The Effect of Caregiver Support Interventions for Informal Caregivers of Community-Dwelling Frail Elderly: A Systematic Review.

The effect of caregiver support interventions for informal caregivers of community-dwelling frail elderly: a systematic review.

Int J Integr Care. 2012 7; 12: e133
Lopez-Hartmann M, Wens J, Verhoeven V, Remmen R

Informal caregivers are important resources for community-dwelling frail elderly. But caring can be challenging. To be able to provide long-term care to the elderly, informal caregivers need to be supported as well. The aim of this study is to review the current best evidence on the effectiveness of different types of support services targeting informal caregivers of community-dwelling frail elderly.A systematic literature search was performed in Medline, PsychINFO, Ovid Nursing Database, Cinahl, Embase, Cochrane Central Register of Controlled Trials and British Nursing Index in september 2010.Overall, the effect of caregiver support interventions is small and also inconsistent between studies. Respite care can be helpful in reducing depression, burden and anger. Interventions at the individual caregivers’ level can be beneficial in reducing or stabilizing depression, burden, stress and role strain. Group support has a positive effect on caregivers’ coping ability, knowledge, social support and reducing depression. Technology-based interventions can reduce caregiver burden, depression, anxiety and stress and improve the caregiver’s coping ability.Integrated support packages where the content of the package is tailored to the individual caregivers’ physical, psychological and social needs should be preferred when supporting informal caregivers of frail elderly. It requires an intense collaboration and coordination between all parties involved. HubMed – depression

Transitional care programs: who is left behind? A systematic review.

Int J Integr Care. 2012 7; 12: e132
Piraino E, Heckman G, Glenny C, Stolee P

Older adults are at risk of rehospitalization if their care transitions from hospital-to-home are not properly managed. The objective of this review was to determine if older patient populations recruited for randomized controlled trials of transitional care interventions represented those at greatest risk of rehospitalization following discharge. Relevant risk factors examined were cognitive impairment, depression, polypharmacy, comorbidity, length of stay, advanced non-malignant diseases, and available social support.Systematic review.Hospital to home.Older hospitalized adults.For inclusion, articles were required to focus on hospital-to-home transitions with a self-care component, have components occurring both before and after discharge, and a randomized controlled trial design. Articles were excluded if participants had a mean age under 55 years, or if interventions focused on developmental disabilities, youth, addictions, or case management, or were solely primary-care based.Following title, abstract, and full review by two authors, 17 articles met inclusion criteria. Risk factors for rehospitalization were often listed either as exclusion criteria or were not reported at baseline by the studies. One study included patients with all identified risk factors for rehospitalization.These data suggest that published studies of transitional care interventions do not often include older adults at highest risk of rehospitalization, raising concerns about the generalizability of their results. Studies are needed that evaluate interventions that explicitly address the needs and characteristics of these patients. HubMed – depression

Impact of Sleep Quality on Amygdala Reactivity, Negative Affect, and Perceived Stress.

Psychosom Med. 2013 Apr 16;
Prather AA, Bogdan R, Hariri AR

ObjectiveResearch demonstrates a negative impact of sleep disturbance on mood and affect; however, the biological mechanisms mediating these links are poorly understood. Amygdala reactivity to negative stimuli has emerged as one potential pathway. Here, we investigate the influence of self-reported sleep quality on associations between threat-related amygdala reactivity and measures of negative affect and perceived stress.MethodsAnalyses on data from 299 participants (125 men, 50.5% white, mean [standard deviation] age = 19.6 [1.3] years) who completed the Duke Neurogenetics Study were conducted. Participants completed several self-report measures of negative affect and perceived stress. Threat-related (i.e., angry and fearful facial expressions) amygdala reactivity was assayed using blood oxygen level-dependent functional magnetic resonance imaging. Global sleep quality was assessed using the Pittsburgh Sleep Quality Index.ResultsAmygdala reactivity to fearful facial expressions predicted greater depressive symptoms and higher perceived stress in poor (? values = 0.18-1.86, p values < .05) but not good sleepers (? values = -0.13 to -0.01, p values > .05). In sex-specific analyses, men reporting poorer global sleep quality showed a significant association between amygdala reactivity and levels of depression and perceived stress (? values = 0.29-0.44, p values < .05). In contrast, no significant associations were observed in men reporting good global sleep quality or in women, irrespective of sleep quality.ConclusionsThis study provides novel evidence that self-reported sleep quality moderates the relationships between amygdala reactivity, negative affect, and perceived stress, particularly among men. HubMed – depression

Sense of Coherence, Depressive Symptoms, Cardiovascular Diseases, and All-Cause Mortality.

Psychosom Med. 2013 Apr 16;
Haukkala A, Konttinen H, Lehto E, Uutela A, Kawachi I, Laatikainen T

ObjectiveThere is increasing interest in whether positive and negative psychological constructs are bipolar opposites of the same phenomenon. We examine whether a positive construct-sense of coherence (SOC)-has independent predictive power over and above depressive symptoms for cardiovascular disease (CVD) and all-cause mortality.MethodsParticipants included 3850 men and 4083 women aged 25 to 74 years who had participated in risk factor surveys conducted in 1992 or 1997. Antonovsky’s 13-item SOC scale was used to measure SOC, and had a correlation of -0.60 with the Beck Depression Inventory.ResultsDuring a mean follow-up time of 14.2 years, there were 670 deaths and 487 nonfatal and fatal CVD events. Higher SOC scores were associated with a lower risk of all-cause mortality (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.84-0.97 per unit), especially among men, but this association became nonsignificant after adjustment for depressive symptoms (RR = 0.99, 95% CI = 0.90-1.08). Among participants without a history of CVD, higher SOC scores were related to a lower risk for CVD (RR = 0.90, 95% CI = 0.83-0.98), but this association disappeared after adjustment for cardiovascular risk factors. Depressive symptoms remained significant predictors of CVD among women in a model including also SOC (RR = 1.24, 95% CI = 1.06-1.46).ConclusionsSOC was related to all-cause mortality among men; the association with CVD events was modest. Measures for SOC and depressive symptoms were significantly correlated, which might result in overlap in their associations with adverse disease and mortality outcomes. HubMed – depression

Association between body mass index and suicide, and suicide attempt among british adults: The health improvement network database.

Obesity (Silver Spring). 2013 Mar; 21(3): E334-E342
Gao S, Juhaeri J, Reshef S, Dai WS

OBJECTIVE: To examine the associations between body mass index (BMI) and incidence rate (IR) of suicide attempt and suicide. DESIGN AND METHODS: 849,434 British adults were identified from The Health Improvement Network (THIN) database between January 2000 and October 2007. BMI was categorized into six levels: <18.5 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30.0-34.9, 35.0-39.9, and ?40 (obese levels I-III). RESULTS: We identified 3,111 suicide attempts by Read codes and 75 suicides with medical records. The overall IR of suicide attempt was 82.2 cases per 100,000 person-years. The IR decreased with BMI in men with depression (471.3-166.0 cases per 100,000 person-years, P for trend = 0.02) and in men without depression (241.5-58.0 cases per 100,000 person-years, P for trend < 0.0001). In women with depression, an L-shaped relationship was observed, that is, a higher rate in underweight group when compared with reference group (503.2 vs. 282.7 per 100,000 person-years) and no significant differences in others (231.8-195.5 cases per 100,000 person-years). In women without depression, the IR was U-shaped with BMI (125.2 in underweight, 68.6 in reference, and 48.5-79.9 cases in overweight and obese I-III groups per 100,000 person-years, P for trend < 0.0001). The above trends remained after adjustment for the covariates. Regarding suicide, the overall IR was 2.0 cases per 100,000 person-years, which tended to decrease with BMI (P = 0.14). CONCLUSIONS: We concluded an inverse linear association between BMI and suicide attempt among men, an L-shaped association in nondepressive women, and a U-shaped association in depressive women were observed. The study also suggested an inverse linear tendency between BMI and suicide. HubMed – depression