NATIONAL INSTITUTE ON AGING NIH STRATEGIC PLAN TO REDUCE AND ULTIMATELY ELIMINATE HEALTH DISPARITIES

The NIA maintains a year-round scientific planning process that draws upon interactions with scientists throughout the world, members of Congress, the Institute's National Advisory Council on Aging (NACA) and other advisory committees, constituency groups, and the public. These interactions stimulate internal consideration of potential new research strategies and provide a broad perspective for refining plans. Emphasis is given to novel proposals and collaborative projects that promise to stimulate activities with other research organizations

Teleological explanation and positive emotion serially mediate the effect of religion on well‐being

Objective: Previous research has demonstrated a robust relationship between religion and well‐being, and it has been proposed that positive emotions are important mediators of this effect. Yet the mechanism via which religion promotes positive emotions has not been widely studied. We sought to examine whether teleological explanations of daily events and resulting positive emotions serially mediated the effects of religion on well‐being. Method: These hypotheses were tested over three studies. In study 1, participants completed measures of religiousness and well‐being, and explained and described three recent personally significant events and their resulting emotions. Studies 2 and 3 adopted an ecological momentary assessment approach to measure teleological explanations, resulting emotions, and well‐being in almost real time. Results: In study 1, teleological explanations and positive emotions serially mediated the effects of religiousness on well‐being. In study 2, momentary teleological explanations of daily events mediated the positive relationship between religiousness and momentary positive emotions. In Study 3, serial mediation of the relationship between religiousness and momentary well‐being by momentary teleological explanations and positive emotions was observed. Conclusions: These results provide evidence of the importance of teleological explanations of daily events in religious enhancement of well‐being

Religious conversion among high security hospital patients: a qualitative analysis of patients’ accounts and experiences on changing faith

Research has shown the importance of religion in recovery from mental illness. Previous studies have investigated why individuals change faith during custody in prison, but there has been no research to date on religious conversion in forensic-psychiatric hospitals. The aim of this study was to understand the experience of religious conversion among patients detained in a UK secure hospital. Thirteen patients who had converted their religion were interviewed and the resultant data were analysed using thematic analysis. Three superordinate themes (‘reasons for changing faith’, ‘benefits of having a new faith’ and ‘difficulties with practising a faith’), incorporating eight subordinate themes, emerged. Understanding patients’ reasons for religious conversion is important for the treatment and support not merely of these individuals, but more broadly with patients in forensic psychiatric care

Optimizing drug therapy in patients with advanced dementia: A patient-centered approach

Background: Advanced dementia is a prevalent health problem in geriatric patients. These patients usually suffer from several chronic diseases, frequently leading to an end-of-life situation lasting months or years, generating complex and often inappropriate medication regimens. Objectives: Describe the re-orientation of drug therapy in patients with advanced dementia utilizing a systematic medication review process. Methods: This non-experimental pre-post analysis included all patients with advanced dementia admitted to acute geriatric unit (AGU) over one year. Medications were reviewed by a multidisciplinary team and together with the patient caregivers; new therapeutic objectives based on end-of-life care principles were established. Medications were classified as preventive, therapeutic, or symptomatic. The average number of medications per patient pre- and post-admission was compared. Results: We included 73 patients (mean age 86.1 years, mean Barthel Index: 14.5/100). At admission, patients had a mean of 7.27 drugs compared to 4.82 at discharge (66.85% reduction, P < 0.05). The main drugs withdrawn were cardiovascular and hematological (35.76%). Drugs for prevention decreased by 66.85% (from 1.8 to 0.6, P < 0.05) and those for symptomatic care decreased by 17,52% (from 2.34 to 1.93, P < 0.05). Conclusion: Medication therapy plans in patients with advanced dementia often do not meet their therapeutic goals. The proposed methodology is a useful tool to assess therapeutic appropriateness

“Should I stay or should I go now?” : A qualitative study of why UK doctors retire

Funding information Our thanks go to the University of Aberdeen Development Trust and the British Medical Association (Scotland) for funding this work. ACKNOWLEDGEMENTS Our thanks to all those doctors who participated in the study. Our thanks also to the BMA (Scotland) for distributing the invitation to take part in the study to their members. No patients or any members of the public were involved in this study.Peer reviewedPostprintPostprin

Frequency and Course of Mild Cognitive Impairment in a Multiethnic Community

Objective To examine incidence rates and antecedents of mild cognitive impairment (MCI) and Alzheimer's disease (AD) among diverse elders without dementia at the initial visit, and to examine the characteristics of elders with MCI who reverted to normal on follow-up examination. Methods A total of 2,364 Caribbean Hispanic, black, or non-Hispanic white subjects, aged 65 or older, who were free of dementia at initial evaluation were followed up every 18 to 24 months. Incidence rate of MCI and AD was determined by examination of neurological, medical, psychiatric, and neuropsychological function. Results Over 10,517 person-years, 21% of normal elderly subjects progressed to MCI (annual incidence rate, 5.1%; 95% confidence interval, 4.6–5.6%). Of those with MCI initially, 21.8% were subsequently diagnosed with AD (annual incidence rate, 5.4%; 95% confidence interval, 4.7–6.3%), 47% remained unchanged, and 31% reverted to normal. Those with MCI were 2.8 times more likely to experience development of AD than normal elderly subjects. MCI with impairment in memory and at least one other cognitive domain was associated with greatest risk for progression to AD and was also least likely to revert to normal at follow-up. Consistent diagnosis of MCI or incident probable or possible AD was 60% sensitive and 94% specific for the pathological diagnosis of AD. Interpretation Impaired memory and language were useful predictors of transition to AD. Reversion to normal from MCI was frequent, but those with impairment in more than one cognitive domain were more likely to progress or remain impaired than those with single-domain impairment. Clinical diagnosis of MCI does not always predict AD neuropathology. Ann Neurol 200

Development and preliminary evaluation of a quality of life measure targeted at dementia caregivers

<p>Abstract</p> <p>Background</p> <p>Providing care for individuals with a progressive, debilitating condition such as dementia can adversely impact the quality of life (QOL) of informal caregivers. To date, there is no existing caregiver quality of life measure for dementia caregivers with breadth of coverage or that is applicable to caregivers of diverse ethnic backgrounds. The purpose of this study was to develop and evaluate a caregiver-targeted quality-of-life measure (CGQOL) for informal caregivers of persons with dementia that can be used with caregivers from a variety of ethnicities.</p> <p>Methods</p> <p>91 items were field tested by telephone interviews with 179 English-speaking and 21 monolingual Spanish-speaking caregivers of persons with dementia. Repeat interviews were conducted with 71 caregivers. Administration time, scale score distributions, item-scale correlations, reliability, and associations of scales with patient and caregiver demographic and caregiving characteristics were estimated. Structure of associations among scales was examined using exploratory factor analysis.</p> <p>Results</p> <p>Item analysis yielded 80 items distributed across 10 scales, with median administration time of 17 minutes [IQR 13.5–22 minutes] and minimal missing data. There were few floor or ceiling effects in scale score distributions. Internal consistency reliability was ≥ 0.78 for all scales; test-retest reliability (intraclass correlation) estimates exceeded 0.70 for 6 scales. More hours weekly spent in caregiving was uniquely associated with worse quality of life on 8 scales (p's ≤ 0.05). Three higher-order dimensions of caregiving assistance, emotional and social concerns, and spirituality and benefits were identified.</p> <p>Conclusion</p> <p>These preliminary results support subsequent evaluation of test-retest reliability, construct validity, and responsiveness to change of this quality-of-life measure for caregivers from diverse ethnicities.</p

A Preliminary Study of Elderly Emergency Service Clients in Chicago and Their Housing-Related Problems

Emergencies to which city agencies respond reveal a connection between homelessness and other housing hardships of the elderly. This study examines a random sample of 125 case records of elderly clients assisted by the Chicago Department of Human Services Emergency Services program between 1984 and 1987. The crises that lead to emergency services, the extent of clients' housing-related problems, and the needs that cluster around shelter placement and other housing related problems are analyzed An extraordinarily broad range of problems and service needs are identified The findings reveal the prevalence of housing problems for the elderly and the relationship between basic needs, patterns of services offered, and certain emergencies, includ ing homelessness. They have implications for improving client services and underscore the importance of ongoing rather than emergency assistance with the elderly. Very old persons without kin who experience crises are at great risk and pose growing dilemmas for urban public agencies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68265/2/10.1177_073346489201100102.pd