Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.
Objectives
Anxiety diagnoses occur in 17.1% in people age 65 years and older. Individuals with anxiety may be at a higher risk of the development of probable Alzheimer’s disease (AD). Previous literature has suggested that anxiolytic medications may exacerbate the risk of AD development. This study explored anxiolytic medication as a potential moderator of AD risk in older adults.
Methods
A secondary data analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was undertaken, analyzing observations from 12,083 participants with normal cognition at the first visit. Survival analysis was utilized to examine if anxiolytic medication use by those with anxiety and/or APOE ε4 moderates the hazard of AD and/or MCI development.
Results
The hazard of probable AD (HR = 3.50, [2.77 – 4.44], p <.0001) or MCI (HR = 2.13, [1.85–2.44], p <.0001) development was statistically significant for those with anxiety. This hazard was no longer statistically significant when specific anxiolytics were used. ε4 carriers experienced a statistically significant hazard of AD (HR = 1.92, [1.52–2.41], p <.001) and MCI (HR = 1.17, [1.04–1.32], p <.05) development. This effect was moderated by the use of anxiolytics.
Discussion
The results of this study suggest that anxiolytics may moderate the effect of anxiety on MCI and AD development, specifically indicating a neutralized hazard for those with ε4 carriers with anxiety.
A descriptive and critical analysis of the available empirical literature on social work psychosocial intervention outcomes for adult hospice patients and caregivers was conducted. The electronic bibliographic databases CINHAL (EBSCO), MEDLINE, ProQuest, EMBASE, Campbell Collaboration, and The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) were searched. Search criteria were (a) social work interventions, (b) intervention was tested, (c) adult hospice patients and/or caregivers, (d) studies within the United States, (e) and studies between 2004 and 2014. Of the 21 studies that met the initial search criteria, 5 publications met all review criteria. Based on assessment of study results, intervention effect, and quality of evidence, the ADAPT Problem-Solving Intervention (PSI) and the Hospice Caregiver Support Project have some indications of practical effect on caregiver quality of life, anxiety, stress, and problem-solving skills. The Caregiver Life Line (CaLL) intervention had little to no effect on caregiver role stress or coping skills. The few available studies provide foundational insight into the need for the expansion of research efforts to evaluate hospice social work interventions and document the contributions of social work to the field.
Given the cultural value of family in Hispanic culture, older Hispanic immigrants are likely to have family caregivers. This study examined the economic implications of caring for older Hispanic adults regarding non-housing financial wealth over time. Using the 2008, 2010, and 2012 waves of the Health and Retirement Study (HRS) and RAND HRS data files, this study compares changes in the non-housing financial wealth between 2008 and 2012 by caregiving and immigration status among Hispanics. This study examined differences in assets between Hispanic caregivers and non-caregivers and more specifically examined the subpopulation of Hispanic caregivers who immigrated prior to and after 1968 as compared to U.S.-born caregivers to better understand the effect of the Immigration and Nationality Amendment Act of 1965 on asset change. Results indicate that caregiving itself did not have a statistically significant association with wealth, but the timing of immigration to the US had a statistically significant correlation (p < .05) with changes in the financial wealth. The findings of this study have implications for policy and program development targeting older adults and caregiving for this population.
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