This study explores the relationship between Adult Protective Service (APS) referrals and the link between dementia type behaviors. The question is does self-neglect, due to dementia precipitate multiple APS referrals? A quantitative-study was conducted based upon a random selection of fifty client files from the years 2014 and 2015. The information collected was based upon data provided to the APS hotline and what was determined by the APS investigators. SPSS software was used to determine the values of the data. Table 1 displays the results of demographics with 37% males and 63% females. Results of this study are inconsistent with the existing literature.

The number of Canadian widows and widowers has doubled since 1971, and these numbers are projected to increase as the Baby Boom generation continues to age. Prior studies demonstrate that remarriage is losing ground to cohabitation following union dissolution, and that cohabitation is increasing among older adults. This study explores post-widowhood repartnering practices among older Canadians on the basis of existing theories on partnership. The data were drawn from the 2007 General Social Survey Cycle 21 (N= 23,404 Canadians aged 45 and older). The cumulative proportion of competing post-widowhood partnership choices are compared using life table analysis. The effects of gender, demographic characteristics, cultural influences, economic resources, and physical health are explored using Cox’s proportional hazard modeling. The findings suggest that dominant theories of partnership are insufficient in explaining post-widowhood repartnering behaviour. Namely, most commonly-measured economic resources do not factor significantly into the post-widowhood repartnering choices of older Canadians. / Graduate / 0626 / 0628 / 0938 / nouellet@uvic.ca

There is growing evidence to suggest that vascular disease plays an important role in late life depressive disorder. The aim of this study was to characterize vascular impairment in late life depression. Assessment of endothelial function, arterial stiffness, and atherosclerosis in a variety of vessel beds was carried out in 25 subjects with late life depression and 21 nondepressed control subjects. All study subjects underwent wave velocity, pulse wave analysis, carotid intima media thickness analysis, and magnetic resonance imaging of the brain and a subset gluteal fat biopsy and direct assessment of small artery endothelial function. There were no baseline differences in demographics or a range of vascular risk factors between the groups. There was a generalised vascular dysfunction in depressed subjects with significantly more atherosclerosis, poorer endothelial function and increased arterial stiffness. On neuroimaging, depressed subjects had significantly more dilated Virchow-Robin spaces in the basal ganglia. White matter lesion volumes in all regions were higher in depressed subjects but not significantly so. Furthermore, subjects with late onset depression (onset >60years) had greater vascular impairment when compared to those with early onset illness. Lastly, depressed subjects who did not respond to antidepressant monotherapy showed more vascular dysfunction compared to responders. The study has a number of limitations including the small sample size and as the study was cross sectional, the observed relationship between vascular dysfunction and depression is associative rather than causal. Further research in larger samples is required to address the methodological limitations of this study. If the study results are confirmed, the use of vasoprotective drugs to improve vascular function or retard atherosclerosis as diasease modifying agents in late life depression would be a rational development.

The Cache County Study on Memory in Aging, funded by the National Institute on Aging, studied longitudinal changes in memory and aging over 12 years’ follow-up in a population-based sample of 5,092 older adults in semirural Cache County, UT. Among the extensive interview procedures, researchers collected information regarding the participants’ demographics, health, genetic factors, diet, physical activity, and cognitive abilities. This study has allowed researchers to investigate how genetic and modifiable lifestyle factors interact to predict health, cognitive function, and psychological wellbeing in older adults. Diet and exercise are important lifestyle factors in maintaining cognitive health and psychological wellbeing throughout the lifespan, including late-life. The current investigation primarily focused on the link between these lifestyle factors and specific genes in predicting cognitive decline and risk for depression among older adults. Older adults are at risk for cognitive and mood changes as they age and certain genes may increase their vulnerability to these changes. However, it is possible that an older adult’s lifestyle behaviors regarding dietary pattern and physical activity may be protective against such genetic vulnerabilities. The genes investigated in this study are related to the production of a protein in the brain that promotes cell growth and survival. A better understanding of the relationship between lifestyle and genetic factors in late-life cognitive decline and depression may offer a better conceptualization of healthy aging and lead to more targeted diet and exercise recommendations. The present study found that engagement in moderate-vigorous physical activity was associated with slower cognitive decline whereas vigorous physical activity was associated with reduced risk for depression. Further, a specific gene was related to worse cognitive functioning among sedentary individuals. Alternatively, greater adherence to the dietary pattern investigated in our study did not reduce risk for depression and was beneficial for cognition in males only.

No description available.

Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2–64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2–72.4) in women and 37.3 (95% CI: 23.6–58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16–3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46–7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.

Abstract Becoming involved in war is an experience that has the potential to shape later-life health. The aim of the present study was to explore Finnish Second World War veterans’ health status and the determinants of self-rated health (SRH) and functional capacity, especially the ability to walk, and to identify risk factors and their combinations that predict late-life mortality among veterans. The study population comprised Finnish Second World War veterans who participated in the Veteran 1992 and Veteran 2004 Project surveys. In 1992, a postal questionnaire was sent to all 242,720 war veterans living in Finland. The follow-up survey, the Veteran 2004 Project, was conducted with a randomized sample of veterans who participated in the Veteran 1992 Project. The total number of participants in the baseline survey was 177,989 men and 48,745 women, and in the follow-up survey, 4,348 men and 651 women. The response rate was high in both surveys: 93% in 1992 and 87% in 2004. All analyses were conducted separately for men without disability, men with disability and women. In a cross-sectional study, SRH and functional capacity was found to be better among 80–84-year-old Finnish war veterans in 2004 compared with 1992, although the prevalence of many diseases increased during the follow-up. Among the 4,999 veterans who participated in both surveys, the majority rated their health as improved or unchanged during the follow-up. Walking difficulties and cardiovascular (CVD), musculoskeletal and neurological diseases were found to be predictors of declined SRH. When exploring functional capacity among veterans, neurological and musculoskeletal diseases, but especially walking difficulties, predicted veterans’ future functional impairment as many as 12 years in advance, and worsening of these conditions was associated with impaired activities of daily living. During an average 9.9-year follow-up, walking difficulties alone or together with multimorbidity and/or with a third risk factor was the most important risk factor for total and for CVD mortality among all veteran groups. In conclusion, the majority of veterans rated their SRH as improved or unchanged during the follow-up. The importance of walking difficulties as a determinant of SRH and functional capacity and as a predictor of mortality was confirmed. / Tiivistelmä Tutkimuksen tarkoituksena oli arvioida suomalaisten toisen maailmansodan veteraanien terveydentilaa ja tutkia, mitkä tekijät vaikuttavat veteraanien itsearvioituun terveyteen ja toimintakykyyn (erityisesti kävelykykyyn) sekä tunnistaa ne riskitekijät ja tekijäyhdistelmät, jotka ennustavat kuolleisuutta. Tutkimuspopulaationa käytettiin Veteraaniprojekti 1992 ja Veteraaniprojekti 2004 -tutkimuksiin osallistuneita veteraaneja. Vuonna 1992 kysely lähetettiin postitse jokaiselle Suomessa tuolloin asuneelle 242 720 veteraanille. Seurantatutkimukseen valittiin 5 750 veteraanin satunnaisotos vuoden 1992 tutkimukseen osallistuneista. Veteraaniprojekti 1992 -tutkimukseen osallistui 177 989 miestä ja 48 745 naista ja seurantatutkimukseen 4 348 miestä ja 651 naista. Osallistumisprosentti oli 93 % (1992) ja 87 % (2004). Analyysit tehtiin erikseen veteraanimiehille joilla ei ollut invaliditeettia, invalidimiehille ja naisille. Poikkileikkaustutkimuksessa tarkasteltiin 80–84-vuotiaiden veteraanien terveyttä ja toimintakykyä vuosina 1992 ja 2004. Vuonna 2004 veteraanit arvioivat terveytensä ja toimintakykynsä paremmiksi kuin samanikäiset veteraanit vuonna 1992, vaikka monet sairaudet yleistyivät seuranta-aikana. Suurin osa molempiin kyselyihin vastanneista 4 999 veteraanista arvioi terveytensä joko parantuneen tai pysyneen ennallaan seuranta-aikana. Veteraanien kokemat kävelyvaikeudet, sydän- ja verisuonisairaudet, tuki-ja liikuntaelinsairaudet sekä neurologiset sairaudet ennustivat itsearvioidun terveyden heikkenemistä. Sydän- ja verisuonisairauksia lukuun ottamatta edellä mainitut tekijät ennustivat myös toimintakyvyn laskua jopa 12 vuotta etukäteen. Myös kävelykyvyn heikkeneminen ja sairauksien paheneminen seuranta-aikana ennustivat toimintakyvyn laskua. Kävelyvaikeudet joko yksin tai yhdessä multimorbiditeetin ja/tai jonkin kolmannen riskitekijän kanssa oli tärkein sekä kokonaiskuolleisuutta että sydän- ja verisuonitautikuolleisuutta ennustava tekijä kaikissa veteraaniryhmissä keskimäärin 9,9 vuoden seuranta-aikana. Yhteenvetona voidaan todeta, että enemmistö tutkimukseen osallistuneista veteraaneista arvioi terveytensä joko parantuneen tai pysyneen ennallaan seuranta-aikana. Koetut kävelyvaikeudet ovat erittäin tärkeä itsearvioitua terveyttä, toimintakykyä ja kuolleisuutta ennustava tekijä.

Situational Action Theory (SAT), a recently developed explanation of criminal conduct, is becoming increasingly studied. Hitherto, however, nearly all tests of the theory and its hypotheses have been based on samples of adolescents or young adults. Studies drawing on the older population have been missing so far. This work addresses the interplay of moral beliefs and the ability to exercise self-control in crime causation among respondents aged 50 years and over. In line with SAT and the results obtained previously for young people, our analyses show that self-control ability affects offending among older adults too, particularly when personal morality is weak.

Bakgrund: Depressioner hos äldre kan vara svårupptäckta till följd av en diffus symtombild samt då diagnossystemen DSM-5 och ICD-11 inte är anpassade för äldre. Många sjuksköterskor har svårigheter i att korrekt identifiera depressioner hos äldre personer. Mer kunskap och förståelse kring depressiva tillstånd hos äldre kan underlätta för psykiatrisjuksköterskor och andra specialistsjuksköterskor att identifiera dessa tillstånd samt leda till en förbättrad psykiatrisk omvårdnad av äldre personer. Syfte: Syftet var att belysa äldre personers erfarenheter av depressiva tillstånd i ålderdomen. Metod: En systematisk litteraturstudie baserad på nio kvalitativa studier genomfördes med Statens beredning för medicinsk och social utvärderings [SBU] metod som grundstruktur. Syntes av de kvalitativa studiernas resultat genomfördes enligt Howell Major och Savin-Baden. Resultat: Två tredje nivåns tema framkom: Det första tredje nivåns temat Att befinna sig på botten speglade den psykiska och existentiella förtvivlan de äldre befann sig i; en situation präglad av orkeslöshet, hopplöshet, självnedvärdering, skuld, skam, stigma, brist på stöd, ensamhet och alienation. Det andra tredje nivåns temat Att ta sig uppåt genom coping och andras stöd återgav de copingstrategier de äldre upplevde hjälpsamma samt betydelsen av andra människors stöd. Slutsats: Äldre personer som lider av depressiva tillstånd i ålderdomen bär erfarenheter av djup förtvivlan ur flera hänseenden och finner kraft i copingstrategier och stöd från andra. Nyckelord: depressiva tillstånd, erfarenheter, psykiatrisk omvårdnad, systematisk litteraturstudie, äldre / Background: Depressions in the elderly can be difficult to detect due to a diffuse symptomatology and because the diagnostic manuals DSM-5 and ICD-11 are not adapted for the elderly. Many nurses have difficulties in correctly identifying depressions in older people. More knowledge and understanding of depressive conditions in the elderly may facilitate for psychiatric-mental health nurses and other advanced practice nurses to identify these conditions and may conduce to an improved psychiatric-mental health nursing care for the elderly. Aim: To shed light on elderly persons’ experiences of depressive conditions in old age. Method: A systematic literature review based on nine qualitative studies was conducted, using Swedish Agency for Health Technology Assessment and Assessment of Social Services [SBU] as basic structure. Synthesis of the qualitative studies was carried out according to Howell Major and Savin-Baden. Result: Two third order themes emerged: The first third order theme, Being at rock bottom, reflected the existential and mental despair the elderly was in; a situation characterized by decrepitude, hopelessness, self-deprecating, guilt, shame, stigma, lack of support, loneliness and alienation. The second third order theme, Moving forward through coping and support from others, portrayed the coping strategies the elderly experienced as helpful and the importance of support from others. Conclusion: Elderly persons suffering from depressive conditions in old age experience different aspects of despair and find their path forward through coping strategies and support from others. Keywords: depressive conditions, elderly, experiences, psychiatric-mental health nursing, systematic literature review

Die Psychologie der Lebensspanne und die Soziologie des Lebensverlaufs betonen die Bedeutung von Kontexten für den Erwerb individueller Fähigkeiten und die Entwicklung im Leben. In Übereinstimmung mit diesen konzeptionellen Annahmen zeigen Studien, dass verschiedene Kontexte die Entwicklung individueller Bereiche beeinflussen. Jedoch ist wenig darüber bekannt, wie kontextuelle Faktoren in der zweiten Lebenshälfte Wohlbefinden formen und wie Wohlbefinden in diesen Lebensphasen von sich schnell verändernden Kontexten beeinflusst wird. In dieser Dissertation werden unter Anwendung des Ökosystemischen Ansatzes von Bronfenbrenner drei Kontexte unterschiedlicher Proximität untersucht, in die die Entwicklung des individuellen Wohlbefindens eingebettet ist. Als erster Kontext wird die vielfältige Ökologie des Lebens und Sterbens in den ehemaligen Regionen Ost- und Westdeutschland herangezogen, um herauszufinden wie dieses Makrosystem Wohlbefinden in den letzten Lebensjahren gestaltet. Als zweiter Kontext wird die Bedeutung des Exosystems von Gesundheitseinrichtungen in Landkreisen (z.B. Anzahl stationärer Pflegereinrichtungen) auf Wohlbefindensverläufe am Lebensende beleuchtet. Als dritten Kontext untersuchen wir, wie das Mikrosystem sozialer Ökologien und Situationen momentanes, affektives Wohlbefinden gestaltet, sowie Altersunterschiede in diesen Assoziationen. Gemeinsam zeigen die drei Studien dieser Dissertation, dass Ökologien auf regionaler, dienstleistender und sozialer Kontextebene Entwicklung von Wohlbefinden in der zweiten Lebenshälfte beeinflussen. Diese Arbeit zeigt, dass Kontexte sowohl kognitives als auch affektives Wohlbefinden und innerhalb des letzteren sowohl Valenz und Aktivierung beeinflussen, und untersucht länger- und kurzfristige Kontext-Wohlbefindens-Assoziationen in späteren Lebensphasen. Die Ergebnisse liefern erste Vorschläge für Interventionen und veränderbare regionale Faktoren für die Erhaltung oder Verbesserung von Wohlbefinden. / Lifespan psychology and life course sociology have long acknowledged the role of context for individual functioning and development throughout life. Consistent with these conceptual notions, empirical studies show that various contextual factors influence development of individual-level outcomes. However, we know little about how contextual factors shape individual-level well-being and how well-being is influenced by fast changing contexts in the second half of life. Applying Bronfenbrenner’s model of human ecology as the overarching theoretical frame, this dissertation examines three sets of contexts that differ in the degree of proximity in which individual well-being and its development is embedded in. As a first context, the multifaceted ecology of living and dying in former regions of East and West Germany is used to investigate how the macrosystem shapes individual well-being in the last years of life. For a second context, the role of the exosystem of county-level health care features (e.g., number of inpatient care facilities) on late-life trajectories in well-being is examined. As a third context, we examine how the microsystem of social ecologies and situations influences momentary affective well-being and how these associations differ across age. Jointly, the three studies in this dissertation show that regional, service, and social ecologies profoundly shape development in well-being during the second half of life. To conclude, this dissertation shows that these contexts influence both cognitive and affective components of well-being, among the affective domain two facets (valence and arousal), and investigates long-term and short-term contextwell- being associations in later life phases. Results provide initial suggestions for interventions and malleable regional factors to maintain or improve well-being.