Laura J. E. Brown

Supporting Well-Being in Retirement through Meaningful Social Roles: Systematic Review of Intervention Studies

CONTEXT The marked demographic change toward greater proportions of older people in developed nations poses significant challenges for health and social care. Several studies have demonstrated an association between social roles in later life and positive health and well-being outcomes. After retiring from work, people may lose roles that provide purpose and social contacts. The outcomes of interventions to promote social roles in retirement have not been systematically reviewed. METHODS We examined three research questions: (1) What kinds of intervention have been developed to promote social roles in retirement? (2) How much have they improved perceived roles? (3) Have these roles improved health or well-being? We included those studies that evaluated the provision of social roles; used a control or comparison group; targeted healthy retirement-transition adults who were living in the community; provided an abstract written in English; took place in a highly developed nation; and reported social role, health, or well-being outcomes. We searched eight electronic databases and combined the results with hand searches. FINDINGS Through our searches, we identified 9,062 unique publications and eleven evaluative studies of acceptable quality, which reported seven interventions that met our inclusion criteria. These interventions varied in year of inception and scope, but only two were based outside North America. The studies rarely reported the quality or meaning of roles. Only three studies used random allocation, thus limiting inferences of causality from these studies. Interventions providing explicit roles and using supportive group structures were somewhat effective in improving one or more of the following: life satisfaction, social support and activity, physical health and activity, functional health, and cognition. CONCLUSIONS Social role interventions may improve health and well-being for people in retirement transition. Future research should improve the quality of intervention and assessment and look at which interventions are most effective and acceptable in facilitating social roles for diverse older populations.

Detecting deficits of sustained visual attention in delirium

Background Inattention is a core clinical feature of delirium and yet the particular aspects of attentional impairment associated with this feature are poorly understood. Objective methods for assessing inattention are also lacking. A new set of computerised tests of attentional deficits designed for use in patients with delirium have been developed. Test performances in patients with delirium, dementia and cognitively normal controls are compared. Methods Eight novel tasks measuring sustained visual attention were administered to 20 older patients with delirium using the Edinburgh Delirium Test Box, a purpose built, computerised neuropsychological testing device. Comparison groups of 18 patients with Alzheimers dementia and 20 cognitively normal patients of similar age were also assessed. Delirium was diagnosed using the Confusion Assessment Method. General cognitive impairment was measured using the Mini-Mental State Examination. Results Patients with delirium had significantly lower scores than both comparison groups on all sustained attention tasks (p values from 0.003 to <0.001). Performance of the dementia patients generally did not differ from the cognitively normal group. Receiver operating characteristic analyses indicated that all tasks showed good or excellent accuracy for discriminating between delirium and dementia (AUC values 0.80–0.94), and between delirium and cognitively normal (AUC values 0.89–0.99) patients. Conclusions Patients with delirium showed marked deficits in sustained visual attention, as measured by objective neuropsychological testing. These attentional deficits were mainly mild or absent in patients with dementia and in cognitively normal controls. Objective testing of sustained visual attention has promising utility in detecting delirium, and in discriminating delirium from dementia.

Cognitive visual perceptual deficits in patients with delirium.

Background: Delirium is a neuropsychiatric disorder characterised by severe cognitive impairment, but the specific neuropsychological profile of this condition has not yet been clearly delineated. Psychiatric symptoms of perceptual disturbance—such as hallucinations, illusions and misperceptions—are common in delirium, suggesting that patients may have deficits in the cognitive systems underlying visual perception. Methods: Five neuropsychological tests of visual perception were administered to 17 older patients with delirium, as well as to two control groups comprising 14 patients with Alzheimer’s dementia and 18 cognitively normal patients. The Mini Mental State Examination and the Consortium to Establish a Registry for Alzheimers Disease verbal memory test were also administered to assess the specificity of any perceptual impairments. Results: Patients with delirium scored significantly lower than cognitively normal patients on all perceptual tasks and significantly lower than patients with dementia on three of these tasks. Mini Mental State Examination scores did not differ between the delirium and dementia groups, and patients with delirium showed significantly better verbal recognition performance than those with dementia. Conclusions: Patients with delirium have specific visual perceptual deficits that cannot be accounted for by general cognitive impairment. These novel findings provide insights into the neural mechanisms underling delirium and might help to improve clinical detection and management of the disorder. The results also support previous suggestions that cognitive perceptual deficits play a causal role in eliciting psychiatric symptoms of perceptual disturbance.

Differential effects of delirium on fluid and crystallized cognitive abilities

Patients with delirium (acute confusional state) show extensive cognitive deficits. These deficits have typically been measured using tests of fluid cognition, which involve the active processing of mental representations. However, the effects of delirium on stored, crystallized dimensions of cognition, such as well-learnt word pronunciation knowledge, are not known. In this study 37 patients (aged 60-85 years) without delirium were recruited before undergoing cardiac surgery. Cognitive assessments were performed 0-8 days before surgery and again 2-9 days after surgery in order to determine the effects of post-operative delirium (POD) on fluid and crystallized aspects of cognition. Crystallized cognition was tested with the National Adult Reading Test (NART). Fluid cognition was tested with digit span, verbal fluency and Stroop tests. Nine patients (24%) developed delirium post-operatively. Patients with delirium showed significant post-operative deficits on most tests of fluid cognition, but no change in the NART measure of crystallized cognition (p=0.95). These results parallel recent findings in Alzheimers dementia and suggest that, despite showing extensive deficits of fluid cognitive processing, crystallized cognition is preserved in delirium. The results also suggest that the NART may be a useful tool for assessing premorbid ability in patients with delirium.

Tract shape modelling provides evidence of topological change in corpus callosum genu during normal ageing

Understanding how ageing affects brain structure is an important challenge for medical science. By allowing segmentation of fasciculi-of-interest from diffusion magnetic resonance imaging (dMRI) data, tractography provides a promising tool for assessing white matter connectivity in old age. However, the output from tractography algorithms is usually strongly dependent on the subjective location of user-specified seed points, with the result that it can be both difficult and time consuming to identify the same tract reliably in cross-sectional studies. Here we investigate whether a novel method for automatic single seed point placement based on tract shape modelling, termed probabilistic model-based neighbourhood tractography (PNT), can reliably segment the same tract from subject to subject in a non-demented cohort aged over 65 years. For the fasciculi investigated (genu and splenium of corpus callosum, cingulum cingulate gyri, corticospinal tracts and uncinate fasciculi), PNT was able to provide anatomically plausible representations of the tract in question in 70 to 90% of subjects compared with 2.5 to 60% if single seed points were simply transferred directly from standard to native space. In corpus callosum genu there was a significant negative correlation between a PNT-derived measure of tract shape similarity to a young brain reference tract and age, and a trend towards a significant negative correlation between tract-averaged fractional anisotropy and age; results that are consistent with previous dMRI studies of normal ageing. These data show that it is possible automatically to segment comparable tracts in the brains of older subjects using single seed point tractography, if the seed point is carefully chosen.

Objective assessment of attention in delirium: a narrative review

Inattention is a core feature of delirium, and valid assessment of attention is central to diagnosis. Methods of measuring attention in delirium can be divided into two broad categories: (i) objective neuropsychological testing; and (ii) subjective grading of behaviour during interview and clinical examination. Here, we review and critically evaluate studies of objective neuropsychological testing of attention in delirium. We examine the implications of these studies for delirium detection and monitoring in clinical practice and research, and how these studies inform understanding of the nature of attentional deficits in delirium.

Old(er) care home residents and sexual/intimate citizenship

ABSTRACT Sexuality and intimacy in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy. When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with how to continue sexual activity with reduced capacity. We review the (Anglophone) academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents (though much of this applies to older people generally). We highlight how ageism (or ageist erotophobia), which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing that recognises constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption. Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically informed practitioner-led work.

Validation of the NANA (Novel Assessment of Nutrition and Ageing) touch screen system for use at home by older adults

Prospective measurement of nutrition, cognition, and physical activity in later life would facilitate early detection of detrimental change and early intervention but is hard to achieve in community settings. Technology can simplify the task and facilitate daily data collection. The Novel Assessment of Nutrition and Ageing (NANA) toolkit was developed to provide a holistic picture of an individuals function including diet, cognition and activity levels. This study aimed to validate the NANA toolkit for data collection in the community. Forty participants aged 65 years and over trialled the NANA toolkit in their homes for three 7-day periods at four-week intervals. Data collected using the NANA toolkit were compared with standard measures of diet (four-day food diary), cognitive ability (processing speed) and physical activity (self-report). Bland-Altman analysis of dietary intake (energy, carbohydrates, protein fat) found a good relationship with the food diary and cognitive processing speed and physical activity (hours) were significantly correlated with their standard counterparts. The NANA toolkit enables daily reporting of data that would otherwise be collected sporadically while reducing demands on participants; older adults can complete the daily reporting at home without a researcher being present; and it enables prospective investigation of several domains at once.

Assessing mood in older adults: a conceptual review of methods and approaches

BACKGROUND Accurate measures of mood state are important for understanding and optimizing health and well-being in later life. A range of different mood assessment measures is available, reflecting the variety of ways in which mood has been conceptualized and the different purposes for which measures have been developed. METHODS We undertook a conceptual review of the literature relating to mood and its assessment in older populations. RESULTS Moods are subjective states of mind that are typically described and quantified using self-report measures. Moods can be conceptually differentiated from the related psychological concepts of emotion, well-being, quality of life, and depression. Quantitative tools for assessing mood state include single-item mood ratings, composite factor scales, and clinical depression assessments. Mood assessments may be administered retrospectively or contemporaneously to the mood state of interest. The method and temporal perspective used to assess mood state will impact on the nature and precision of the mood data that are collected, and the types of research questions that can be addressed. CONCLUSIONS No single mood assessment technique can be considered optimal for all situations. Rather, both the type of tool and the temporal perspective taken must be selected according to the nature of the study design and the research question being addressed. More thorough and frank reporting of the rationale for, and limitations of, mood assessment techniques are also essential for continued development of mood research with older adults.

The challenges and opportunities in researching intimacy and sexuality in care homes accommodating older people: a feasibility study.

Abstract Aim To explore the challenges of conducting research on sexuality and intimacy among older care home residents. Background Sexuality and intimacy are neglected in care policies and practices. Design Qualitative analytical study drawing on poststructuralist theorizing. Methods Semi‐structured interviews were conducted with residents and spouses (n = 6) and care staff (n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of ‘research‐ready’ care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. Results Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age‐group concerned. However, residents and care home staff can also draw on counter‐discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. Conclusion Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject.