Self-Perception of Aging and Satisfaction With Children’s Support

Objectives: Those with self-beliefs in negative aging may desire a stronger support network to buffer against potential threats and may hence see their current network as less than adequate. This study investigated whether negative self-perception of aging is associated with increased dissatisfaction with children’s support. Method: Six hundred and forty Chinese older adults with at least one child and a total of 2,108 adult children rated the degree of support received from each child individually and the degree to which it met their expectation. Additionally, the participants responded to measures of self-perception of aging (both positive and negative), neuroticism, instrumental activities of daily living, chronic illnesses, financial strain, and living status. The multilevel dataset was analyzed using mixed-effects regression. Results: Individuals who had a more negative self-perception of aging, who were younger, who lived alone, and who had fewer children provided lower support satisfaction ratings after support received from children was controlled for. Positive self-perception of aging was unrelated to support satisfaction. Neuroticism did not account for the relationship between negative self-perception of aging and support satisfaction. Discussion: A negative self-perception of aging may create vulnerability to intergenerational tension that puts older people at risk of adverse psychological and physical health outcomes

Short-term effects of a gain-focused reappraisal intervention for dementia caregivers: A double-blind cluster-randomized controlled trial

Objectives To examine the effects of a benefit-finding intervention, the key feature being the use of gain-focused reappraisal strategies to find positive meanings and benefits in caring for someone with dementia. Design: Cluster-randomized double-blind controlled trial. Setting: Social centers and clinics. Participants: 129 caregivers. Inclusion criteria were (a) primary caregiver aged 18+ and without cognitive impairment, (b) providing ≥14 care hours per week to a relative with mild-to-moderate Alzheimer's disease, and (c) scoring ≥3 on the Hamilton Depression Rating Scale. Exclusion criterion was care-recipient having parkinsonism or other forms of dementia. Interventions: The benefit-finding intervention was evaluated against two treatment-as-usuals, namely, simplified psychoeducation (lectures only) and standard psychoeducation. Each intervention lasted eight weeks, with a 2-hour session per week. Randomization into these conditions was based on center/clinic membership. Measurements: Primary outcome was depressive symptom. Secondary outcomes were Zarit Burden Interview, role overload, and psychological well-being. Self-efficacy beliefs and positive gains were treated as mediators. Measures were collected at baseline and posttreatment. Results: Regression analyses showed BF treatment effects on all outcomes when compared with SIM-PE, and effects on depressive symptoms and Zarit burden when compared with STD-PE. Effect sizes were medium-to-large for depressive symptoms (d=-0.77– -0.96), and medium for the secondary outcomes (d=|0.42–0.65|). Furthermore, using the bootstrapping method, we found significant mediating effects by self-efficacy in controlling upsetting thoughts and positive gains, with the former being the primary mediator. Conclusions: Finding positive gains reduces depressive symptoms and burden and promotes psychological well-being primarily through enhancing self-efficacy in controlling upsetting thoughts

Psychological Interventions for Dementia Caregivers:What We Have Achieved, What We Have Learned

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver’s ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts have received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined

Quality of life of the Chinese elderly in Hong Kong : preliminary findings from two focus groups studies

In addressing the issues of developing a culturally sensitive and elderly relevant measure of quality of life, the research teams resort to a multi-staged approach. The first is to take on an easier target group (i.e. those living in community and are reasonably mobile) in an attempt to develop an initial measure for the elderly people living in community. Assuming that this initial measurement will be largely applicable to the frail ones, an alternative version will be developed based on the modification of the former. So the first stage was a series of focus groups designed to exhaust meanings and components of quality of life as reported by the elderly people living in the community. The second stage involved a representative survey of elderly people drawn from the general household survey lists generated by the Censis and Statistics Department. It was from the community survey that a valid measure called Hong Kong Quality of Life for the Elderly in Community Scale (HKQoLECS) was developed (Chan et al, 2000). However, just about the time when a proposal to study the frail was drawn, WHOQOL Study Group in Edinburgh approached the Hong Kong WHOQOL study group to develop a WHOQOL-elderly protocol. The Hong Kong Team then thought it was a good opportunity to collaborate with the WHOQOL Study Group. However, it also means that we have to adopt the WHOQOL-100 (100 items version) as a base rather than using the newly developed HKQoLECS. Nonetheless, the Hong Kong Team, taking that the domains and facets in HKQoLECS were fairly similar to the WHOQOL-100\u27s, accepted to follow the WHOQOL Study Group protocol in developing a WHOQOL version specificially for the elderly people. Procedure taken was almost the same. Focus groups were run in the same way as before, except that WHOQOL-100 was used to facilitate (or frame) the responses of the participants. The present monograph attempted to make comparison between the findings from the first stage focus groups and those from the focus groups using WHOQOL protocol. For clarity of presentation, a brief overview on quality of life concepts and literature will be given first. Then the first focus gropus study and the WHOQOL-elderly focus groups study will be presented in separate sections. The final section will be a comparison of findings from the two focus groups studies

Relationship between cortical thickness and neuropsychological performance in normal older adults and those with mild cognitive impairment

Mild cognitive impairment (MCI) has been extensively investigated in recent decades to identify groups with a high risk of dementia and to establish effective prevention methods during this period. Neuropsychological performance and cortical thickness are two important biomarkers used to predict progression from MCI to dementia. This study compares the cortical thickness and neuropsychological performance in people with MCI and cognitively healthy older adults. We further focus on the relationship between cortical thickness and neuropsychological performance in these two groups. Forty-nine participants with MCI and 40 cognitively healthy older adults were recruited. Cortical thickness was analysed with semiautomatic software, Freesurfer. The analysis reveals that the cortical thickness in the left caudal anterior cingulate (p=0.041), lateral occipital (p=0.009) and right superior temporal (p=0.047) areas were significantly thinner in the MCI group after adjustment for age and education. Almost all neuropsychological test results (with the exception of forward digit span) were significantly correlated to cortical thickness in the MCI group after adjustment for age, gender and education. In contrast, only the score on the Category Verbal Fluency Test and the forward digit span were found to have significant inverse correlations to cortical thickness in the control group of cognitively healthy older adults. The study results suggest that cortical thinning in the temporal region reflects the global change in cognition in subjects with MCI and may be useful to predict progression of MCI to Alzheimer's disease. The different pattern in the correlation of cortical thickness to the neuropsychological performance of patients with MCI from the healthy control subjects may be explained by the hypothesis of MCI as a disconnection syndrome