Joyce Siette

Age-specific effects of voluntary exercise on memory and the older brain.

BACKGROUNDnPhysical exercise in early adulthood and mid-life improves cognitive function and enhances brain plasticity, but the effects of commencing exercise in late adulthood are not well-understood.nnnMETHODnWe investigated the effects of voluntary exercise in the restoration of place recognition memory in aged rats and examined hippocampal changes of synaptic density and neurogenesis.nnnRESULTSnWe found a highly selective age-related deficit in place recognition memory that is stable across retest sessions and correlates strongly with loss of hippocampal synapses. Additionally, 12 weeks of voluntary running at 20 months of age removed the deficit in the hippocampally dependent place recognition memory. Voluntary running restored presynaptic density in the dentate gyrus and CA3 hippocampal subregions in aged rats to levels beyond those observed in younger animals, in which exercise had no functional or synaptic effects. By contrast, hippocampal neurogenesis, a possible memory-related mechanism, increased in both young and aged rats after physical exercise but was not linked with performance in the place recognition task. We used graph-based network analysis based on synaptic covariance patterns to characterize efficient intrahippocampal connectivity. This analysis revealed that voluntary running completely reverses the profound degradation of hippocampal network efficiency that accompanies sedentary aging. Furthermore, at an individual animal level, both overall hippocampal presynaptic density and subregional connectivity independently contribute to prediction of successful place recognition memory performance.nnnCONCLUSIONSnOur findings emphasize the unique synaptic effects of exercise on the aged brain and their specific relevance to a hippocampally based memory system for place recognition.

A bout of voluntary running enhances context conditioned fear, its extinction, and its reconsolidation

Three experiments used rats to examine the effect of a single bout of voluntary activity (wheel running) on the acquisition, extinction, and reconsolidation of context conditioned fear. In Experiment 1, rats provided with access to a wheel for 3 h immediately before or after a shocked exposure to a context froze more when tested in that context than rats provided with access to the wheels 6 h after the shocked exposure or rats not provided with access to the wheels. In Experiment 2, rats provided with access to the wheels immediately before or after a nonshocked exposure to the conditioned context froze less when tested in that context than rats provided with access to the wheels 6 h after the nonshocked exposure or rats not provided with access to the wheels. In Experiment 3, rats provided with access to wheels immediately after an extended nonshocked exposure to the conditioned context again froze less, whereas rats provided with access to the wheels after a brief nonshocked exposure froze more on the subsequent test than sedentary controls. These results show that a single bout of running can enhance acquisition, extinction, and reconsolidation of context conditioned fear.

To befriend or to be a friend: a systematic review of the meaning and practice of “befriending” in mental health care

Abstract Background: “Befriending” involves pairing a volunteer with a person with a mental illness in the community to spend social time together. The term can have very different connotations. Aims: To review how “befriending” was used in mental health care. Method: A systematic review with a narrative synthesis was used to explore how befriending is conceptualised and practiced. We extracted descriptions of “befriending” from efficacy studies, befriending manuals, and reports from the gray literature and explored the practical implications of the different concepts of “befriending”. Results: The lay understanding of the phrase “to befriend” is “to be a friend to”. This contrasts to codes of practice used by befriending organisations, which describes a relationship distinct from friendship. The literature (12 relevant papers total) suggests a spectrum of practices; at one end is a relationship that is professional or therapeutic in nature, while at the other end, the relationship is conceptualised as much closer to a naturally occurring friendship. Conclusion: The different concepts determine distinct practices, which may lead to confusion when the term befriending is used. The term “befriending”, may be understood to concern friendship, which may be inappropriate where the organisation offers a professional style relationship.

Effectiveness of befriending interventions: a systematic review and meta-analysis

Objective Befriending is an emotional supportive relationship in which one-to-one companionship is provided on a regular basis by a volunteer. It is commonly and increasingly offered by the voluntary sector for individuals with distressing physical and mental conditions. However, the effectiveness of this intervention on health outcomes is largely unknown. We aim to conduct a systematic review of the benefits of befriending. Design Systematic review. Methods A systematic search of electronic databases was conducted to identify randomised controlled trials and quasi-experimental trials of befriending for a range of physical and mental health indications including depression, anxiety, mental illness, cancer, physical illness and dementia. Main outcomes included patient-relevant and disease-specific outcomes, such as depression, loneliness, quality of life, self-esteem, social support and well-being. Results A total of 14 trials (2411 participants) were included; 7 were judged at low risk of bias. Most trials showed improvement in symptoms associated with befriending but these associations did not reach statistical significance in all trials. Befriending was significantly associated with better patient-reported outcomes across primary measures (standardised mean difference 0.18 (95% CI, −0.002 to 0.36, I2=26%, seven trials)). However, there was no significant benefit on single outcomes, including depression, quality of life, loneliness ratings, self-esteem measures, social support structures and well-being. Conclusions There was moderate quality evidence to support the use of befriending for the treatment of individuals with different physical and mental health conditions. This evidence refers to an overall improvement benefit in patient-reported primary outcomes, although with a rather small effect size. The current evidence base does not allow for firm conclusions on more specific outcomes. Future trials should hypothesise a model for the precise effects of befriending and use specified inclusion and outcome criteria.

Assessing Social Networks in Patients with Psychotic Disorders: A Systematic Review of Instruments.

Background Evidence suggests that social networks of patients with psychotic disorders influence symptoms, quality of life and treatment outcomes. It is therefore important to assess social networks for which appropriate and preferably established instruments should be used. Aims To identify instruments assessing social networks in studies of patients with psychotic disorders and explore their properties. Method A systematic search of electronic databases was conducted to identify studies that used a measure of social networks in patients with psychotic disorders. Results Eight instruments were identified, all of which had been developed before 1991. They have been used in 65 studies (total N of patients = 8,522). They assess one or more aspects of social networks such as their size, structure, dimensionality and quality. Most instruments have various shortcomings, including questionable inter-rater and test-retest reliability. Conclusions The assessment of social networks in patients with psychotic disorders is characterized by a variety of approaches which may reflect the complexity of the construct. Further research on social networks in patients with psychotic disorders would benefit from advanced and more precise instruments using comparable definitions of and timescales for social networks across studies.

Additional exposures reverse the latent inhibitory effects of recent and remote exposures.

We studied the learning produced by simple exposures to a stimulus. Exposures depressed orienting and subsequent conditioned freezing in rats. A remotely preexposed conditioned stimulus (CS) conditioned better and overshadowed a novel CS more than a recently preexposed CS. Additional preexposures reversed these effects: a remotely preexposed CS elicited more orienting, conditioned worse and overshadowed less than a recently preexposed CS. Exposure to a compound composed of a novel CS and a remotely preexposed CS resulted in the novel CS subsequently conditioning better than a novel CS exposed in compound with a recently preexposed CS. The results were interpreted to mean that stimulus-alone exposures produce a loss in associability which recovers across time, that this restoration deepens the loss in associability, and that this deepening is regulated by a common error term.

Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data

OBJECTIVEnTo examine home care service-related and person-based factors associated with time to entry into permanent residential aged care.nnnDESIGNnLongitudinal cohort study using routinely collected client management data.nnnSETTINGnA large aged care service provider in New South Wales and the Australian Capital Territory, Australia.nnnPARTICIPANTSnA total of 1116 people aged 60xa0years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30,xa02016.nnnMETHODSnSurvival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used.nnnRESULTSnBy December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (nxa0=xa0235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratioxa0=xa00.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer.nnnCONCLUSIONSnGreater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults care choices.

Longitudinal variation in pressure injury incidence among long-term aged care facilities

ObjectivenTo examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation.nnnDesignnLongitudinal incidence study using routinely-collected electronic care management data.nnnSettingnA large aged care service provider in New South Wales and the Australian Capital Territory, Australia.nnnParticipantsnAbout 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016.nnnMain Outcome MeasurenRisk-adjusted PI incidence rates over eight study quarters.nnnResultsnIncidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038).nnnConclusionsnThere is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention.

Integrating social engagement instruments into Australian community aged care assessments to enhance service provision

Rich social relationships contribute to improved well-being and health outcomes, yet aged care client assessments tend to focus almost exclusively on physical issues. We aim to explore the experiences of aged care staff following their use of social engagement and well-being instruments as part of routine assessments for home-care clients. The social engagement (Australian Community Participation Questionnaire, ACPQ) and well-being (ICEpop CAPability Measure for Older Adults, ICECAP-O) instruments were embedded into the centralised information system of an Australian aged care provider. Staff administered these instruments during routine client assessments across a 9-month period involving 289 assessments. Semistructured interviews with 12 staff members were conducted and themes explored using qualitative content analysis. Key factors related to the acceptability of instrument adoption were found. Staff reported the instruments were convenient to use and were valuable in eliciting information for care plan development. Staff found that the instruments complemented their standard assessment procedures and did not disrupt their routine workload. They emphasised that the information gained greatly assisted their discussions with clients, identified social needs, and enhanced client involvement in decisions about desired services. There were also some challenging elements, including staff concerns regarding their ability to deal with emotional responses from clients evoked by the survey questions. ACPQ and ICECAP-O are useful tools for identifying psychosocial client needs, are feasible for use by large-scale aged care organisations and provide valuable information to guide decision-making about services. Future research should identify the long-term effects on improving social participation and client outcomes.

The Use of Data Analytics to Build an Australian Context-Sensitive Health Informatics Framework for Consumer-Directed Community Aged Care.

The challenge of providing services that meet the growing needs of an ageing population is one confronted by communities across Australia and internationally. The aim of this study was to: a) undertake semi-structured interviews and focus groups across a sample of service and technical staff to identify the interconnection between communication, information, work practices and performance; and b) carry out a comprehensive review of existing data sources to identify the data linkages required to identify and monitor performance across different dimensions of the quality of aged care spectrum. The results from this study provided empirical evidence of the interconnection between communication, information, work practices and performance; and highlighted numerous potential data linkages which can be used to monitor performance across different dimensions of aged care. These included: the uptake and utilisation of community care services, community aged care client interactions and transitions (with hospitals and other health care providers), and quality of life measures (e.g., health and safety status, symptoms of depression and anxiety, social integration and mortality rates).