCOPUS, and the Cochrane database. Common and conflicting findings among the literature were examined.
Thirty-eight studies met the inclusion criteria. Six studies examined the prevalence and predictors of anxiety, and 37 studies investigated the prevalence and predictors of depression. Five studies examined both anxiety and depression in the same sample. Prevalence data on anxiety and depression varied significantly, as did comparisons with rates in younger populations. Findings on predictors of anxiety and depression were contradictory.
There is a large degree of heterogeneity among studies of centenarians’ psychological status. Findings conflict on the prevalence and predictors of anxiety and depression and rates compared with younger age groups. Variation in findings may result from the different inclusion criteria, sampling methods, and measurement tools. Better harmonization of centenarian study methodologies may improve consistency of findings to aid in developing clinical interventions.
Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.
LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.
While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.
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