This study investigated gender differences in the relationship between alcohol consumption and cognitive impairment among older adults in South Korea.

Using data from the Korean Longitudinal Study of Ageing, 2,471 females and 1,657 males were analyzed separately. Cognitive impairment was measured based on the Korean version of the Mini-Mental State Exam score. Logistic regression was conducted to examine the relationship between alcohol consumption and cognitive impairment among Korean older adults.

Multivariate analysis showed that compared to moderate drinkers, past drinkers were more likely to be cognitively impaired for women, while heavy drinkers were more likely to be cognitively impaired for men.

Findings suggest that the relationship between alcohol consumption and cognition varies with gender. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

Frailty is highly prevalent in older people, but its association with cognitive function is poorly understood. The aim of this study was to examine the association between cognitive function and frailty in community-dwelling older adults.

Data were from the 2008 Living Profiles of Older People Survey, comprising 10,388 nationally representative sample aged 65 years and older living in the community in South Korea. Frailty criteria included unintentional weight loss, exhaustion, weakness, low physical activity, and slow walking speed. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Multinomial logistic regression models were constructed with frailty status regressed on cognitive impairment and subdomains of cognitive function, adjusting for covariates.

Those who were frail showed a higher percentage of cognitive impairment (55.8% in men, 35.2% in women) than those who were not (22.1% in men, 15.6% in women). Cognitive impairment was associated with an increased risk of frailty in men (odds ratio (OR) = 1.81, 95% confidence interval (CI): 1.25–2.60) and women (OR = 1.69, 95% CI: 1.25–2.30) even after controlling for all covariates. Among the subdomains of cognitive function, time orientation, registration, attention, and judgment were associated with a lower likelihood of frailty in both men and women after adjusting for confounders. Among women higher scores on recall, language components, and visual construction were also significantly associated with lower odds of frailty.

Cognitive impairment was associated with a higher likelihood of frailty in community-dwelling older men and women. Total scores and specific subdomains of cognitive function were inversely associated with frailty.

Loneliness has been associated with physical and mental health problems. It has also been considered a serious social problem that increases the use and costs of health services. The most widely used instrument in Europe for measuring loneliness is the de Jong Gierveld Loneliness Scale (DJGLS). The aim of this study was to examine the psychometric properties of the 11-item DJGLS by means of the Rasch model, and its convergent and discriminant validity.

Participants were a representative sample of Spanish community-dwelling adults aged 60 and older. We evaluated sociodemographic variables, health, social support, social activity, and subjective well-being measures.

Person and item fit statistics, and standardized residual principal component analysis revealed that the DJGLS was essentially unidimensional. However, we found DIF across marital status and living arrangements. Moderate to high associations were found between loneliness and depression, self-rated loneliness, positive and negative emotions, and satisfaction with life. The DJGLS differentiated between well known-groups according to gender, marital status, living arrangements, health, structural and functional aspects of social networks, and social activity.

The DJGLS is a valid and reliable instrument for measuring loneliness in Spanish older adults. The addition of a few items in order to improve the measurement range is strongly recommended. Our findings are consistent with previous research indicating that loneliness is an important aspect of mental health and subjective well-being, and support the use of the scale to detect vulnerable population in old age.

Dementia is an emerging health priority in Australian Aboriginal communities, but substantial gaps remain in our understanding of this issue, particularly for the large urban section of the population. In remote Aboriginal communities, high prevalence rates of dementia at relatively young ages have been reported. The current study is investigating aging, cognitive decline, and dementia in older urban/regional Aboriginal Australians.

We partnered with five Aboriginal communities across the eastern Australian state of New South Wales, to undertake a census of all Aboriginal men and women aged 60 years and over residing in these communities. This was followed by a survey of the health, well-being, and life history of all consenting participants. Participants were also screened using three cognitive instruments. Those scoring below designated cut-offs, and a 20% random sample of those scoring above (i.e. “normal” range), completed a contact person interview (with a nominated family member) and medical assessment (blind to initial screening results), which formed the basis of “gold standard” clinical consensus determinations of cognitive impairment and dementia.

This paper details our protocol for a population-based study in collaboration with local Aboriginal community organizations. The study will provide the first available prevalence rates for dementia and cognitive impairment in a representative sample of urban Aboriginal people, across city and rural communities, where the majority of Aboriginal Australians live. It will also contribute to improved assessment of dementia and cognitive impairment and to the understanding of social determinants of successful aging, of international significance.

Recent studies that describe the multidimensionality of the Zarit Burden Interview (ZBI) challenge the traditional dual-factor paradigm of personal and role strains (Whitlatch et al., 1991). These studies consistently reported a distinct dimension of worry about caregiver performance (WaP) comprising items 20 and 21.The present study aims to compare WaP against conventional ZBI domains in a predominantly Chinese multi-ethnic Asian population.

We studied 130 consecutive dyads of family caregivers and patients. Factor analysis of the 22-item ZBI revealed four factors of burden. We compared WaP (factor 4) with the other three factors, personal strain, and role strain via: internal consistency; inter-factor correlation; item-to-total ratio across Clinical Dementia Rating (CDR) stages; predictors of burden; and interaction effect on total ZBI score using two-way analysis of variance.

WaP correlated poorly with the other factors (r = 0.05–0.21). It had the highest internal consistency (Cronbach's α = 0.92) among the factors. Unlike other factors, WaP was highly endorsed in mild cognitive impairment and did not increase linearly with disease severity, peaking at CDR 1. Multiple regression revealed younger caregiver age as the major predictor of WaP, compared with behavioral and functional problems for other factors. There was a significant interaction between WaP and psychological strain (p = 0.025).

Our results corroborate earlier studies that WaP is a distinct burden dimension not correspondent with traditional ZBI domains. WaP is germane to many Asian societies where obligation values to care for family members are strongly influential. Further studies are needed to better delineate the construct of WaP.

Aspects of eudaimonic well-being, such as personal growth (PG) and purpose in life (PL), have been highlighted as important to older adults’ health. We investigated the relationship of PG and PL with patterns of survival to the age of 85 years and older.

The sample included 8,880 women from the Women's Health Initiative cohort who reached 85 years of age by December 1, 2013, and for whom data on the PG and PL constructs were available. Women were classified into mutually exclusive outcomes: Healthy, Prevalent, Incident, Disabled, and Deceased. PG and PL were each assessed using a modified seven-item measure derived from the Psychological Well-Being scale.

Women were most commonly classified as Healthy (38.2%, n = 3,395), followed by Incident (24.4%, n = 2,163), Disabled (19.0%, n = 1,685), Prevalent (14.3%, 1,273), and Deceased (4.1%, n = 364). Women with low PL and PG levels were more likely to have prevalent mobility disability and disease or incident death before the age of 85 years. Specifically, those who reported low levels of PG and PL had a 2.1- and 3.6-fold higher risk, respectively, of death.

These findings indicate that even among the oldest old, experience of purposeful life engagement and continuing PG may contribute to better health outcomes.

Sense of coherence (SOC) is associated with the capability to cope with caregiving. Our aims were (1) to describe the trajectory of SOC in aged spousal caregivers of persons with mild Alzheimer's disease (AD) in 3-year follow-up and (2) to identify baseline determinants influencing SOC change.

Both AD (n = 170) (CDR-SOB, MMSE, NPI, ADCS-ADL) and caregiver- (n = 170) (BDI, SOC) related efficacy parameters were evaluated annually. Follow-up time was 3 years. The relationship of potential baseline factors with longitudinal SOC was analyzed using linear mixed models.

The mean drop-out-adjusted SOC score (148.5 at baseline) was decreased by 4.56 points (p = 0.002) during the follow-up. Caregivers’ depression at baseline predicted the significant decrease of SOC (every + 1 BDI point decreases 2.181 points in SOC, p = 0.0001). When caregiver's depression was not taken into account in the analysis, female gender, and higher age and AD patient's lower baseline MMSE were associated significantly (p < 0.05) with decreasing SOC score in the follow-up. Other studied covariates were not associated with SOC change.

SOC is not as stable as expected, but decreases during long-lasting caregiving. Caregiver's depression at baseline predicts SOC decrease over time. In the future, caregiver dependent factors should be evaluated at the beginning of caregiving to target individualized support programmes to the vulnerable caregivers.

Suicide among older people is one of the most rapidly emerging healthcare issues. The objective of this study was to identify the factors associated with suicide ideation in the aged population in South Korea.

The study recruited 684 subjects older than 65 years old (males = 147, females = 537, mean age = 78.20±7.02 years), and trained interviewers performed the interviews. The study was performed as part of a community mental health suicide prevention program. The subjects’ socio-demographic data, physical health, alcohol problems, social relationships, psychological well-being, and depression severity were all considered. The Korean version of the Beck Scale for Suicide Ideation (K-BSI) was used to evaluate the intensity of suicide ideation. Correlation and hierarchical multiple regression analyses were performed to identify the factors associated with the K-BSI. The study results were tested using a path analysis.

Depression severity was positively correlated with suicide ideation, and economic status, psychological well-being, and social relationships were negatively correlated with suicide ideation. Depression severity had the largest direct impact, and economic status and social relationships had indirect impacts on suicide ideation. Psychological well-being exerted both direct and indirect influences.

Depression severity was the most important predictor of suicide ideation among older people. Other direct and indirect factors played secondary roles. Effective suicide prevention strategies should focus on early detection and active intervention for depression. Socio-economic programs may also indirectly reduce suicide ideation among the aged population.

The changing demographics of societies mean that medical students worldwide must be sufficiently prepared to care competently for patients with dementia through development of appropriate knowledge, skills, and attitudes. No previous research had explored undergraduate medical students’ attitudes toward people with dementia.

An adapted version of the Approaches to Dementia Questionnaire (ADQ) was completed by 501 medical undergraduates in years 1, 3, and 5 of their degree programs in the UK and Malaysia. Non-parametric statistical analysis focused on any differences between year groups and geographical locations.

The mean ADQ response indicated a generally positive attitude across the sample, comparable with other healthcare professionals previously surveyed. Year 3 and year 5 students expressed significantly more positive attitudes than year 1 students. Year 1 students based in the UK expressed significantly more positive attitudes than year 1 student based in Malaysia, but there were no significant differences between year 3 students based in different locations.

The more positive attitudes found amongst year 3 and year 5 students compared to year 1 may be a result of teaching emphasizing a person-centered approach. The differences between entry-level students from Malaysia and the UK may reflect variance in cultural norms and expectations, or the ADQ's “Western” origin. Medical schools aiming to equip students with dementia-specific skills and knowledge can draw on the generally positive attitudes found in this study.

Autobiographical memory (ABM), personal semantic memory (PSM), and autonoetic consciousness are affected in individuals with mild cognitive impairment (MCI) but their relationship with Alzheimer's disease (AD) biomarkers are unclear.

Forty-five participants (healthy controls (HC) = 31, MCI = 14) completed the Episodic ABM Interview and a battery of memory tests. Thirty-one (HC = 22, MCI = 9) underwent β-amyloid positron emission tomography (PET) and magnetic resonance (MR) imaging. Fourteen participants (HC = 9, MCI = 5) underwent one imaging modality.

Unlike PSM, ABM differentiated between diagnostic categories but did not relate to AD biomarkers. Personal semantic memory was related to neocortical β-amyloid burden after adjusting for age and apolipoprotein E (APOE) ɛ4. Autonoetic consciousness was not associated with AD biomarkers, and was not impaired in MCI.

Autobiographical memory was impaired in MCI participants but was not related to neocortical amyloid burden, suggesting that personal memory systems are impacted by differing disease mechanisms, rather than being uniformly underpinned by β-amyloid. Episodic and semantic ABM impairment represent an important AD prodrome.

Meta-analyses show efficacy of several psychological and pharmacological interventions for late-life psychiatric disorders, but generalization of effects to routine mental health care for older people remains unknown. Aim of this study is to investigate the improvement of functioning within one year of referral to an outpatient mental health clinic for older adults.

Pre-post measurement of the Health of Nations Outcome Scale 65+ (HoNOS 65+) in 704 older people referred for psychiatric problems (no dementia) to any of the seven participating mental health care organizations.

The pre-post-test Cohen's d effect size was 1.08 in the total group and 1.23 in depressed patients, the largest subgroup. Linear regression identified better functioning at baseline, comorbid personality disorder, somatic comorbidity and life events during treatment as determinants of a worse outcome.

Functioning of older persons with psychiatric problems largely improves after treatment in routine mental health care.

The Geriatric Anxiety Inventory (GAI) was developed to assess anxiety in older adults. The objectives of this work were as follows: (a) to analyze the psychometric properties of the Chinese version of the GAI (GAI-CV), and (b) to explore the extent of anxiety and related factors in the elderly Chinese residents of Beijing.

Participants in this study included 1,047 people (59.4% female) more than 60 years old who were living in the community. They were randomly selected from 15 communities in Beijing. Basic information was collected. Anxiety was measured using the GAI-CV, the Self-Rating Anxiety Scale (SAS), and the Beck Anxiety Inventory (BAI).

The GAI-CV exhibited good internal consistency (Cronbach's α = 0.94) and demonstrated good concurrent validity against the SAS (r = 0.52, p = 0.018) and the BAI (r = 0.560, p = 0.000). Item response theory (IRT) analyses showed that the items of the GAI-CV exhibited high difficulty (0.97–2) and discrimination parameters (1.91–5.33). The items exhibited information parameters greater than 1.25 with the exceptions of items 2, 12, and 18. The GAI-CV scores were significantly associated with gender, age, and chronic disease. However, no significant differences due to marriage or education were found.

The GAI is a new scale that was specifically designed to measure anxiety in older people. The results of this study suggest that the GAI-CV had good psychometric properties, but some items need to be modified. IRT analyses indicated that the GAI-CV provided good measures of anxiety across the moderately high to very high levels. The GAI-CV may be a useful instrument for further research studies aimed at analyzing high-level anxiety among older adults in China.

There are no studies that have identified the ability to recognize and manage delirium among Italian health providers caring for patients at risk. Therefore, the Italian Association of Psychogeriatrics (AIP) conducted a multicenter survey among doctors, nurses, psychologists and physiotherapists to assess their competence regarding the theme of delirium and its management in the everyday clinical practice.

The survey period was 1st June 2013 to 30th November 2013. The invitation to participate was sent via email, with publication on the AIP website. The survey included 14 questions and two case vignettes.

A total of 648/1,500 responses were collected. Most responders were doctors (n = 322/800), followed by nurses (n = 225/500), psychologists (n = 51/100), and physiotherapists (n = 30/100). Generally, doctors and psychologists correctly defined delirium, while nurses and physiotherapists did not. The most frequently used diagnostic tools were the Confusion Assessment Method (CAM) and the Diagnostic and Statistical Manual of Mental Disorders-IV. Delirium intensity was rarely assessed. Hypoactive delirium was generally managed with non-pharmacological approaches, while hyperactive delirium with a combination of non-pharmacological and pharmacological approaches. However, possible causes of delirium were under-assessed by half of doctors and by the majority of other professionals. Nurses, psychologists and physiotherapists did not answer the case vignettes, while doctors identified the correct answer in most cases.

This is the first Italian survey among health providers caring for patients at risk of delirium. This is also the first survey including doctors, nurses, psychologists and physiotherapists. The results emphasize the importance of training to improve knowledge of this relevant unmet medical need.