Mark I. Weinberger

Prostate cancer: psychosocial implications and management.

This review summarizes some of the key psychosocial issues related to prostate cancer, both generally and for an older adult population. It focuses on three main areas: quality-of-life issues, psychosocial implications and management of these psychosocial issues. Broadly, the article presents information on the general background, screening guidelines, common side effects of treatment and current psychiatric and psychological management strategies in prostate cancer. The article addresses the clinical approaches, as well as the complexities that surface when deciding the treatment for patients with prostate cancer. Clinical and future implications are also discussed.

How happy have you felt lately? Two diary studies of emotion recall in older and younger adults

The current studies investigated age-related biases in recall of emotion in older and younger adults. In two prospective–retrospective, Internet-based diary studies, older (aged 65 years and older) and younger participants (aged 18 to 37) reported on their affect at the end of every day. Participants then recalled their affect during the diary rating periods. In both studies, recall bias was assessed by comparing retrospective reports to the prospective diary ratings. Older adults tended to overestimate positive affect more than younger adults, who themselves tended to overestimate negative affect more than older adults, relative to diary ratings. Age-related patterns of recall bias are discussed in light of recent literature on the interface between cognition and emotion in ageing, particularly on increased positivity and reduced negativity effects in emotional processing and recall.

Medication Beliefs and Self-Reported Adherence Among Community-Dwelling Older Adults

BACKGROUND Nonadherence to medications among older adults can compromise quality care. Among older adults with chronic diseases, nonadherence rates can reach 50%. Individual-level obstacles to full adherence may come from psychological, illness (and disability due to aging or other impairments), and tangible barriers. In this study, we examine the barriers associated with nonadherence among community-dwelling older persons participating in Aging Service Network nutrition programs. OBJECTIVE The goal of this study was to examine the relation of psychological, illness, and tangible barriers to reported medication adherence among older adults in a community, nonmedical setting. METHODS Older adults (N = 299) receiving congregate meals participated in a study of factors associated with medication-taking behaviors and adherence. Self-reported medication nonadherence was measured by using the Morisky Medication Adherence Scale. Psychological barriers were assessed by using a risk/benefit score (perceived concerns vs necessity of medications). Illness barriers reviewed included overall cognitive functioning, disability, medical burden, and depression. Tangible barriers included number of medications, difficulty handling medication, and perceived cost. RESULTS Most participants took multiple medications (mean, 4.8) each day, and 4 of 10 older adults (41% [122 of 299]) reported at least 1 nonadherent behavior. The psychological barrier of a low risk/benefit score (odds ratio = 0.73 [95% CI, 0.6-0.94]) and the tangible barrier of difficulty opening the medication bottle (odds ratio = 2.16 [95% CI, 1.3-3.6]) were independently associated with nonadherence. CONCLUSIONS In a community-dwelling sample of older adults, nonadherence to medication was associated with both tangible and psychological barriers. Beliefs about medication can be powerful barriers to a successful adherence strategy. Adherence interventions should address the multilevel barriers (psychological, illness, and tangible) to adherence among older adults.

Predictors of New Onset Depression in Medically Ill, Disabled Older Adults at 1 Year Follow-Up

OBJECTIVE Although medical illness and physical disability are strongly associated with depression, the majority of older adults who experience medical illness or disability at any given time are not depressed. The aim of these analyses was to identify risk factors for new onset depression in a sample of medically ill, disabled older adults. METHODS The authors used data from a representative sample of homebound older adults who recently started receiving Medicare home healthcare services for medical or surgical problems (N = 539). The authors report on the rate and baseline predictors of new onset major or minor depression, using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders, at 1-year follow-up. Our analyses were conducted with a subsample of older adults (N = 268) who did not meet criteria for major or minor depression and were not on an antidepressant medication at our baseline interview. RESULTS At 1-year follow-up, 10% (28/268) of patients met criteria for either major (3%; 9/268) or minor depression (7%; 19/268). In multivariate analyses, the authors found that worse self-rated health (odds ratio [OR] = 0.53, p = 0.042), more somatic depressive symptoms (OR = 1.19, p = 0.015), greater number of activities of daily living (ADL) limitations at baseline (OR = 1.63, p = 0.014), and greater decline in ADL functioning from baseline to 1 year (OR = 1.59, p = 0.022) were all independently associated with onset depression. CONCLUSION These findings underscore the significant fluctuations in both depression and disability in high-risk older adults and suggest that both persistent and new onset disability increase the risk of depression. They may also help in designing preventive strategies to promote the ongoing good mental health of these high-risk patients over time.

Emotional complexity in younger, midlife, and older adults.

Questions pertaining to emotional complexity in adult development are being pursued from a number of vantage points. The current studies sought to clarify the study of emotional complexity by comparing and contrasting 2 dominant perspectives on emotional complexity in different age groups (i.e., covariation and absolute-level approaches). Results indicate that emotional complexity is a multifaceted construct and that methodology will impact substantive findings and developmental trends that emerge from the data. Recommendations and considerations for future research are discussed, including, for example, within- versus cross-domain ideas of emotional complexity.

Depression and barriers to mental health care in older cancer patients

To review the literature on depression in cancer patients with a particular focus on depression assessment and barriers to mental health treatment in older cancer patients.

Depression Care for Patients at Home (Depression CAREPATH): home care depression care management protocol, part 2.

High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home (Depression CAREPATH) intervention was designed to meet the needs of medical and surgical patients who suffer from depression. The interventions clinical protocols are designed to guide clinicians in managing depression as part of routine home care.

Depression Care for Patients at Home (depression Carepath): Intervention Development and Implementation, Part 1

High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home intervention was designed for managing depression as part of ongoing care for medical and surgical patients. The intervention provides home health agencies the resources needed to implement depression care management as part of routine clinical practice.

The PHQ-2 on OASIS-C: a new resource for identifying geriatric depression among home health patients.

Since Medicare first implemented the home care Outcome and Assessment Information Set (OASIS) in 1999, we have learned a great deal about depression among the homebound elderly. First, we know that major depression is a highly prevalent illness in home care. With depression rates at almost 15%, home care—along with nursing homes—has among the highest rates of any healthcare setting (Bruce et al., 2002; Parmelee et al., 1992; Jones et al., 2003).

Age differences in the organization of emotion knowledge: Effects involving valence and time frame.

Older and younger adults attend to and remember emotion information differently. The present study builds on this work by investigating age-related differences in the schematic organization of emotion knowledge. Younger and older adults reported on their experiences of positive and negative affect, both today and in general. Of primary interest was judgment speed as a function of matches (e.g., positive-positive) or mismatches (e.g., negative-positive) in valence and time frame across consecutive trials. Older adults exhibited stronger valence-related priming effects and weaker time-frame-related priming effects, relative to younger adults. Results remained significant when controlling for individual differences in speed, speed variability, motor priming, temperament, and life satisfaction. The discussion focuses on the manner in which age differences in the schematic organization of emotion knowledge might contribute to age differences in the self-concept, affective processing, and emotional experience.