OBJECTIVES:This study examined the effectiveness of a virtual reality based nostalgic cognitive training program for older adults attending day-care centers. METHODS:In this two-arm randomized controlled trial (N = 55; mean age = 81.24 years), participants received 12 sessions of VR-based nostalgic cognitive training integrating culturally familiar Taiwanese life scenes (1960s-1990s) with structured multidomain cognitive tasks, or routine activities. The prespecified primary outcome was global cognitive function (MoCA-T). Prespecified secondary outcomes were nostalgia propensity (SNS), depressive symptoms (GDS-15), psychological well-being (PWB-18) and life satisfaction (LSI-SF). Generalized estimating equations (GEE) were used to examine intervention effects. This trial was retrospectively registered at ClinicalTrials.gov (Identifier: NCT06973551). RESULTS:Significant group × time interactions for MoCA-T, SNS, and GDS-15 favored the experimental group. No significant group × time interaction was found for PWB-18 or LSI-SF, although PWB-18 showed within-group improvement in the experimental group. CONCLUSIONS:VR-based nostalgic cognitive training may provide short-term benefits for global cognitive function, nostalgia propensity, and depressive symptoms among older adults in day-care settings.
OBJECTIVES:This study examined the bidirectional association between social participation and mental health among older adults and whether multimorbidity moderated this association. METHODS:Three wave longitudinal data (2011-2018) from the China Longitudinal Healthy Longevity Survey were analyzed using cross-lagged panel models. Social participation and mental health were assessed by self-reported questionnaires. Multimorbidity was defined as the coexistence of two or more chronic diseases. Analyses were conducted for the overall sample and separately for those with and without multimorbidity. RESULTS:Social participation was positively associated with subsequent mental health across waves. Mental health was positively associated with social participation in the later wave, supporting a bidirectional association. Subgroup analysis revealed a significant bidirectional association among older adults with multimorbidity, whereas no significant longitudinal association was found among those without multimorbidity. CONCLUSIONS:Social participation and mental health are bidirectionally associated among Chinese older adults, with multimorbidity significantly moderating this relationship. Social participation should be prioritized to older adults with multimorbidity. CLINICAL IMPLICATIONS:Clinicians and community health practitioners may consider assessing social participation alongside mental health and chronic disease burden in older adults, particularly those with multimorbidity. Opportunities for meaningful social engagement could be incorporated into community and chronic disease management services.
OBJECTIVES:To develop and validate the Sexuality and Intimacy in Dementia Questionnaire (SIDQ), an observational instrument for assessing verbal and physical expressions of intimacy and sexuality in nursing home residents with dementia. METHODS:The SIDQ was developed through expert review, content validity assessment and face validity testing. Data were collected from 62 questionnaires across seven nursing home organizations. Construct validity was evaluated using exploratory factor analysis. Internal consistency, inter-item correlations, and test-retest reliability were assessed following COSMIN and DeVellis guidelines. RESULTS:Content and face validity showed that the SIDQ was clear, relevant and acceptable for using in dementia care. After removing items with low communalities, exploratory factor analysis revealed two factors: verbal intimacy and sexuality (2 items) and physical intimacy and sexuality (4 items). These explained 79.41% of the variance. Internal consistency was good (α = .72 and α = .84). Test-retest reliability was excellent (ICC= .95, 95% CI: .875-.991). CONCLUSIONS:The SIDQ showed good preliminary psychometric properties and provides a structured way to assess observable expressions of intimacy and sexuality in people with dementia. CLINICAL IMPLICATIONS:The SIDQ may support nursing staff in recognizing residents' intimate and sexual needs, facilitate communication within care teams and with families.
OBJECTIVES:Loneliness represents a global concern, particularly in late adulthood. As a multifaceted construct-encompassing social, emotional, and existential dimensions-it has been linked to mental health among older individuals. In the current study, the associations of three loneliness types with depression and anxiety were examined in individuals aged 65 and older. METHODS:Two hundred thirty-seven participants who were aged 65 and older (Mean Age = 70.87, SD = 5.55) were included in the analyses. Two hierarchical regression analyses were performed to investigate which type(s) of loneliness are associated with depression and anxiety after controlling for demographic variables. RESULTS:Results indicated that existential, social, and emotional loneliness were significantly related to depression. Specifically, existential loneliness showed the strongest association with depression. Moreover, only existential loneliness was significantly associated with anxiety. CONCLUSIONS:The findings of the current study added substantially to our understanding of differential influences of loneliness types on depression and anxiety in older individuals. CLINICAL IMPLICATIONS:Findings implicated that all loneliness types-but first existential loneliness-should be addressed while working with older adults experiencing depressive symptoms. However, in cases where the primary mental health concern is anxiety, targeted intervention on existential loneliness is especially recommended.
OBJECTIVES:To evaluate the feasibility, acceptability, and design principles of a culturally embedded, cognitively guided, modular tabletop cognitive activity for older adults with MCI or dementia in long-term care (LTC). METHODS:An exploratory sequential mixed-methods study in Taiwanese licensed LTC settings included 17 stakeholders and a 10-resident validation cohort with MCI or dementia. Feasibility was assessed by recruitment, retention, adherence, preparation time, social-validity indicators, directed content analysis, and observed distress and engagement during toolkit use. RESULTS:Across 189 observed difficulty events, cultural mismatch and ungraded cognitive demands accounted for 73.4% of engagement barriers. The modular framework comprised cultural resonance, stepped cognitive demand, and lowered operational barriers. Stakeholders judged it acceptable; prototype testing showed 100% recruitment and retention, high social validity, and reduced preparation time from 18.4 ± 3.2 to 2.5 ± 0.8 minutes (p < .001). CONCLUSIONS:This culturally responsive modular toolkit appears feasible and acceptable for supporting cognitive activity programming in LTC and warrants further controlled testing. CLINICAL IMPLICATIONS:LTC teams may enhance cognitive-stimulation activities by using culturally familiar, graded, low-preparation toolkits adaptable to resident abilities.
OBJECTIVE:This study examined the interactive relationships among health literacy, psychological resilience, and fear of progression (FoP) in patients with chronic heart failure and their caregivers. METHODS:A total of 300 dyads were recruited. The Actor - Partner Interdependence Mediation Model was used to analyze actor, partner, and mediation effects. RESULTS:For both patients and caregivers, health literacy and psychological resilience negatively predicted individual FoP. Caregivers' health literacy positively predicted their psychological resilience, while no such association was found in patients. Psychological resilience mediated the health literacy-FoP association in both groups. Patients' health literacy could indirectly alleviate caregivers' FoP via caregivers' psychological resilience. CONCLUSIONS:FoP in chronic heart failure is a dyadic psychological phenomenon. Interventions should target both patients and their caregivers to reduce fear of disease progression and improve family mental health.Clinical Implications: Dyad-based interventions that enhance health literacy and psychological resilience in both patients and caregivers may effectively alleviate FoP and promote overall family well-being.
OBJECTIVES:To synthesize evidence on determinants of quality of life (QoL) among older adults with type 2 diabetes mellitus (T2DM) within an aging-relevant biopsychosocial framework. METHODS:A narrative review was conducted using Scopus. The search was performed in September 2025 and included peer-reviewed articles published between 2007 and 2025. Eligible studies examined QoL or health-related QoL among adults aged 60 years and older with T2DM. Screening was conducted independently by two reviewers, with disagreements resolved by consensus. Forty-eight studies met the inclusion criteria and were synthesized narratively. RESULTS:The included studies varied in design, region, and QoL measurement. QoL was shaped by interconnected clinical, psychological, cognitive, functional, behavioral, pharmacological, social, and sociodemographic determinants. Greater clinical and treatment-related burden, depression, diabetes-related distress, cognitive impairment, functional limitation, and reduced mobility were generally linked with poorer QoL. Self-management, physical activity, treatment adherence, caregiver competence, and social support were generally linked with better QoL. CONCLUSIONS:QoL in later-life diabetes reflects interactions among disease burden, emotional and cognitive vulnerability, functional capacity, self-management, and social-caregiving context. CLINICAL IMPLICATIONS:QoL-oriented care should include psychological, cognitive, medication, functional, and social-caregiving assessment, alongside age-sensitive self-management support.
OBJECTIVES:This systematic review aims to synthesize evidence on the effectiveness of non-pharmacological interventions (e.g. behavioral interventions, psychoeducational interventions) for improving sleep among caregivers of people with mild cognitive impairment or dementia. METHODS:A literature search, conducted across eleven databases identified randomized controlled trials (RCTs), was conducted. The primary outcome was sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Twenty-one RCTs involving 1,964 caregivers (mean age 64.06 years; 74.94% female) were included. RESULTS:Compared with control conditions (usual care, enhanced usual care, or attention control), non-pharmacological interventions significantly reduced PSQI score at end-of-intervention, based on five studies involving 334 caregivers (Mean Difference=-1.27 points, 95% confidence interval [-2.34, -0.19], p=.021). All trials had a high overall risk of bias, and the certainty of evidence was very low. CONCLUSIONS:Non-pharmacological interventions may yield modest improvements in sleep quality among informal caregivers; however, confidence in this estimate is limited by high risk of bias of included studies and very low certainty of evidence.
OBJECTIVES:Dementia caregiving often involves unpredictable situations, which can be difficult to navigate and stressful for caregivers. We used a non-randomized waitlist-controlled trial to pilot-test the feasibility, acceptability, and preliminary efficacy of an improv-based dementia caregiving intervention. METHODS:Caregivers attended a four-week group intervention (90 minutes/session). Caregiving self-efficacy, well-being, and communication skills were assessed before the intervention, after the intervention, and one month later. Descriptive and non-parametric statistics were used to examine change across time points. RESULTS:Of 18 enrolled caregivers, 16 completed the intervention (88.8%), and 15 completed both follow-up assessments (93.8%). All reported high satisfaction with the intervention, citing new communication skills they learned. There was a significant improvement in caregivers' self-efficacy after the intervention (adjusted p = .013, Wilcoxon r = .74) and at follow-up (adjusted p = .029, Wilcoxon r = .68), and subjective well-being after the intervention (adjusted p = .016, Wilcoxon r = .73). No significant changes were noted in the waitlist control group. DISCUSSION:Preliminary evidence suggests that dementia caregivers experience improved self-efficacy and well-being when they learn improv-based communication principles in a small-group setting. CLINICAL IMPLICATIONS:Using improvisational techniques shows promising benefits to help caregivers deal with caregiving situations in the moment.
OBJECTIVES:Research on adult-child caregivers with childhood maltreatment (CM) histories has been conducted predominantly in North America. This qualitative study examined the psychological conflicts and protective factors among Japanese adult-child caregivers with CM histories. METHODS:Semi-structured interviews were conducted with 10 Japanese adult-child caregivers (5 men, 5 women; mean age = 60.40, SD = 6.13). Data were analyzed using the Modified Grounded Theory Approach. RESULTS:Caregiving often reactivated negative childhood emotions, suggesting that unresolved trauma may also be reactivated in East Asian contexts. Even among caregivers with CM histories, those with emotionally responsive childhood memories, rather than material provision alone, maintained positive feelings toward parents that supported caregiving. When such emotional bonds were absent, external social support helped sustain caregiving; however, caregivers without either resource, relying solely on self-demanding beliefs, faced serious health risks. CONCLUSIONS:Reactivation of unresolved childhood experiences during caregiving may occur across cultural contexts, while emotionally responsive childhood memories and external social support are key protective factors enabling continued caregiving. CLINICAL IMPLICATIONS:Healthcare and welfare professionals should recognize that caregivers with CM histories may face hidden vulnerabilities and benefit from proactive, outreach-oriented, and trauma-informed support.
OBJECTIVES:Individuals with mild cognitive impairment (MCI) and Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are at greater risk for mental health concerns than those without cognitive impairments. We report the implementation of psychological services for patients with MCI and mild AD/ADRD within a large public health-care system in the United States. METHODS:Preimplementation process included identifying a clinic champion. Referrals were initially provided by the clinic champion and then opened to the entire Memory Assessment Clinic with predetermined eligibility guidelines. Patients were seen on a short-term basis, using CBT- or ACT-based therapy. Initial sessions were conducted in person; follow-up sessions were in person and via telehealth. RESULTS:Patients saw an average of a 2.2-point reduction in depression symptoms and a 2-point reduction in anxiety symptoms. Implementation barriers and facilitators are listed in the full-text of the article. CONCLUSIONS:This clinic implementation demonstrates the feasibility of evidence-based psychotherapy clinics within existing geriatric clinics. Future work should examine the impact of CBT and ACT to treat anxiety and depression in patients with these neurocognitive disorders. CLINICAL IMPLICATIONS: Patients with MCI and mild AD/ADRD show a clear interest in psychotherapy services, and initial efficacy data suggest there is a clinical benefit for mental health symptoms.
OBJECTIVES:This study explored co-occurrence patterns between multidimensional sleep impairments and Traditional Chinese Medicine (TCM)-informed constitution patterns in community-dwelling older adults. Specifically, we examined these associations without assuming diagnostic equivalence or causal direction. METHODS:A cross-sectional study of 305 adults (aged ≥ 65 years) in Kinmen, Taiwan, used structured, face-to-face interviews. Assessments included the Pittsburgh Sleep Quality Index (PSQI) and Body Constitution Questionnaire (BCQ), which evaluates Yin-Xu (diminished nourishing/cooling), Yang-Xu (reduced metabolic vitality), and Stasis (impaired circulation). RESULTS:Participants (mean age 75.2 years; 66.2% women) showed a 51.5% prevalence of sleep impairment (PSQI ≥ 5). Individuals with PSQI ≥ 5 exhibited significantly higher Yin-Xu, Yang-Xu, and Stasis scores compared to those with PSQI < 5. Higher constitutional imbalances consistently correlated with poorer global sleep and specific PSQI components (Cohen's d > 0.9). CONCLUSIONS:Multidimensional sleep impairments were associated with TCM-defined constitutional imbalances. The BCQ may serve as a complementary, culturally relevant tool for characterizing constitution-related vulnerability profiles alongside standard sleep assessment. CLINICAL IMPLICATIONS:Integrating BCQ-informed assessments into community care supports earlier recognition of subclinical sleep disturbances. This approach facilitates culturally sensitive communication, sleep-health education, and appropriate follow-up for older adults.
OBJECTIVES:Prolonged wartime displacement disrupts continuity, identity, and social belonging in later life. This study examined the experiences of displaced older women who participated in an Open Studio (OS) art-based group intervention during an extended evacuation. METHODS:In this qualitative study, semi-structured interviews were conducted with seven women (aged 62-96) from a northern Israeli kibbutz who attended a weekly OS over approximately 18 months of displacement. The data were analyzed using reflexive thematic analysis. RESULTS:Four themes were identified:(1) Displacement as a rupture in continuity in later life, (2) The Open Studio as a restorative space of agency, (3) Creative processes as integrative and transformative, and (4) Relational holding through belonging, facilitation, and tensions. CONCLUSIONS:An Open Studio can provide a developmentally sensitive psychosocial response to displaced older adults experiencing collective trauma. The findings underscore the potential of creative engagement in later life to sustain identity, purpose, and growth in conditions of displacement. In contexts of forced rupture, art-based spaces may offer older adults a means of preserving continuity in the face of upheaval. CLINICAL IMPLICATIONS:Community-art-based interventions can help restore agency, continuity, and belonging in later life, but trauma-informed facilitation is needed to contain vulnerability and emotional activation.
OBJECTIVES:Culturally adapt and validate the Caregiving Ambivalence Scale (CAS) for Brazil. METHODS:Two independent translations and back-translations were conducted. Conceptual, cultural, and idiomatic equivalence were evaluated (Fleiss' Kappa = 1.0). The Brazilian CAS, a sociodemographic questionnaire, the Depression Anxiety and Stress Scale -21 were administered online to 111 family caregivers of people with Alzheimer's across Brazil. RESULTS:Parallel Analysis and an Exploratory Factor Analysis indicated a single empirical dimension with excellent fit indices (χ2 = 4.921; df = 5, p = .430; CFI = 0.999; TLI = 1.000; RMSEA = 0.000). The CAS was significantly associated with depression (β = 0.589), stress (β = 0.653), and anxiety (β = 0.455) when controlling for sociodemographic variables. CONCLUSIONS:The Brazilian version of CAS is still in the early stages of validation, but demonstrated good psychometric properties and equivalence to the original instrument. CLINICAL IMPLICATIONS:The Brazilian version of CAS has the potential to support interventions to promote caregivers' mental health.
OBJECTIVE:To identify multidimensional risk factors associated with poor sleep quality and to develop and temporally validate a machine learning-based model for predicting the 2-year risk of poor sleep quality among community-dwelling older adults in China. METHODS:Data were drawn from the China Health and Retirement Longitudinal Study (2011-2018). Participants aged ≥ 60 years with good baseline sleep were included. Missing data were imputed using a random forest-based iterative method, and key predictors were selected using LASSO regression. Multiple machine learning algorithms were trained with cross-validation and evaluated using discrimination, calibration, and clinical utility metrics, with SHAP used for model interpretation. RESULTS:Among 3,471 participants, 23.2% developed poor sleep quality. Fifteen predictors across demographic, biological, psychological, and social-behavioral domains were identified. LightGBM performed slightly better overall (AUC = 0.641). CONCLUSIONS:The model demonstrated acceptable predictive performance and potential utility for early identification and targeted intervention. CLINICAL IMPLICATIONS:Poor sleep quality in older adults reflects the combined contributions of demographic, biological, psychological, and social factors, underscoring the need for multidimensional assessment framework in clinical and community settings. Identifying cumulative risk across emotional, physical, and social domains may facilitate earlier detection of high-risk individuals and more targeted prevention and intervention strategies.
OBJECTIVES:Evaluate the efficacy and acceptability of a two-session online program, The Empowered Caregiver, for caregivers of people living with dementia. METHODS:A randomized controlled trial (RCT) research design was used to examine efficacy with caregivers randomly assigned to the program (n = 219) or wait-list control (n = 219) conditions. Self-reported data were collected at three timepoints: baseline, after program completion, and 45 days post-completion. Program content areas included: caregiving supports, independence, communication, and dementia behaviors. Acceptability data was collected by program participants. RESULTS:Significant improvements after completing the program and short-term maintenance 45 days post-program completion were found for self-efficacy, emotional health strain, role captivity, mastery, personal gain, unmet needs distress, symptoms of anxiety and depression, behavioral intentions and actions. The majority of participants (55%) attended both sessions; 74% attended one session; and 26% did not attend either session. Participants evaluated the program as highly acceptable. CONCLUSIONS:Results indicated that The Empowered Caregiver was efficacious in improving outcomes along with short-term maintenance across outcomes and was viewed as a very acceptable approach. CLINICAL IMPLICATIONS:The two-session protocol delivered online by volunteer community educators serves as a model for developing and implementing pragmatic and scalable educational and skill-building programs.
OBJECTIVES:This study aimed to culturally adapt the Modified Dementia Worry Scale (MDWS) into Turkish, and to examine dementia worry within a broader behavioral health framework in community-dwelling older adults. METHODS:A total of 242 cognitively healthy adults aged ≥ 60 years were included. Construct validity was examined through convergent, known-groups, and incremental validity approaches. Structural validity was evaluated using confirmatory factor analysis. Multivariable and hierarchical linear regression analyses were conducted to examine associations with subjective memory complaints, perceived stigma, anxiety, and depressive symptoms. RESULTS:The Turkish MDWS demonstrated excellent internal consistency (Cronbach's α = 0.93) and high test - retest reliability (ICC = 0.895). Confirmatory factor analysis supported a unidimensional structure. Dementia worry was strongly associated with subjective memory complaints and moderately associated with perceived stigma and anxiety, while showing no significant association with age or depressive symptoms in adjusted models. Dementia-specific psychosocial variables explained substantial additional variance beyond general emotional distress. CONCLUSIONS:The MDWS is a reliable and valid instrument for assessing dementia worry in community-dwelling older adults. Findings support dementia worry as a distinct behavioral health construct, shaped primarily by subjective cognitive appraisal and stigma-related processes rather than objective aging or depressive symptomatology.
OBJECTIVES:This study examined the effects of an age-adapted mindfulness-based cognitive therapy (MBCT) program on depression, anxiety, stress, mindfulness, and sleep quality among older adults. METHODS:A quasi-experimental pretest - posttest design with intervention and control groups was used. Sixty-two community-dwelling adults aged 60 years and older completed the study. The intervention group participated in an eight-week, age-adapted, group-based MBCT program, while the control group received no psychological intervention. Outcomes were assessed using validated self-report measures. Within-group changes were analyzed using paired samples t-tests, and between-group differences were examined using analysis of covariance (ANCOVA) controlling for baseline scores. Effect sizes were calculated using Cohen's dz for within-group comparisons and Cohen's d for between-group differences. RESULTS:The intervention group showed significant improvements in mindfulness, sleep quality, depression, and stress symptoms compared to the control group, while anxiety scores showed improvement trends. ANCOVA confirmed these gains after adjusting for baseline differences. Large effect sizes suggest clinically meaningful effects. CONCLUSIONS:Age-adapted MBCT appears to be a feasible and clinically meaningful non-pharmacological intervention for older adults. CLINICAL IMPLICATIONS:Group-based, age-adapted mindfulness interventions may serve as a valuable component of geriatric mental health services and can be successfully integrated into community-based programs.
