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Previous studies have identified a number of psychosocial risk factors of dysregulated cortisol (frequently referred to as the “stress hormone”) among older adults with depression. However, these studies have typically only examined a handful of risk factors at a time and have sometimes yielded inconsistent results.
This study aims to address this gap in the literature by simultaneously examining a range of relevant psychosocial predictors of diurnal cortisol among 54 older adults with a depressive disorder. Salivary cortisol was assessed upon awakening, at 5 PM, and at 9 PM across two consecutive days. Participants also completed measures of global psychosocial stress, current psychiatric symptomatology, pervasive distress (e.g. history of past depression), and protective factors (e.g. social support, resiliency, extent to which one has “made sense” of a significant stressor).
High levels of current depressive symptoms, psychiatric comorbidities, past depressive episodes, trait anxiety, and poorer ability to make sense of one's stress were found to be associated with flatter (more abnormal) cortisol slopes. However, when all of these variables were entered simultaneously in a multiple regression analysis, only history of past depression and the degree of sense made of stress emerged as unique predictors of cortisol in the model.
These findings have important implications for identifying depressed elderly individuals with dysregulated cortisol patterns who may be most at risk for health complications. Treatments that aim to limit the chronicity of depression and help to increase the sense made of stress could potentially have a positive impact on health.
Background: There has been limited focus on evaluation of continuing education (CEU) and continuing medical education (CME) in the fields of gerontology and geriatrics. The increasing elderly population combined with the limited clinical workforce highlights the need for more effective methods of continuing education. Traditionally, outcomes of CEU and CME programs relied on self-report measures of satisfaction with the scope and quality of the training, but more recent efforts in this area have focused on outcomes indicating level of improved skills and attitudinal changes of medical and allied health professionals towards working with elderly patients in need of assistance.
Methods: This study focused on the use of “Action Plans” as a tool to stimulate changes in clinical programs following training, along with attempting to determine typical barriers to change and how to deal with them. More than 600 action plans were obtained from participants attending various continuing education classes providing training on care of patients with dementia (PWD) and their families. Both qualitative and quantitative methods, including logistic regression models were used to analyze the data.
Results: Three months following training 366 participants reported whether they were successful in implementing their action plans and identified factors that either facilitated or hindered their goal to make changes outlined in their action plans. Despite the low response rate of program participants, the “action plan” (with follow up to determine degree of completion) appeared to stimulate effective behavioral changes in clinicians working with dementia patients and their family members. Seventy three percent of the respondents reported at least some level of success in implementing specific changes. Specific details about barriers to change and how to overcome them are discussed.
Conclusions: Our results support that developing and writing action plans can be a useful tool to self- monitor behavioral change among trainees over time.
The Mini-Mental State Examination (MMSE) is a commonly used instrument for assessing mental impairment. Previous proposals for its underlying structure have focused on scores obtained from a single administration of the test. Because the MMSE is widely used in longitudinal studies, we examined the pattern of relations among the rates of chance of the items. Data were obtained from 63 subjects for 1.5 years or more. The relations among the rates of change of the MMSE items were described by a five-factor solution that accounted for 75% of the variance and comprised factors pertaining to orientation and concentration, obeying commands, learning and repetition, language, and recall. This was in contrast to the structure of the scores obtained from a single administration of the MMSE, which was best described by a two-factor solution. In order to provide a clinical validation, factor scores derived from the MMSE factors were used to predict scores on the Memory and Behavior Problems Checklist and the Brief Cognitive Rating Scale.
A large percentage of older adults must endure at least one chronic medical illness. Clinically significant depression and anxiety are common among these patients. Specific psychotherapy approaches as well as adaptations required to address the unique issues of this population have not been delineated in the literature. We outline a cognitive-behavioral therapy approach and discuss five treatment issues we have found to be important for this population. These issues include: (1) resolving practical barriers to participation; (2) accepting depression as a separate and reversible problem; (3) limiting excess disability; (4) counteracting the loss of important social roles and autonomy; and (5) challenging the perception of being a “burden.” A case study of a chronic obstructive pulmonary disease (COPD) patient with depression is presented and recommendations for future research are suggested.
Cognitive behaviour therapy (CBT) has proven efficacy as a treatment for depression in older people. An important debate amongst therapists working with older people is whether CBT needs to be adapted to ensure optimal treatment outcome and, if so, what adaptations are necessary. It is accepted that psychotherapy with older people can differ from psychotherapy with younger people in a number of important respects because of the higher likelihood of chronic conditions, changes in cognitive capacity, potential loss experiences and different cohort belief systems. As psychotherapists are often much less comfortable dealing with physical problems, they may become negatively biased in terms of outcome when patients present with co-morbid health issues. The impact of loss experiences in older people can also be overemphasized in their importance by inexperienced therapists and can result in lowered expectations for therapy outcome. Consequently, there is a need to develop a model that addresses age related issues within a coherent cognitive therapy framework suitable for older people. This paper describes a CBT model that is augmented with applied gerontological knowledge, taking account of cohort beliefs, intergenerational linkages, sociocultural context, health status/beliefs and role investments/transitions. Clinical examples are used throughout to illustrate clinical implications of the model.
This article provides a cognitive-behavioral model for psychotherapeutic interventions with suicidal elders. The approach is based on a general model of cognitive behavioral therapy (CBT) with older adults described in Laidlaw, Thompson, Dick-Siskin and Gallagher-Thompson (2003), with specific application to suicidal older adults (Coon & Gallagher-Thompson, 2001). The appeal of CBT in working with older clients is its practical nature and psychoeducational orientation aimed at empowering elderly clients to utilize the techniques outside the psychotherapeutic relationship, with the goal of helping elders develop skills that lead toward better daily self-management and increased life satisfaction. In addition, CBT can be effective in either an individual or group format (DeVries & Coon, 2002). This article begins with a brief review of the characteristics associated with suicide in this population, then describes a CBT model appropriate for use with elders struggling with affective disorders, suicidal ideation, or suicidal behaviors, and ends with a case example illustrating the model's use with suicidal older adults.
The purpose of this chapter is twofold: to summarize basic results from two longitudinal studies of how elders adapt to death of their spouse, depending on whether the death was due to natural causes or to suicide; and to review what these studies have found regarding the possible correlates of good versus poor outcome. A final objective is to present some thoughts about unanswered questions and to suggest further research to shed light on these issues.
The University of Southern California (USC) spousal bereavement study
Although spousal loss occurs predominantly late in life (U.S. Bureau of Census, 1988), few studies have systematically assessed the response to this loss in older adults. The primary objective of the USC study was to assess longitudinally the impact of spousal loss on the mental and physical health of older widows and widowers. In addition, we also evaluated specific predictors of bereavement outcome in light of existing theory and previous research (e.g., Freud, 1917b; Parkes & Brown, 1972). Of particular interest in the USC study were the following factors, each of which alone, and in combination, was thought to be causally related to bereavement outcome: personality and ego strength, social support, religiosity, marital quality, anticipation of loss, and cumulative losses/stressors.
Sample characteristics and research design
Two samples of older adults were compared in the USC study. One sample comprised 212 recently widowed elders (99 males and 113 females) who had lost their spouse as a result of natural causes.
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