ABSTRACT Objective The long‐term impact of coping behaviors and strategies on the risk of geriatric depression remains unclear. We examined coping strategies and behaviors in mid‐to‐late life as predictors of major depressive disorder (MDD) during approximately 15 years of follow‐up. Method Overall, 1039 participants were assessed for coping behaviors and strategies in 2000, and their MDD status was diagnosed by a standard psychiatrist‐based assessment in 2014–2015. The Stress and Coping Inventory was used to assess the frequency of six coping behaviors: consulting, planning, positive reappraisal, avoidance, fantasizing, and self‐blame. Subsequently, we assessed two coping strategies: approach‐oriented and avoidance‐oriented. Logistic regression examined associations between coping behaviors and strategies and MDD, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results Among 1039 participants (mean age: 72.6 ± 5.4 years in 2014–2015), 86 (8.3%) were diagnosed with MDD. Among the six coping behaviors, planning (OR: 0.47, 95% CI: 0.24–0.90) and positive reappraisal (OR: 0.36, 95% CI: 0.17–0.74) were associated with a lower risk of MDD, whereas fantasizing (OR: 3.20, 95% CI: 1.64–6.24) was associated with a higher risk. An approach‐oriented coping strategy was associated with a lower risk of MDD (OR: 0.42, 95% CI: 0.18–0.94), while an avoidance‐oriented coping strategy was associated with a higher risk (OR: 3.88, 95% CI: 1.28–11.75). Conclusion Coping behaviors and strategies in mid‐to‐late life were associated with subsequent MDD risk among older adults, suggesting that coping style is a potentially modifiable target for geriatric depression prevention.
ABSTRACT Objectives Opioid use disorder (OUD) is increasingly recognised as a risk factor for cognitive impairment and dementia, but the biological mechanisms underlying this association remain unclear. We aimed to investigate the involvement of established neurodegenerative, vascular, or inflammatory pathways. Methods We performed a two‐sample Mendelian randomisation study using summary‐level genetic data from nine genome‐wide association studies of individuals predominantly of European ancestry. Genetic instruments for OUD liability were used to estimate associations with neurodegenerative, vascular, and inflammatory phenotypes, including amyloid‐β, tau, cerebral amyloid angiopathy, cerebral microinfarcts, and C‐reactive protein (CRP). Causal effects were estimated using inverse‐variance weighted Mendelian randomisation, with replication and Bayesian colocalisation analyses used to further evaluate the findings. Results There was little evidence that genetic liability to OUD was associated with amyloid‐β, tau, or vascular phenotypes. A modest positive association was observed with CRP ( β = 0.11, 95% CI 0.04–0.18, p = 2 × 10 −3 ). This association was replicated in an independent dataset ( β = 0.12, 95% CI 0.05–0.19, p = 1.59 × 10 −3 ). A nominal inverse association was also observed with IL‐15 ( β = −0.23, 95% CI −0.43 to −0.03, p = 2.2 × 10 −2 ), although colocalisation did not support a shared causal variant at implicated loci. Conclusions Genetic liability to OUD showed little evidence of association with the neurodegenerative or vascular phenotypes examined; however, these findings do not exclude the involvement of Alzheimer's disease or cerebrovascular pathways, particularly given the limited power and the use of only three genetic instruments. The observed inflammatory associations should be considered hypothesis‐generating, particularly given the lack of colocalisation support, and require further investigation.
ABSTRACT Objectives Most people with dementia prefer remaining in their own homes as long as possible. Smart home assistive technologies are being developed to enhance safety and autonomy of people with dementia and to support their caregivers. However, evidence for their efficacy and effectiveness in community‐based dementia care remains uncertain. Hence, we aim to systematically review the available evidence on the efficacy of smart home assistive technology devices for supporting people with dementia living in their homes. Methods We conducted a systematic review following PRISMA‐2020 guidelines (PROSPERO ID:CRD420251051358). We comprehensively searched four databases. Eligible studies examined smart home or wearable devices used by people with dementia in home or supported accommodation settings. We systematically performed quality assessment, data extraction, and the GRADE assessment. Meta‐analyses were conducted when three or more studies investigated similar outcomes. Results We screened 3176 abstracts and identified 18 eligible studies that investigated 17 devices. There is level‐2 evidence supporting the use of companion robots, electric calendar, a night‐time home monitoring system and the People Power Caregiver system. Our meta‐analysis did not find evidence supporting the use of the investigated devices for reducing caregiver burden ( p = 0.68; Hedges’s g = 0.01; 95% CI −0.14 to 0.17). Conclusions Smart home technologies for dementia care are acceptable and feasible. However, current evidence for their efficacy remains limited. Larger clinical trials are required to strengthen their evidence base and justify their routine use in supporting people with dementia and caregivers.
Key Points Introduces sericulture as a novel, highly feasible psychosocial intervention that bridges geriatric care with the preservation of endangered cultural heritage. Demonstrates how culturally embedded occupations can elicit spontaneous, natural reminiscence and deep biographical reflections among older adults. Empowers institutionalized older adults to transition from passive care recipients to active caregivers. Provides a scalable framework for utilizing local traditions to restore social roles for vulnerable older adults while revitalizing community heritage.
Background To date, no longitudinal study has assessed the effect of agitation on societal costs-particularly informal care costs-over time in Alzheimer's Disease (AD) patients with Agitation and Aggression (A/A) symptoms.Objectives This study estimates the impact of A/A symptoms evolution on longitudinal care costs including informal care costs in moderate-to-severe AD, considering patient and caregiver socioeconomic characteristics.Design A longitudinal trajectory clustering method was used on this longitudinal, prospective, multicenter observational cohort study. Setting and Participants: 262 community-dwelling and long-term care facility (LTCF) patients of both sexes, aged 60 years and older, with clinically significant A/A symptoms were recruited from memory centers in southwest France.Methods Patients were followed for 12 months. A/A data was recorded by clinicians using the Neuropsychiatric Inventory (NPI-c). Costs were estimated from a societal perspective, including healthcare and informal care, using the RUD questionnaire. K-means longitudinal method identified A/A evolution profiles. Cost differences across A/A evolution profiles were analyzed using Generalized Linear Models.Results Two A/A evolution profiles were identified: mild symptoms at baseline with improvement (A) and moderate symptoms at baseline with limited improvement or stability (B). Annual costs were & euro;22,959 in group A and & euro;23,625 in group B excluding supervision, and & euro;52,111 and & euro;56,149, respectively, including supervision. In LTCF residents, higher A/A severity was associated with increased medical visits and medication costs, though overall cost differences were smaller. Informal care neared 70% of total costs for community-dwelling patients, with supervision covering the majority of these costs.Conclusions Evolution of A/A symptoms significantly increases both healthcare and informal care costs, particularly in at-home settings. Integrating systematic monitoring of behavioral symptoms into routine care would enable personalized, cost-effective strategies. Informal care costs, often undervalued and overlooked in economic analyzes, underscores the need for improvement in resource allocation and quality of life, for both patients and caregivers.Clinical trial number NCT03554226
