ICC-dementia (International Centenarian Consortium - dementia): an international consortium to determine the prevalence and incidence of dementia in centenarians across diverse ethnoracial and sociocultural groups.

BACKGROUND: Considerable variability exists in international prevalence and incidence estimates of dementia. The accuracy of estimates of dementia in the oldest-old and the controversial question of whether dementia incidence and prevalence decline at very old age will be crucial for better understanding the dynamics between survival to extreme old age and the occurrence and risk for various types of dementia and comorbidities. International Centenarian Consortium - Dementia (ICC-Dementia) seeks to harmonise centenarian and near-centenarian studies internationally to describe the cognitive and functional profiles of exceptionally old individuals, and ascertain the trajectories of decline and thereby the age-standardised prevalence and incidence of dementia in this population. The primary goal of the ICC-Dementia is to establish a large and thorough heterogeneous sample that has the power to answer epidemiological questions that small, separate studies cannot. A secondary aim is to examine cohort-specific effects and differential survivorship into very old age. We hope to lay the foundation for further investigation into risk and protective factors for dementia and healthy exceptional brain ageing in centenarians across diverse ethnoracial and sociocultural groups. METHODS: Studies focusing on individuals aged ≥95 years (approximately the oldest 1 percentile for men, oldest 5th percentile for women), with a minimum sample of 80 individuals, including assessment of cognition and functional status, are invited to participate. There are currently seventeen member or potential member studies from Asia, Europe, the Americas, and Oceania. Initial attempts at harmonising key variables are in progress. DISCUSSION: General challenges facing large, international consortia like ICC-Dementia include timely and effective communication among member studies, ethical and practical issues relating to human subject studies and data sharing, and the challenges related to data harmonisation. A specific challenge for ICC-Dementia relates to the concept and definition of'abnormal' in this exceptional group of individuals who are rarely free of physical, sensory and/or cognitive impairments

Psycho-social factors associated with mental resilience in the Corona lockdown.

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p < 0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p < 0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics

What doesn’t kill you makes you stronger: Sense of coherence moderates growth from stress amidst the first wave of COVID-19 outbreak

Purpose This study explored the role of perceived severity of the pandemic, post-traumatic stress and sense of coherence in the development of post-traumatic growth from exposure to COVID-19 among Hong Kong citizens. Methods A longitudinal online survey was launched during the first local outbreak in Spring 2020. Time 1 was collected at the peak of the outbreak (Mid-March to early-April) with measurements of post-traumatic stress, perceived severity, and sense of coherence; while Time 2 was conducted at the palliation of the outbreak (late-April to early May) with post-traumatic growth measured. Moderated mediation models were tested with SPSS PROCESS version 3.30. Results Among the 327 participants who completed both T1 and T2 questionnaires, 28.4% exhibited probable post-traumatic stress disorder, while 18.0% experienced significant post-traumatic growth in at least one domain. Post-traumatic growth was more likely among people with higher socio-economic backgrounds and with family or close friends having experienced medical quarantine or being tested positive for SAR-CoV-2. The interaction between sense of coherence and post-traumatic stress significantly mediated the link relationship of perceived severity on post-traumatic growth, such that growth was more likely among participants with higher post-traumatic stress and sense of coherence. Conclusion Echoing with the transformational model, our findings highlight the importance of traumatic stress and adaptive coping resources in developing post-traumatic growth. Severe judgments of the novel and challenging pandemic could be conducive to growth, especially when the individuals possess high sense of coherence

Exemplary Care among Chinese Dementia Familial Caregivers

Objective: This study investigates the feasibility of using the Exemplary Care Scale (ECS) among Chinese dementia familial caregivers, and reports its psychometric properties. Method: Back translation was used to develop the Chinese version of ECS (C-ECS). Three hundred and ninety-seven dyads of caregivers and their relatives with dementia responded to an assessment battery which included questions on care recipients&#8217; cognition, behavioral and psychological symptoms, daily activities assistance, social support, and caregiver well-being. Results: Results of an exploratory principal component analysis revealed two subscales in the 11-item C-ECS: considerate caregiving and preserving esteem. C-ECS and its subscales demonstrated sufficient reliability, as well as criteria-related validity through its association with care recipient&#8217;s cognition and health, and caregivers&#8217; well-being and social support. Discussion: Our findings provide preliminary support to C-ECS as a reliable and valid measure of exemplary caregiving among Hong Kong Chinese familial dementia caregivers. In the light of the increasing importance of familial care in dementia care planning, we recommend the use of this brief scale in regular caregiver assessment in research and service delivery

Risk perception as a double-edged sword in policy compliance in COVID-19 pandemic? A two-phase evaluation from Hong Kong

The emphasis of risk has been recognized as a crucial component to effective and successful policy compliance amidst crisis. Yet, during the COVID-19 pandemic, when the dreadfulness of the risk may fluctuate with the severity of the prolonged pandemic, and the nature of public health policy is not confined purely to public health concerns, perceived risk may not always lead to policy compliance. Two surveys (during almost zero case period and during the biggest outbreak) were conducted to examine the dichotomous role of perceived risk and perceived susceptibility in influencing policy compliance in Hong Kong. Although policy compliance increases with the scale of the outbreak, results from path analysis showed that perceived susceptibility and perceived severity have an indirect role in policy complying behaviour when the objective risk is low. Risk variables, such as attitude, knowledge, benefit and trust, have directly shaped policy compliance. More importantly, perceived severity of COVID-19 boosts policy compliance but perceived susceptibility was associated with disobedience to public health policy. Meanwhile, Hong Kong citizens have a selective and conscious preference in regard to the stringency of public health policy: they welcome more law and order, with increasing magnitude of penalty, but reject lockdown measures such as curfew. Regression results implied that demography had a mild contribution to public health policy stringency, with only the female gender being statistically related to higher policy acceptance. This study calls for further reflection on the role of risk, especially perceived susceptibility, in mobilizing policy compliance to COVID-19 related measures

Positive aspects of caregiving in familial care for nonagenarians and centenarians : Findings from Hong Kong Centenarian Study

Caregiving is often filled with pains and gains. Family caregiving for the fast-growing but vulnerable population of near-centenarians and centenarians (NCCs) may contain distinct gratifying aspects. We analyzed quantitative and qualitative data from family caregivers of community-dwelling older adults aged 95 or above in Hong Kong. Quantitative analysis of data from 143 caregivers revealed that higher age and intact hearing ability of their NCC, lack of a domestic helper, higher dependence on basic activities of daily living, higher independence on instrumental activities of daily living, and better self-rated health were related to higher scores on positive aspects of caregiving. Qualitative analysis of data from 96 caregivers identified three themes regarding these positive experiences: (i) acquiring skills to render care; (ii) fulfilling family love and obligation, and (iii) preparing for own graceful aging. Our findings elaborated the nature and mechanisms of caregiving gains against the unique backdrop of exceptional longevity of the care recipients and the Chinese cultural expectations of filial piety

Multiphase optimization of a multicomponent intervention for informal dementia caregivers: a study protocol

Abstract Background Family caregiver interventions are essential to support dementia caregiving. However, such interventions are typically complex and consist of multiple components. Existing evidence rarely delineates the effectiveness and interactions between individual components. To optimise intervention, we adopt the multiphase optimisation strategy (MOST) to test the implementation fidelity and determine the effect of each component and the interactions between each component and the corresponding outcome. Methods A prospective, assessor-blinded, randomised clinical trial with fractional factorial design using the MOST principle. Two hundred fifty family dementia caregivers will be randomised to one of 16 experimental conditions in a fractional factorial design involving six intervention components: (1) dementia and caregiving education; (2) self-care skills; (3) behavioural symptom management; (4) behavioural activation; (5) modified mindfulness-based cognitive therapy; and (6) support group. The first one is the core component, and the five remaining will be examined. Physical health, caregiver burden, stress, psychological well-being, anxiety and depressive symptoms, and social support will be assessed over the 12-month study period. Following the intention-to-treat principle, linear mixed models and regression analyses will be used to examine the specific effect of the five components and their two-way interactions to propose the most effective combination. Discussion This is the first study adopting the multiphase optimisation strategy to identify the most active and engaging components of a psychological intervention for caregivers of patients with dementia. In view that dementia caregiver interventions are increasingly diversified and complex, such knowledge is important to maximise the intervention efficacy and allow the intervention to be implemented within an efficient timeframe and dosage. The optimisation of caregiver support interventions is critical to enhance the health outcomes of caregivers and care recipients, thereby, delaying possible institutionalisation and reducing the costs of long-term dementia care. Trial registration This study was retrospectively registered in the WHO Primary Registry – Chinese Clinical Trials Registry (ChiCTR2300071235). (Protocol date 30/10/2020; version identifier 2020–2021-0045). Registered on 9 May, 2023. Reporting method SPIRIT guideline was followed. Patient or public contribution No patient or public involvement