Who benefits most from expectancy effects? A combined neuroimaging and antidepressant trial in depressed older adults

AbstractDepressed patients’ expectations of improvement drive placebo effects in antidepressant clinical trials, yet there is considerable heterogeneity in the magnitude of expectancy effects. The present study seeks to identify those individuals who benefit most from expectancy effects using baseline neuroimaging and cognitive measures. Older adult outpatients diagnosed with major depressive disorder (MDD) participated in a prospective, 8-week clinical trial in which expectancy was experimentally manipulated and its effects on depression outcome measured. Based on the literature, we selected a priori 12 cognitive and brain-based variables linked to depression and expectancy, together with demographic variables, and incorporated them into a combined moderator. The combined moderator was developed as a weighted combination of the individual moderators, and was used to identify individuals who benefited most from expectancy effects. The combined moderator was found to predict differential change in depression severity scores between the high- vs. low-expectancy groups with a medium-size effect (Spearman effect size: 0.28). While at the sample level no expectancy effect was found, the combined moderator divided older adults with MDD into those who did and those who did not improve as the result of expectancy manipulation, with those benefiting from the manipulation showing greater processing speed, executive function, and frontostriatal white matter tract integrity. The findings suggest that it is possible to identify a subgroup of older adult individuals with MDD for whom expectancy manipulation results in greater antidepressant treatment response, supporting a precision medicine approach. This subgroup is characterized by distinct cognitive dysfunction and neuroimaging impairments profiles.

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ALEXA, ASSESS MY MEMORY: THE FEASIBILITY OF EXTENDED HEALTH MONITORING IN AN OLDER-ADULT-LIVING COMMUNITY

Innovation in Aging ◽

10.1093/geroni/igz038.1224 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S337-S337

Author(s):

Jensen Davis ◽

Shannon Howard ◽

Gregory King ◽

Phanidar Boddu ◽

Kiran Jyothi ◽

...

Keyword(s):

Older Adults ◽

Older Adult ◽

Health Monitoring ◽

Low Income ◽

Wearable Sensors ◽

Voice Recognition ◽

Positive Attitudes ◽

Before And After ◽

Housing Complex ◽

The Individual

Abstract The goal of most older adults is to live independently in their own homes, for as long as possible. There are many advantages to aging in place for the individual, but also challenges as changes in cognitive and physical health can occur over time. Especially for older adults living alone, tracking these changes is critical for early intervention and prevention. The relatively easy availability of consumer technology may provide one mechanism for monitoring older adults in their homes. We designed a pilot study to test the feasibility and acceptability of using wearable sensors (Fitbit sensors), in conjunction with automated interactive voice recognition technology (Amazon Echo), to monitor older adults’ physical and cognitive health during daily activities. Participants (7 females, 2 males; 65-80 years of age) were recruited from a housing complex for older adults with low income. They were interviewed about health monitoring technology before and after a 2-week measurement period during which they were expected to wear the Fitbit daily and interact with the Amazon Echo for 8 consecutive days. Feasibility challenges included limited skill in Echo interactions, remembering to do the assessments, and charging/uploading Fitbit data. Qualitative analysis of interviews revealed generally positive attitudes about technology, but low comfort operating the devices. These preliminary findings suggest that with additional training for older adults, sensors and voice recognition technologies could have significant roles in maintaining older adult quality of life by contributing to early detection of decline and timely intervention.

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Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety

Innovation in Aging ◽

10.1093/geroni/igab051 ◽

2022 ◽

Vol 6 (1) ◽

Author(s):

Robert Toups ◽

Theresa J Chirles ◽

Johnathon P Ehsani ◽

Jeffrey P Michael ◽

John P K Bernstein ◽

...

Keyword(s):

Older Adults ◽

Older Adult ◽

Inverse Correlation ◽

The United States ◽

Evidence Base ◽

Driving Performance ◽

Cognitive Measures ◽

Conducting Research ◽

Risky Driving Behaviors ◽

Design And Methods

Abstract Background and Objectives Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers. Research Design and Methods Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review. Results Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints. Discussion and Implications There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy.

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Initial evaluation of the Older Adult Social-Evaluative Situations Questionnaire: a measure of social anxiety in older adults

International Psychogeriatrics ◽

10.1017/s1041610212001275 ◽

2012 ◽

Vol 24 (12) ◽

pp. 2009-2018 ◽

Cited By ~ 6

Author(s):

Christine E. Gould ◽

Lindsay A. Gerolimatos ◽

Caroline M. Ciliberti ◽

Barry A. Edelstein ◽

Merideth D. Smith

Keyword(s):

Older Adults ◽

Social Anxiety ◽

Psychometric Properties ◽

Older Adult ◽

Convergent Validity ◽

Discriminant Validity ◽

Short Form ◽

Depression Scale ◽

Demographic Variables ◽

Community Dwelling

ABSTRACTBackground: The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES).Methods: Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire.Results: Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables.Conclusions: Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults.

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Participation of Chronically Ill Older Adults in Their Life-Prolonging Treatment Decisions: Rights and Opportunity

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800010321 ◽

1998 ◽

Vol 17 (1) ◽

pp. 1-23 ◽

Cited By ~ 9

Author(s):

Sarah Shidler

Keyword(s):

Older Adults ◽

Health Care ◽

Decision Making ◽

Clinical Practice ◽

Older Adult ◽

Chronically Ill ◽

Treatment Decisions ◽

The Individual ◽

The Right ◽

Legal Guidelines

ABSTRACTThe right of the individual to participate in her life-prolonging treatment decisions, either as a decision maker or by having her treatment wishes used as a decision-making criterion, is the result of an evolution in legal guidelines over the last two decades. Although necessary, these legal guidelines are however not sufficient to assure the individual's opportunity to participate. For the chronically ill older adult residing in a health care institution, the opportunity to participate in decisions concerning life-prolonging treatments implicitly depends on the effective communication among three key actors (the individual, her physician, and her proxy). The necessity of this communication has important implications for clinical practice and future empirical research.

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Talk or Walk? Gait Speed over Self-Report in Association with Cognitive Speed in Healthy Older Adults

GeroPsych ◽

10.1024/1662-9647/a000202 ◽

2019 ◽

Vol 32 (1) ◽

pp. 41-52

Author(s):

Matthew C. Costello ◽

Shane J. Sizemore ◽

Kimberly E. O’Brien ◽

Lydia K. Manning

Keyword(s):

Older Adults ◽

Older Adult ◽

Gait Speed ◽

Well Being ◽

Self Report ◽

Subjective Report ◽

Healthy Older Adults ◽

Relative Value ◽

Cognitive Speed ◽

Age Range

Abstract. This study explores the relative value of both subjectively reported cognitive speed and gait speed in association with objectively derived cognitive speed. It also explores how these factors are affected by psychological and physical well-being. A group of 90 cognitively healthy older adults ( M = 73.38, SD = 8.06 years, range = 60–89 years) were tested in a three-task cognitive battery to determine objective cognitive speed as well as measures of gait speed, well-being, and subjective cognitive speed. Analyses indicated that gait speed was associated with objective cognitive speed to a greater degree than was subjective report, the latter being more closely related to well-being than to objective cognitive speed. These results were largely invariant across the 30-year age range of our older adult sample.

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Prescription of Exercise in Older Adults, Physiotherapeutic Approach

Medical & Clinical Research ◽

10.33140/mcr.02.05.01 ◽

2017 ◽

Vol 2 (5) ◽

Keyword(s):

Older Adults ◽

Older Adult ◽

Exercise Prescription

• Identify the changes related to aging that must be taken into account for the prescription of the exercise • Define the appropriate functional assessmentsforthe prescription of the exercise in the older adult • Recognize the factors that influence the adherence to exercise by older adults • Describe according to the objectives the correct exercise prescription for older adults.

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Physical Inactivity in Older Adult Couples: A Dyadic Analysis Using Continuous In-Home Monitoring

Innovation in Aging ◽

10.1093/geroni/igaa057.1327 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 412-412

Author(s):

Chao-Yi Wu ◽

Lyndsey Miller ◽

Rachel Wall ◽

Zachary Beattie ◽

Jeffrey Kaye ◽

...

Keyword(s):

Mental Health ◽

Older Adults ◽

Older Adult ◽

Physical Inactivity ◽

Home Monitoring ◽

Health Determinants ◽

Dyadic Analysis ◽

Physical And Mental Health ◽

Positive Health ◽

Aging Research

Abstract Many older adults remain inactive despite the known positive health implications of physical activity (e.g. improved mood, reduced mortality risk). Physical inactivity is a known interdependent phenomenon in couples, but the majority of research identifies determinants of physical inactivity at the individual level. We estimated the average amount of physical inactivity for older adult couples and, using dyadic analysis, identified physical and mental health determinants thereof. Forty-eight heterosexual older adult couples (mean age=70.6, SD=6.63) from the Veterans Integrated Service Network 20 cohort of the Collaborative Aging Research using Technology (CART) initiative were included in this study. Both dyad members wore actigraph devices for a month. The average number per day of inactive periods (defined as no movement or sleep activity for ≥ 30 minutes) was estimated. Multilevel modeling revealed that, within couples, there was no difference between partners in the average number of inactive periods, but on average across couples, males had more inactive periods per day (13.4, SD=4.43) than females (12.3, SD=4.87). For males, older age was the only variable associated with more inactive periods (β=0.13, p=.013). For females, more depressive symptoms in men were associated with fewer inactive periods (β=-0.37, p=.002), and more dependence in completing their own IADLs predicted more inactive periods (β=2.80, p<.001). All models were adjusted for covariates. Viewing couples’ activity as a unit, rather than as separate individuals, provides a novel approach to identifying pathways to reduce inactivity in older adults, especially when focusing on mental health issues and decreased independence within the couple.

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Sex Difference in Self-Reported Sexual Functioning Among Frail Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1002 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 313-313

Author(s):

Brianne Olivieri-Mui ◽

Sandra Shi ◽

Ellen McCarthy ◽

Dae Kim

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Sex Differences ◽

Sexual Function ◽

Older Adult ◽

Sexual Functioning ◽

Social Life ◽

Well Being ◽

Adult Males ◽

Males And Females

Abstract Frailty may differentially impact how older adult males and females perceive sexual functioning, an important part of well-being. We assessed the level of frailty (robust, pre-frail, frail) for anyone with data on 11 sexual functioning questions asked in wave 2 of the National Social Life, Health, and Aging Project, 2010-2011 (n=2060). Questions covered five domains: overall sexual function (OSF), sexual function anxiety (SFA), changes in sexual function (CSF), erectile/vaginal dysfunction (EVD), and masturbation. Logistic regression identified sex differences in frailty and reporting worse sexual functioning. Linear regression predicted the number of domains reported as worse. Among males (n=1057), pre-frailty meant higher odds of reporting SFA (OR 1.8 95%CI 1.2-6.6), CSF (OR 1.7 95%CI 1.1-2.7), and EVD (OR 1.5 95%CI 1.0-2.2). Among females (n=1003), there was no difference in reporting by frailty. Females were more likely to report worse OSF (Robust: OR 7.4, 95%CI 4.8-11.4; Pre-frail: OR 6.2, 95%CI 3.9-9.9; Frail: OR 3.4 95%CI 1.7-6.6), but less likely to report SFA (Robust OR .3, 95%CI .2-.5; Pre-frail OR .2, 95%CI .1-.3; Frail OR .2 95%CI .1-.3). Pre-frail and frail females reported fewer domains as worse (Pre-frail coefficient -0.21 SE 0.09, Frail -0.43 SE 0.14). As frailty worsened, males reported more domains as worse (Pre-frail 0.24 SE 0.07, Frail 0.29 SE 0.08). Self-reported sexual functioning differs by sex at all levels of frailty, and reporting by males, but not females, changes with frailty. Providers should be aware that sexual functioning is of importance to both sexes despite varying degrees of frailty.

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Depressive Symptoms Among Rural “Left-Behind” Older Adults: A Test of the High Outmigration Penalty Hypothesis

The Journals of Gerontology Series B ◽

10.1093/geronb/gbab040 ◽

2021 ◽

Author(s):

Qian Song ◽

Haowei Wang ◽

Jeffery A Burr

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Rural Communities ◽

Older Adult ◽

Psychological Health ◽

Economic Conditions ◽

Adult Density ◽

Chinese Adults ◽

Older Chinese ◽

Older Chinese Adults

Abstract Objectives We investigated whether there was a “high outmigration penalty” for psychological health among older adults in rural China by assessing 2 potential community stressors associated with major sociodemographic changes in the community—increased outmigration and older adult density. We also investigated whether disparities in community economic conditions moderated the association between community stressors and depressive symptoms. Methods We employed 3 waves of data from the China Health and Retirement Longitudinal Study (2011–2015), using multilevel negative binomial models to address our research questions. Results Our results supported the “high outmigration penalty” hypothesis. Older adults living in low-income rural communities may experience an aggravated mental health penalty compared to those living in high-income rural communities. Higher older adult density was also associated with more depressive symptoms but only in less wealthy communities. Community differences in economic conditions were key factors buffering the high outmigration disadvantage associated with the psychological health of older Chinese adults. Discussion Rural outmigration may have deepened existing intercommunity health disparities among older adults. Policies should be developed to address community-level factors negatively associated with the well-being of older Chinese adults living in high outmigration and less wealthy rural communities.

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Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study

Pharmaceuticals ◽

10.3390/ph14060526 ◽

2021 ◽

Vol 14 (6) ◽

pp. 526

Author(s):

Sławomir Murawiec ◽

Marek Krzystanek

Keyword(s):

Depressive Symptoms ◽

Pilot Study ◽

Antidepressant Treatment ◽

Case Series ◽

Symptom Cluster ◽

Study Results ◽

Cluster Matching ◽

The Individual ◽

Meta Analyses ◽

Effectiveness Studies

Despite treating depression with antidepressants, their effectiveness is often insufficient. Comparative effectiveness studies and meta-analyses show the effectiveness of antidepressants; however, they do not provide clear indications as to the choice of a specific antidepressant. The rational choice of antidepressants may be based on matching their mechanisms of action to the symptomatic profiles of depression, reflecting the heterogeneity of symptoms in different patients. The authors presented a series of cases of patients diagnosed with depression in whom at least one previous antidepressant treatment was shown to be ineffective before drug targeted symptom cluster-matching treatment (SCMT). The presented pilot study shows for the first time the effectiveness of SCMT in the different clusters of depressive symptoms. All the described patients obtained recovery from depressive symptoms after introducing drug-targeted SCMT. Once validated in clinical trials, SCMT might become an effective and rational method of selecting an antidepressant according to the individual profile of depressive symptoms, the mechanism of their formation, and the mechanism of drug action. Although the study results are preliminary, SCMT can be a way to personalize treatment, increasing the likelihood of improvement even in patients who meet criteria for treatment-resistant depression.

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