Cognitive Therapy with Aged Persons: Implications of Research Design for Its Implementation and Evaluation

On the basis of intervention research with elderly persons, numerous research design issues are discussed that influence the implementation and evaluation of cognitive therapy with aged individuals. These issues reflect a concern for the impact of placebo effects, sampling, and attrition on treatment efficacy, as well as attention to the measurement of rational thinking in the aged. Moreover, environmental support for rational solutions to everyday problems among older persons may vary. It is argued that given the limited research to date, an awareness of such issues must temper conclusions about the effectiveness of cognitive interventions with older persons.

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The Case of Thematic Tests Adapted to Older Adults

Rorschachiana Journal of the International Society for the Rorschach ◽

10.1027/1192-5604/a000015 ◽

2011 ◽

Vol 32 (1) ◽

pp. 46-71 ◽

Cited By ~ 6

Author(s):

Benoît Verdon

Keyword(s):

Older Adults ◽

Older Persons ◽

Older Men ◽

Elderly Persons ◽

Mental Processes ◽

Men And Women ◽

Projective Tests ◽

New Material ◽

Older Men And Women ◽

Latent Content

Since the 1950s, the growing interest of clinicians in using projective tests to study normal or pathological aging processes has led to the creation of several thematic tests for older adults. This development reflects their authors’ belief that the TAT is not suitable to the concerns and anxieties of elderly persons. The new material thus refers explicitly to situations related to age; it aims to enable older persons to express needs they cannot verbalize during consultations. The psychodynamic approach to thematic testing is based on the differentiation between the pictures’ manifest and latent content, eliciting responses linked to mental processes and issues the respondent is unaware of. The cards do not necessarily have to show aging characters to elicit identification: The situations shown in the pictures are linked to loss, rivalry, helplessness, and renunciation, all issues elderly respondents can identify with and that lead them to express their mental fragilities and resources. The article first explains the principles underlying four of these thematic tests, then develops several examples of stories told for card 3BM of the TAT, thus showing the effectiveness of this tool for the understanding and differentiation of loss-related issues facing older men and women.

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The impact of functional limitations on disability and the moderating effects of psychological attributes in community-dwelling older persons

PsycEXTRA Dataset ◽

10.1037/e536922011-045 ◽

1998 ◽

Author(s):

G. I. J. M. Kempen ◽

M. J. G. van Heuvelen ◽

E. van Sonderen ◽

R. H. S. van den Brink ◽

A. C. Kooijman ◽

...

Keyword(s):

Older Persons ◽

Functional Limitations ◽

Community Dwelling ◽

Moderating Effects ◽

Psychological Attributes ◽

The Impact

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MHealth Applications for People with Cognitive Impairment and Their Caregivers: A Scoping Review (Preprint)

10.2196/preprints.22474 ◽

2020 ◽

Author(s):

Qing Zhao ◽

Pei Chen ◽

Yu Zhang ◽

Haining Liu ◽

Xianwen Li

Keyword(s):

Cognitive Impairment ◽

Sample Size ◽

Research Design ◽

Scoping Review ◽

Life Support ◽

Small Sample ◽

Mobile Technologies ◽

Control Group ◽

Caregiver Support ◽

The Impact

BACKGROUND Mobile health application has become an important tool for healthcare systems. One such tool is the delivery of assisting in people with cognitive impairment and their caregivers. OBJECTIVE This scoping review aims to explore and evaluate the existing evidence and challenges on the use of mHealth applications that assisting in people with cognitive impairment and their caregivers. METHODS Nine databases, including PubMed, EMBASE, Cochrane, PsycARTICLES, CINAHL, Web of Science, Applied Science & Technology Source, IEEE Xplore and the ACM Digital Library were searched from inception through June 2020 for the studies of mHealth applications on people with cognitive impairment and their caregivers. Two reviewers independently extracted, checked synthesized data independently. RESULTS Of the 6101 studies retrieved, 64 studies met the inclusion criteria. Three categories emerged from this scoping review. These categories are ‘application functionality’, ‘evaluation strategies’, ‘barriers and challenges’. All the included studies were categorized into 7 groups based on functionality: (1) cognitive assessment; (2) cognitive training; (3) life support; (4) caregiver support; (5) symptom management; (6) reminiscence therapy; (7) exercise intervention. The included studies were broadly categorized into four types: (1) Usability testing; (2) Pilot and feasibility studies; (3) Validation studies; and (4) Efficacy or Effectiveness design. These studies had many defects in research design such as: (1) small sample size; (2) deficiency in active control group; (3) deficiency in analyzing the effectiveness of intervention components; (4) lack of adverse reactions and economic evaluation; (5) lack of consideration about the education level, electronic health literacy and smartphone proficiency of the participants; (6) deficiency in assessment tool; (7) lack of rating the quality of mHealth application. Some progress should be improved in the design of smartphone application functionality, such as: (1) the design of cognitive measurements and training game need to be differentiated; (2) reduce the impact of the learning effect. Besides this, few studies used health behavior theory and performed with standardized reporting. CONCLUSIONS Preliminary results show that mobile technologies facilitate the assistance in people with cognitive impairment and their caregivers. The majority of mHealth application interventions incorporated usability outcome and health outcomes. However, these studies have many defects in research design that limit the extrapolation of research. The content of mHealth application is urgently improved to adapt to demonstrate the real effect. In addition, further research with strong methodological rigor and adequate sample size are needed to examine the feasibility, effectiveness, and cost-effectiveness of mHealth applications for people with cognitive impairment and their caregivers.

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Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

BMC Health Services Research ◽

10.1186/s12913-021-06668-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jennifer Mann ◽

Fintan Thompson ◽

Robyn McDermott ◽

A. Esterman ◽

Edward Strivens

Keyword(s):

Older People ◽

Older Persons ◽

Hospital Admissions ◽

Community Dwelling ◽

Trial Registration ◽

Significant Finding ◽

Complex Needs ◽

Primary Practice ◽

The Impact ◽

Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

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Do Public Pensions Improve Mental Wellbeing? Evidence from the New Rural Society Pension Insurance Program

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052391 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2391

Author(s):

Fang Wang ◽

Haitao Zheng

Keyword(s):

Mental Health ◽

Rural Society ◽

Rural Elderly ◽

Public Pensions ◽

Mental Wellbeing ◽

Elderly Persons ◽

Pension Insurance ◽

Beneficial Effects ◽

Pension Income ◽

The Impact

The causal effect of public pensions on the mental wellbeing of the elderly in lower and middle-income countries deserves further investigation. This paper first constructed a theoretical framework for the impact of New Rural Society Pension Insurance pensions in China on the mental wellbeing of the rural elderly, and described potential channels through which pension income may affect mental wellbeing. We then used the fixed effect model and the instrument variable approach to estimate the casual effects of pension income on the mental wellbeing of the rural elderly. The results reveal that pension income improves mental wellbeing by relieving depression of the rural elderly; however, the beneficial effects of pension income are very limited. Pension income has no beneficial effects on the mental health of the rural elderly in the east region, whereas it slightly relieves depression of those in the middle and west regions. We also found that pension income produces small improvements in the mental health of older females, elderly persons living independently, and those with relatively poor economic conditions.

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Psychological distress during COVID-19 pandemic in low-income and middle-income countries: a cross-sectional study of older persons in Thailand

BMJ Open ◽

10.1136/bmjopen-2020-047650 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047650

Author(s):

Wiraporn Pothisiri ◽

Paolo Miguel Manalang Vicerra

Keyword(s):

Psychological Distress ◽

Low Income ◽

Older Persons ◽

Online Survey ◽

Well Being ◽

Secondary Outcome ◽

Ageing Society ◽

Psychological Well Being ◽

Middle Income ◽

The Impact

ObjectiveThe COVID-19 situation in Thailand was controlled with various social measures. Much of the information covered in the media and in studies focused on the public health and economic aspects of the pandemic. This study aimed to explore the psychological well-being of older people, which is important especially in an ageing society categorised as low income or middle income due to the limits of economic and healthcare resources.SettingThe impact of COVID-19 on older persons in Thailand, an online survey, taken across nine provinces within the five regions of the country.ParticipantsInformation was collected from 1230 adults aged at least 60 years old.If an older person was illiterate, unable to access the internet or had a disability preventing them from responding to the survey, an intermediary residing in the community conducted the survey interview.Primary and secondary outcome measuresThe analysis focused on the worries of older adults and the factors associated with psychological distress experienced during the pandemic using logistic regression analysis.ResultsThe majority of people aged at least 60 years old experienced psychological distress during COVID-19. Employment loss (OR 1.08, 95% CI 0.78 to 1.38), inadequate income (OR 1.77, 95% CI 1.28 to 2.44) and debt incursion (OR 2.74, 95% CI 1.57 to 4.80) were detrimental to psychological well-being. The negative changes in the perception of their health status (OR 1.92, 95% CI 1.23 to 2.99) and decreased life satisfaction (OR 1.49, 95% CI 0.45 to 1.87) also weighed on older Thais. The protective factors for psychological well-being were residing in rural areas (OR 0.46, 95% CI 0.35 to 0.61) and being married (OR 0.75, 95% CI 0.55 to 1.01).ConclusionObserving the concerns of the older population is important for introducing policies that can alleviate their precarious financial and health statuses.

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Validation of Cognitive Rehabilitation as a Balance Rehabilitation Strategy in Patients with Parkinson’s Disease: Study Protocol for a Randomized Controlled Trial

Medicina ◽

10.3390/medicina57040314 ◽

2021 ◽

Vol 57 (4) ◽

pp. 314

Author(s):

Aida Arroyo-Ferrer ◽

Francisco José Sánchez-Cuesta ◽

Yeray González-Zamorano ◽

María Dolores del Castillo ◽

Carolina Sastre-Barrios ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Therapy ◽

Cognitive Processing ◽

Processing Speed ◽

Cognitive Rehabilitation ◽

Neurodegenerative Disorder ◽

Control Group ◽

Motor Symptoms ◽

The Impact

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. This disease is characterized by motor symptoms, such as bradykinesia, tremor, and rigidity. Although balance impairment is characteristic of advanced stages, it can be present with less intensity since the beginning of the disease. Approximately 60% of PD patients fall once a year and 40% recurrently. On the other hand, cognitive symptoms affect up to 20% of patients with PD in early stages and can even precede the onset of motor symptoms. There are cognitive requirements for balance and can be challenged when attention is diverted or reduced, linking a worse balance and a higher probability of falls with a slower cognitive processing speed and attentional problems. Cognitive rehabilitation of attention and processing speed can lead to an improvement in postural stability in patients with Parkinson’s. Methods: We present a parallel and controlled randomized clinical trial (RCT) to assess the impact on balance of a protocol based on cognitive rehabilitation focused on sustained attention through the NeuronUP platform (Neuronup SI, La Rioja, Spain) in patients with PD. For 4 weeks, patients in the experimental group will receive cognitive therapy three days a week while the control group will not receive any therapy. The protocol has been registered at trials.gov NCT04730466. Conclusions: Cognitive therapy efficacy on balance improvement may open the possibility of new rehabilitation strategies for prevention of falls in PD, reducing morbidity, and saving costs to the health care system.

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The impact of chronic disease and disability on the elderly

South African Journal of Physiotherapy ◽

10.4102/sajp.v55i3.567 ◽

1999 ◽

Vol 55 (3) ◽

pp. 9-14

Author(s):

C. J. Eales

Keyword(s):

Health Care ◽

Chronic Disease ◽

Chronic Diseases ◽

Health Care Systems ◽

The Elderly ◽

Therapeutic Interventions ◽

Elderly Persons ◽

Care Systems ◽

And Function ◽

The Impact

Health care systems for elderly people should aim to delay the onset of illness, reducing the final period of infirmity and illness to the shortest possible time. The most effective way to achieve this is by health education and preventative medicine to maintain mobility and function. Changes in life style even in late life may result in improved health, effectively decreasing the incidence of chronic diseases associated with advancing age. This paper presents the problems experienced by elderly persons with chronic diseases and disabilities with indications for meaningful therapeutic interventions.

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Prevalence and Correlates of Depression in Elderly Persons

Psychological Reports ◽

10.2466/pr0.1980.47.3f.1055 ◽

1980 ◽

Vol 47 (3_suppl) ◽

pp. 1055-1061 ◽

Cited By ~ 9

Author(s):

Edward F. Raymond ◽

Timothy J. Michals ◽

Robert A. Steer

Keyword(s):

Health Care ◽

Regression Analysis ◽

Health Care Providers ◽

Older Persons ◽

Stepwise Regression ◽

The Elderly ◽

Elderly Persons ◽

Care Providers ◽

Self Assessment ◽

Psychiatric Intervention

A sample of 504 elderly persons living within a metropolitan area were questioned about their socio-medical characteristics and administered the Wakefield Self-assessment Depression Inventory. The distribution of depression scores indicated that 34.5% were depressed. Stepwise regression analysis was next used to examine the relationships between the characteristics and depression scores. Total number of self-reported symptoms and being partially housebound were positively associated with depression. Recommendations were made that health care providers for the elderly be alerted that older persons with physical complaints and those who are partially restricted to their homes may tend to develop levels of depression which might require psychiatric intervention.

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