Lisa Boss

Loneliness and cognitive function in the older adult: a systematic review.

BACKGROUND Loneliness is a significant concern among the elderly, particularly in societies with rapid growth in aging populations. Loneliness may influence cognitive function, but the exact nature of the association between loneliness and cognitive function is poorly understood. The purpose of this systematic review was to synthesize current findings on the association between loneliness and cognitive function in older adults. METHOD A comprehensive, electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, report written in English, human participants with a mean age ≥ 60 years, and published from January 2000 through July 2013. The total number of studies included in this systematic review was ten. RESULTS Main findings from the ten studies largely indicate that loneliness is significantly and negatively correlated with cognitive function, specifically in domains of global cognitive function or general cognitive ability, intelligence quotient (IQ), processing speed, immediate recall, and delayed recall. However, some initial correlations were not significant after controlling for a wide range of demographic and psychosocial risk factors thought to influence loneliness. CONCLUSIONS Greater loneliness is associated with lower cognitive function. Although preliminary evidence is promising, additional studies are necessary to determine the causality and biological mechanisms underlying the relationship between loneliness and cognitive function. Findings should be verified in culturally diverse populations in different ages and settings using biobehavioral approaches.

Endogenous Sex Hormones and Cognitive Function in Older Adults A Systematic Review

Estrogen and testosterone may influence cognition in older adults, but the relationship between sex hormones and cognitive function is complex. The aim of this systematic review is to examine the role of sex hormones in cognitive function among older adults. A comprehensive, electronic review of literature was performed. Inclusion criteria were original quantitative research, written in English, used human subjects with a mean age of ≥60 years, and published from January 1997 through May 2012. Findings were mixed, although potential patterns were identified. Estradiol levels were potentially associated with benefits to episodic memory, semantic memory, verbal memory, and verbal learning in females only. The association between testosterone and cognitive function was mixed in both genders. Mixed findings may have been influenced by methodological differences and future studies should include research designs with ample rigor, sufficiently powered samples, consistent cognitive measurements, and clear descriptions of handling and storage of biological specimens.

Examining Differences between Homebound Older Adult Pet Owners and Non-pet Owners in Depression, Systemic Inflammation, and Executive Function

ABSTRACT Homebound older adults are prone to depression, which is linked to systemic inflammation that promotes executive function decline. A companion animal may reduce the negative biobehavioral processes asso- ciated with depression, inflammation, and reduced executive function in homebound older adults. The primary aim of this study was to examine dif- ferences between homebound older adult pet owners and non-pet owners in depression, salivary C-reactive protein (CRP), and executive function. The secondary aim was to determine if the level of attachment to pets was as- sociated with depression, salivary CRP, and executive function. The study was cross-sectional and investigated homebound older adult pet owners and non-pet owners (n = 88) using psychometrically reliable and valid instru- ments (Geriatric Depression Scale Short Form and CLOX 1). Salivary CRP was assessed with immunoassay. Level of attachment to pets was measured using a Likert scale (0–10). Mean age for the total sample was 75 years (SD = 9). Forty-eight (55%) participants owned pets (56% dogs, 25% cats, 4% other pets, 15% both cats and dogs). Pet owners reported a high level of attachment to pets (Median = 10). Pet owners had significantly higher ex- ecutive function than non-pet owners (t = –2.07; p = 0.04) but there were no significant differences in executive function between cat owners and dog owners (t = 1.53; p = 0.14). Pet owners and non-pet owners were similar in depression (t = –1.80, p = 0.08) and salivary CRP levels (t = 0.27, p = 0.79). Level of attachment to pets was significantly and positively correlated with executive function (r = 0.30; p = 0.04) but was not significantly correlated with depression (r = 0.04, p = 0.77) or salivary CRP (r = –0.04, p = 0.80). Compared with non-pet owners, pet owners had better executive function but similar depression and salivary CRP levels. Reasons for these findings are unclear. Significant positive correlation be- tween pet attachment and executive function suggests further investigation in this area. Future studies with larger samples and a longitudinal design are needed to investigate the biobehavioral changes over time in relation to pet ownership, level of attachment to pets, and executive func- tion in homebound older adults.

Social Support and Cognition: Early Childhood Versus Older Adulthood.

Cognitive development in early childhood and cognitive preservation in older adulthood are critical for leading healthy life. Social engagement can significantly affect cognition, but their relationships are unclear. The purpose of this review was to synthesize current findings on the relationship between social engagement and cognition in early childhood and older adulthood. PubMed, Web of Science, Ovid Medline, and PsycINFO were searched for studies published in 1995-2015 for a comprehensive review. Included in this review were 42 articles written in English, published in peer-reviewed journals with participants’ age being 2 to 6 or ≥65 years, and measurement of social engagement and cognition. Overall, greater social engagement was associated with higher levels of cognition across the life span, association of which seemed more prominent in populations at risk of cognitive impairment. Additional research is needed to elucidate biobehavioral mechanisms underlying these relationships and to test the efficacy of new interventions.

Identifying Cognitive Impairment in Hospitalized Older Adults to Prevent Readmission: Two Case Studies

ABSTRACT Objective: To describe two patient outcomes post-discharge from an acute hospital admission. Both patients underwent cognitive testing during hospitalization. Methods: A battery of cognitive tests was administered to two hospitalized older adult patients. Both patients were evaluated in their homes within 72 hours of discharge and again at 14- and 30-days by a nurse practitioner. Results: One of the patients was readmitted within 30 days of hospital discharge due to complications from an amputation. This patient did not perform well on cognitive measures which may have been related to his pain levels and/or his medication regimen. Conclusions: Not all readmissions are avoidable; however, if readmissions are related to cognitive impairment, implementing strategies tailored to this population may reduce readmission rates. Clinical Implications: Risk factors for readmission should be identified so the discharge team can develop a tailored plan of care. Including both the patient and an informal caregiver may reduce the chance of a hospital readmission in older adults with cognitive impairment regardless of the etiology.

Effects of Animal-assisted Activities on Biobehavioral Stress Responses in Hospitalized Children: A Randomized Controlled Study

Purpose This study assessed the effectiveness of animal‐assisted activities (AAA) on biobehavioral stress responses (anxiety, positive and negative affect, and salivary cortisol and C‐reactive protein [CRP] levels) in hospitalized children. Design and Methods This was a randomized, controlled study. Method Forty‐eight participants were randomly assigned to receive a 10‐minute AAA (n = 24) or a control condition (n = 24). Anxiety, positive and negative affect, and levels of salivary biomarkers were assessed before and after the intervention. Results Although increases in positive affect and decreases in negative affect were larger in the AAA condition, pre‐ and post‐intervention differences between the AAA and control conditions were not significant. In addition, pre‐ and post‐intervention differences between the conditions in salivary cortisol and CRP were not statistically significant. Baseline levels of anxiety, cortisol, and CRP had a significant and large correlation to the corresponding post‐intervention measures. Scores on the Pet Attitude Scale were high but were not associated with changes in anxiety, positive affect, negative affect, or stress biomarkers. Conclusions Although changes were in the expected direction, the magnitude of the effect was small. Future randomized controlled trials with larger recruitment are needed to determine the effectiveness of AAAs in reducing biobehavioral stress responses in hospitalized children. Practice Implications Nurses are positioned to recommend AAA as a beneficial and safe experience for hospitalized children. HighlightsDifferences between the AAA and control conditions were not significant.Increases in positive affect were larger in the AAA condition.Decreases in negative affect were larger in the AAA condition.Patients reported positive attitude towards pets and reported enjoying the AAAs.Nurses may recommend AAA as a beneficial experience for hospitalized children.

Utility of Braden Scale Nutrition Subscale Ratings as an Indicator of Dietary Intake and Weight Outcomes among Nursing Home Residents at Risk for Pressure Ulcers.

The Braden Scale for Pressure Sore Risk© is a screening tool to determine overall risk of pressure ulcer development and estimate severity of specific risk factors for individual residents. Nurses often use the Braden nutrition subscale to screen nursing home (NH) residents for nutritional risk, and then recommend a more comprehensive nutritional assessment as indicated. Secondary data analysis from the Turn for Ulcer ReductioN (TURN) study’s investigation of U.S. and Canadian NH residents (n = 690) considered at moderate or high pressure ulcer (PrU) risk was used to evaluate the subscale’s utility for identifying nutritional intake risk factors. Associations were examined between Braden Nutritional Risk subscale screening, dietary intake (mean % meal intake and by meal timing, mean number of protein servings, protein sources, % intake of supplements and snacks), weight outcomes, and new PrU incidence. Of moderate and high PrU risk residents, 61.9% and 59.2% ate a mean meal % of <75. Fewer than 18% overall ate <50% of meals or refused meals. No significant differences were observed in weight differences by nutrition subscale risk or in mean number protein servings per meal (1.4 (SD = 0.58) versus 1.3 (SD = 0.53)) for moderate versus high PrU risk residents. The nutrition subscale approximates subsequent estimated dietary intake and can provide insight into meal intake patterns for those at either moderate or high PrU risk. Findings support the Braden Scale’s use as a preliminary screening method to identify focused areas for potential intervention.

Ethical Issues in Geriatric Research

Imagine yourself as a new research investigator conducting your first pilot study. Your ultimate goal is to develop an intervention that will alleviate detrimental health outcomes in the older adult population. In your first interaction with a potential study participant, Mrs. S., you suspect she may have dementia because she has asked the same question about the study at least five times. How should you proceed with the informed consent process? Should you enroll Mrs. S, despite your suspicion that she may not understand your study? Both new research investigators and experienced investigators will face ethical dilemmas like this one with Mrs. S. on a regular basis. Ethics is the study of conduct and character, and understanding ethics in the context of research with the geriatric population is critical in order for researchers to make the best decisions when ethical dilemmas present themselves. This chapter describes basic ethical issues in geriatric research, including ageism, informed consent concerns, challenges of under-recruitment, and information security risks that concern geriatric researchers.

Depression, loneliness, and pet attachment in homebound older adult cat and dog owners

Background: Companion animals may reduce depression and loneliness in socially isolated homebound older adults. However, whether owning a cat or dog is more beneficial in this population remains unknown. Materials and Methods: Pet attachment and the levels of depressive symptoms and loneliness were examined in 39 homebound older adults who exclusively owned a cat(s) or a dog(s). Cat owners (n = 12) and dog owners (n=27) were assessed for depressive symptoms (Geriatric Depression...

Spiritual Pain in Meals on Wheels’ Clients

Background: Meals on Wheels’ clients are at risk for spiritual pain due to advanced age, social isolation, and failing health. They are also prone to stress, depression, and loneliness, placing them at risk for adverse biological disruptions and health outcomes. The purpose of the study was to examine associations of spiritual pain with psychosocial factors (stress, depression, loneliness, religious coping) and salivary biomarkers of stress and inflammation (cortisol, IL-1β) in Meals on Wheels’ clients. Methods: Data were collected cross-sectionally from 88 elderly (mean age 75.4). Spiritual pain, stress, depression, loneliness, and religious coping were measured with standardized instruments, and salivary biomarkers were assessed with enzyme immunoassays. Results: Spiritual pain was significantly and positively correlated with stress (r = 0.35, p ≤ 0.001), depression (r = 0.27, p = 0.01), and negative religious coping (r = 0.27, p = 0.01). Correlations with loneliness, positive religious coping, and salivary biomarkers were non-significant. Conclusion: Spiritual pain is an important concept in this population. Research should be expanded to understand the significance of spiritual pain in conjunction with psychosocial and biological variables and its potential impact on physical, mental, and cognitive health outcomes in the elderly.