No abstract

BackgroundCurrent dementia medications have small effect sizes, many adverse effects and do not change the disease course. Therefore, it is critically important to study alternative treatment strategies. The goal of this study was to pilot-test a novel, integrative group exercise program for individuals with mild-to-moderate dementia called Preventing Loss of Independence through Exercise (PLIÉ), which focuses on training procedural memory for basic functional movements (e.g., sit-to-stand) while increasing mindful body awareness and facilitating social connection.MethodsWe performed a 36-week cross-over pilot clinical trial to compare PLIÉ with usual care (UC) at an adult day program for individuals with dementia in San Francisco, CA. Assessments of physical performance, cognitive function, physical function, dementia-related behaviors, quality of life and caregiver burden were performed by blinded assessors at baseline, 18 weeks (cross-over) and 36 weeks. Our primary outcomes were effect sizes based on between-group comparisons of change from baseline to 18 weeks; secondary outcomes were within-group comparisons of change before and after cross-over.ResultsTwelve individuals enrolled (7 PLIÉ, 5 UC) and 2 withdrew (1 PLIÉ, 18 weeks; 1 UC, 36 weeks). Participants were 82% women (mean age, 84 ± 4 years); caregivers were 82% daughters (mean age, 56 ± 13 years). Effect sizes were not statistically significant but suggested potentially clinically meaningful (≥0.25 SDs) improvement with PLIÉ versus UC for physical performance (Cohen’s D: 0.34 SDs), cognitive function (0.76 SDs) and quality of life (0.83 SDs) as well as for caregiver measures of participant’s quality of life (0.33 SDs) and caregiver burden (0.49 SDs). Results were similar when within-group comparisons were made before and after cross-over.ConclusionsPLIÉ is a novel, integrative exercise program that shows promise for improving physical function, cognitive function, quality of life and caregiver burden in individuals with mild-to-moderate dementia. Larger randomized, controlled trials are warranted.Trial RegistrationClinicalTrials.gov NCT01371214

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults.

Background-While it has been reported that persons with posttraumatic stress disorder manifest tonic autonomic activation, the literature contains numerous counter-examples. In revisiting the question, this study employed a novel method of mattress actigraphy to unobtrusively estimate heart rate and respiratory sinus arrhythmia over multiple nights of sleep in the home.

Gender differences were examined in the identity processes of identity assimilation (maintaining identity despite age changes), identity accommodation (changing identity) and balance (using both processes) and in the relationship of these processes to self-esteem. We tested a community sample of 222 adults (131 females and 91 males) ranging from 40 to 84 years of age (M = 57.5, SD = 12.1). Analysis of variance yielded evidence showing greater use of identity accommodation for women. Identity accommodation was negatively associated with self-esteem for both genders, while identity assimilation was positively associated with self-esteem for women only. For both men and women, identity balance was positively related to self-esteem. Women's use of the identity processes in relation to self-esteem is discussed. Societal views on aging are suggested to impact women, such that they engage in identity accommodation while benefiting from identity assimilation. From these findings, it appears that examining the processes contributing to the maintenance of self-esteem may be a more useful approach to characterizing the aging process and gender differences than focusing on mean differences alone.

No abstract

Depression, a significant problem among older adults, is most commonly reported in the primary care setting. To offer the treatments for depression preferred by many older adults, clinical providers and researchers have called for the creation of integrative psychosocial care options in primary care, using mental health providers working in collaboration with medical providers. In this article, we examine the empirical status of integrating treatment for depression in older adults in the primary care setting by summarizing the current models of integrated care and latest research developments. We discuss the strengths and limitations of the current integration models and offer recommendations for expanding work in this important area.

Memory is a salient area of functioning in adulthood known to be influenced by beliefs about performance. To date, individual variations in memory beliefs have not been systematically examined. The present study used hierarchical linear regressions to examine the relationship between Memory Controllability Index (MCI) subscales and identity processes in 250 adults (M = 58.01, 40 to 91 years), controlling for age, gender, and self-rated health. The ability to integrate age-related changes into identity was positively related to MCI scales measuring assessment of ability, potential to improve memory, and belief in the value of using memory strategies. The identity scale measuring negative age-related changes was related to lower memory self-assessment, ability to improve, and the belief that memory decline is inevitable. Contrary to expectation, the tendency to resist making changes in identity was not related to controllability. Findings support the utility of understanding memory-related beliefs in middle and later adulthood in terms of identity processes.