International Journal Of Geriatric Psychiatry[JOURNAL]
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200 papers
Conceptualising the Role of Dementia Champions Across Health and Social Care: A Qualitative Study Informed by Theory of Change (The DemChamp Study).
James T, Leverton M, Samsi K … +1 more , Newton C
Int J Geriatr Psychiatry · 2025 May · PMID 40399239 · Full text
OBJECTIVES: People who work in health and social care frequently come into contact with people living with dementia, highlighting the need for a dementia aware and competent workforce. Some health and care services have...
OBJECTIVES: People who work in health and social care frequently come into contact with people living with dementia, highlighting the need for a dementia aware and competent workforce. Some health and care services have implemented 'Dementia Champions' (DCs) to address this, but the role is rarely seen in domiciliary homecare services. We aim to conceptualise the DC role across health and social care to learn how it is implemented in practice and consider how it can be applied to homecare. METHODS: We conducted 30 semi-structured interviews with health and social care workers who either work as DCs or have experience/knowledge of working with them. We used framework analysis to analyse the data, informed by a Theory of Change (ToC) approach which involved identifying the 'inputs' involved in the role (tasks and responsibilities); and the short, medium, and long-term mechanisms required to implement, embed, and maintain the role. RESULTS: We identified key tasks and responsibilities of a DC which varied between and within sectors and services. The was a lack of role clarity and rarely a role description, which was considered a barrier to the role's success. The DC role is typically voluntary with no remuneration and performed on top of existing roles with no protected time for specific DC tasks. DCs typically take on the role due to a passion for good dementia care and a desire to make a difference, meaning feedback and feeling valued were important. The DC role provides an opportunity for career development, which was considered essential to retaining DCs, and health and social care workers generally. We present these findings as five themes which map onto our ToC framework to explore how the DC role is implemented, embedded, and maintained in practice. CONCLUSIONS: Across all services, there is need for role clarity, with a DC role description at the outset to set out the tasks, responsibilities, and boundaries of the role. The DC role needs protected time for workers to implement it and undertake training. We will use these findings to develop and refine our ToC framework to reflect its applicability for the homecare sector.
Changes in the Emergency Department Visits Among the Older Adults With Dementia Before, and After the Nationwide Social Distancing Measures: An Interrupted Time Series Analysis.
Moon J, Lee KS, Sung HK … +1 more , Kim S
Int J Geriatr Psychiatry · 2025 May · PMID 40397491 · Full text
OBJECTIVES: Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions...
OBJECTIVES: Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions in social interactions and raising concerns about unforeseen impacts on vulnerable populations, particularly older individuals with dementia. This study examines the impact of extended social isolation on dementia patients receiving emergency care. METHODS: We conducted a nationwide study of emergency department (ED) visits among dementia patients aged 65+ during various phases of pandemic-related social distancing. Segmented quasi-Poisson regression models were used to determine changes in ED visits during and after social distancing compared to pre-social distancing. RESULTS: From 2017 to 2022, there were 203,772 ED visits by patients with dementia among older patients. The proportion of ED visits by patients with dementia decreased from 17% pre-pandemic to 15% during social isolation. Interrupted time series analysis revealed a decline in ED visits during social distancing (step change: 0.849, 95% confidence interval [CI] 0.804-0.897; slope change: 1.000, 95% CI 0.996-1.003) followed by a rebound after restrictions were lifted (step change: 1.076, 95% CI 1.024-1.131; slope change: 1.009, 95% CI 0.994-1.025). However, monthly admission and mortality rates increased during social distancing. CONCLUSION: This study observed a decline in ED visits by patients with dementia among older patients during social distancing, followed by a rebound after restrictions were lifted. However, the social distancing period was associated with increased hospitalization and mortality. These findings underscore the importance of maintaining healthcare accessibility for vulnerable older adults.
Prevalence of Dementia in European, Chinese and Indian/Fijian-Indian Populations in Aotearoa New Zealand: A Protocol.
Cullum S, Wu X, Rivera-Rodriguez C … +18 more , Krishnamurthi R, Broadbent J, Yates S, Martinez-Ruiz A, Tippett L, Garrett N, Menzies O, Ao BT, Hikaka J, Fa'alau F, Ma'u E, Chacko E, Chan A, Dudley M, Faull R, Croucher M, Kerse N, Cheung G
Int J Geriatr Psychiatry · 2025 May · PMID 40390139 · Full text
OBJECTIVES: Aotearoa New Zealand (NZ) is a bicultural nation (Māori and European) with a growing population of Asian and Pacific peoples. Recent analysis of national routinely collected data suggests dementia prevalence...
OBJECTIVES: Aotearoa New Zealand (NZ) is a bicultural nation (Māori and European) with a growing population of Asian and Pacific peoples. Recent analysis of national routinely collected data suggests dementia prevalence is higher in Māori and Pacific peoples when compared with European and Asian, and that inequities in dementia care for Māori, Asian, and Pacific people with dementia exist. A population-based dementia prevalence study is needed to confirm these findings. The aim of this protocol is to describe a dementia prevalence study focussing on the European, Chinese and Indian populations in NZ. The findings will be compared to a separate study on Māori populations using a similar study design. METHODS: This is a cross-sectional screen-interview survey of people aged ≥ 65 from European, Chinese and Indian/Fijian-Indian backgrounds in sampled meshblocks within two regions of NZ. Stage 1 involves screening eligible participants at the door using the brief cognitive scale of the Community Screening Instrument for Dementia (CSI-D). Stage 2 involves interviewing random samples of screen positive and negative participants using the 10/66 dementia protocol. With a margin of error of approximately 3%, and a confidence level of 5%, a total of 485 European, 410 Chinese and 425 Indian/Fijian-Indian people will be interviewed with the 10/66 protocol. Age-standardised prevalence estimates of 10/66 dementia will be back-weighted for study design. CONCLUSION: This study will provide evidence for suspected ethnic inequalities in dementia, inform new culturally appropriate dementia management strategies, and contribute to improved outcomes for people with dementia in NZ.
Clozapine Treatment in Patients With a Neurocognitive Disorder.
Triest A, Kok RM
Int J Geriatr Psychiatry · 2025 May · PMID 40389802 · Publisher ↗
OBJECTIVES: Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are...
OBJECTIVES: Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder. METHODS: A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files. RESULTS: We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi = 14.47, df = 2, p < 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration. CONCLUSION: Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.
How Disease-Modifying Therapies Challenge Dementia Care Continuity in Japan: From Promise to Paradox.
Ito K, Hatakeyama A, Okamura T
Int J Geriatr Psychiatry · 2025 May · PMID 40369793 · Full text
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Incidence and Risk Factors of Postoperative Delirium in Elderly Patients Following Hip Fracture Surgery: A Nationwide Retrospective Cohort Study in Taiwan.
Shih CA, Yang DC, Wang WM … +3 more , Wu YL, Yang YC, Ku HC
Int J Geriatr Psychiatry · 2025 May · PMID 40354105 · Full text
BACKGROUND: Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended h...
BACKGROUND: Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended hospital stays, increased mortality risk, and higher nursing costs. In postoperative hip fracture patients, delirium results in a higher complication rate, poorer functional recovery, increased readmission rates, repeat surgeries, and elevated mortality. Despite these serious consequences, the literature provides limited information on the incidence of postoperative delirium following hip fracture surgeries in Asians. Additionally, there is a lack of long-term, comprehensive nationwide population-based studies, highlighting an important area for future research. This study aims to understand the incidence and risk factors of postoperative delirium in hip fracture patients using representative population data. METHODS: We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort consisted of 118,682 patients aged 65 years or older who were diagnosed with hip fractures. The delirium incidence was observed per 1000 person-years. The Cox proportional hazards model was used to investigate the incidence of delirium among hip fracture patients. RESULTS: The incidence of the first episode of delirium after hip surgery in the elderly was 1.87 events per 1000 PYs. Factors associated with delirium included being female (adjusted hazard ratio [aHR]: 0.59; 95% confidence interval [CI]: 0.53-0.64), age ≥ 95 years (aHR: 3.52; 95% CI: 2.74-4.51), comorbid dementia (aHR: 2.63; 95% CI: 2.38-2.92), and ICU stay 2-3 days (aHR: 2.85; 95% CI: 1.28-6.37). The occurrence of delirium was significantly associated with an ICU stay of ≥ 4 days, dementia, as well as 30-day, 90-day, and 1-year mortality (p < 0.001). CONCLUSIONS: This study highlights the relatively low incidence of postoperative delirium in elderly hip fracture patients in Taiwan. Key risk factors identified include advanced age, female gender, comorbid dementia, and prolonged ICU stays. These findings underscore the need for targeted prevention and early intervention strategies to improve patient outcomes.
Age Trajectories of Mental and Cognitive Health From Midlife to Older Adulthood: Examination of Cohort and Gender Roles in Taiwan.
Chiu CJ, Wray LA, Chen JY … +1 more , Hou SY
Int J Geriatr Psychiatry · 2025 May · PMID 40347445 · Publisher ↗
OBJECTIVES: This study examined the age trajectories of mental and cognitive health from midlife to older adulthood, and how age and gender impacted mental and cognitive health change across age cohorts. METHODS: Multile...
OBJECTIVES: This study examined the age trajectories of mental and cognitive health from midlife to older adulthood, and how age and gender impacted mental and cognitive health change across age cohorts. METHODS: Multilevel modeling was used to analyze the panel data on cognitive function, life satisfaction, and depressive symptoms from the 1996-2011 Taiwan Longitudinal Study on Aging (N = 5131). RESULTS: Cognitive function gradually declined with chronological age (β = -0.041, p < 0.001), and declined faster in earlier-born cohorts (β = -0.168, p < 0.001). Life satisfaction showed the opposite effect with age and cohort: while earlier-born cohorts reported lower life satisfaction (β = -0.498, p < 0.05), life satisfaction increased with chronological age (β = 0.015, p < 0.05). Older adults reported more depressive symptoms, but this phenomenon was only significantly associated with age cohort (β = 3.530, p < 0.001). Widened differences between men and women in life satisfaction and depressive symptoms were associated with age cohort but not chronological age per se. CONCLUSIONS: Men and later-born cohorts experienced significantly better mental and cognitive health than women and earlier-born cohorts. Age- and gender-related changes in mental and cognitive health in later life should be considered within the socio-culturally contextualized birth cohort.
The Association of Apathy With Incident Dementia: A Multiple Mediation Analysis of Cardiovascular Risk Factors.
Lindhout JE, van Dalen JW, van Gool WA … +2 more , Richard E, Hoevenaar-Blom MP
Int J Geriatr Psychiatry · 2025 May · PMID 40347436 · Full text
OBJECTIVES: Despite established links between apathy, cardiovascular disease, and dementia, it remains unclear if cardiovascular risk factors (CVRF) play a mediating role in the association between apathy and dementia. I...
OBJECTIVES: Despite established links between apathy, cardiovascular disease, and dementia, it remains unclear if cardiovascular risk factors (CVRF) play a mediating role in the association between apathy and dementia. If apathy increases dementia risk via lifestyle-related dementia risk factors, targeted lifestyle interventions could help high-risk individuals. METHODS: We used data from the preDIVA study including 3303 individuals aged 70-78 years. Apathy was assessed using the geriatric depression scale, and CVRF (cardiovascular risk factors) (systolic blood pressure, cholesterol, diabetes, body mass index (BMI), smoking, and physical activity) were considered as potential mediators. Outcome was incident dementia during 12 years of follow-up. We assessed mediation using Multiple Mediation Analysis (MMA). RESULTS: Of the association between apathy and dementia (HR 1.49 [95% CI 0.99-2.41]), 27% was mediated by physical inactivity, BMI and diabetes combined. Of this total, physical inactivity mediated 28% of the effect (HR 1.12, 95% CI 1.03-1.29), diabetes 9% of the effect (HR 1.04, 95% CI 1.02-1.10), and BMI counteracted these effects by -12% (HR 0.95, 95% CI 0.88-0.98). CONCLUSION: The relationship between apathy and dementia is partly mediated by physical inactivity, BMI and diabetes. Apathy is an important clinical marker that signals the existence of potentially modifiable pathways, providing an opportunity for lifestyle interventions. To potentially reduce dementia risk via lifestyle modification in patients with apathy, a tailored approach should be taken to overcome the characterizing symptom of diminished motivation.
Facility-Level Variation of Resident Loneliness in Assisted Living and Associated Organizational Context Factors: A Repeated Cross-Sectional Study.
Hoben M, Dampf H, Devkota R … +4 more , Corbett K, Hogan DB, McGrail KM, Maxwell CJ
Int J Geriatr Psychiatry · 2025 May · PMID 40338173 · Full text
BACKGROUND AND OBJECTIVES: Loneliness is common among nursing home residents, and it is also thought to be a problem in assisted living (AL). However, we lack research on loneliness in AL. Our objectives were to assess c...
BACKGROUND AND OBJECTIVES: Loneliness is common among nursing home residents, and it is also thought to be a problem in assisted living (AL). However, we lack research on loneliness in AL. Our objectives were to assess changes in risk-adjusted prevalence of loneliness in AL, and facility-level variations in loneliness before and during the COVID-19 pandemic, and facility-level factors associated with AL resident loneliness during the pandemic. RESEARCH DESIGN AND METHODS: This population-based, repeated cross-sectional study used Resident Assessment Instrument-Home Care (RAI-HC) data (01/2017-12/2021) from Alberta, Canada. On a system-level, we estimated quarterly, risk-adjusted loneliness prevalence, and used segmented regressions to assess whether loneliness changed after the start of the pandemic. For risk adjustment, we used resident-covariates known to be associated with loneliness, but out the health system's or AL home's control (e.g., age or cognitive impairment) to enable fair comparisons over time. Linking AL home surveys, collected in COVID-19 waves 1 (March-June 2020) and 2 (October 2020-February 2021) to RAI-HC records, we used covariate-adjusted general estimating equations (GEE) to assess AL home factors (e.g., staffing shortages, social distancing measures) associated with resident-level loneliness during the pandemic. RESULTS: Quarterly samples included 2026-2721 residents. Loneliness [95% confidence interval] fluctuated between 13.6% [11.5%-15.7%], and 16.8% [14.4%-19.2%], with no statistically significant increase during the pandemic. Facility-level median [inter-quartile range] loneliness prevalence varied considerably before (14.9% [8.3%-21.1%) and during the pandemic (13.5% [6.9%-21.3%]). GEEs included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Facility-factors associated with decreased odds of loneliness included: facilitating caregiver involvement (odds ratio = 0.531 [95% confidence interval: 0.286-0.986]), essential visitor policies (0.672 [0.454-0.994]), and video calls with volunteers or religious/spiritual leaders (0.603 [0.435-0.836]). Facilitating outdoor activities/visits (2.486 [1.561-3.961], and providing hallway-based activities (1.645 [1.183-2.288]) were associated with increased odds of loneliness. DISCUSSION AND IMPLICATIONS: Loneliness did not change during COVID-19 in AL on a health system level, but varied considerably between facilities before and during the pandemic. Modifiable facility-level factors explained variations in loneliness within facilities, suggesting important targets for policies and improvement interventions.
The Role of Social Media in Mitigating the Long-Term Impact of Social Isolation on Mental and Cognitive Health in Older Adults During the COVID-19 Pandemic: The HUNT Study.
Ibsen TL, Zotcheva E, Bergh S … +9 more , Gerritsen D, Livingston G, Lurås H, Mamelund SE, Mork Rokstad AM, Strand BH, Thingstad P, Oude Voshaar RC, Selbæk G
Int J Geriatr Psychiatry · 2025 May · PMID 40338168 · Full text
BACKGROUND: The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear. AIM: To investigate the long-term associa...
BACKGROUND: The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear. AIM: To investigate the long-term association of social isolation with mental and cognitive health in older adults and whether social media use mitigated this association. METHOD: Data from the Norwegian Trøndelag Health Study before (2017-2019), during (January 2021), and after the pandemic (2021-2023) were analysed (N = 4844, 53% women, mean age 80 years). Multi-adjusted mixed-effects linear regression estimated differences in changes in mental (CONOR-MHI) and cognitive (MoCA) health related to self-reported social isolation and social media use. Beta (β) represents differences in change in z-score of CONOR-MHI or MoCA. RESULTS: Social isolation was associated with a steeper decline in mental health than no social isolation (β = 0.07, 95% CI 0.01, 0.13) but was not associated with change in cognitive health. Daily social media use was not related to change in mental health, whereas it was associated with a less steep cognitive decline than no social media use (< 1 h: β = 0.13, 95% CI 0.05, 0.20; ≥ 1 h: β = 0.10, 95% CI 0.01, 0.15). Stratified by social isolation, daily social media use < 1 h was related to a less steep cognitive decline than no social media use in both isolated (β = 0.15, 95% CI 0.02, 0.28) and non-isolated individuals (β = 0.13, 95% CI 0.03, 0.22). CONCLUSION: Individuals experiencing social isolation during the pandemic had a steeper decline in mental, but not cognitive health, compared to those not isolated. Social media use did not buffer the decline in mental health but was associated with less steep cognitive decline. The pandemic showed limits of relying solely on digital solutions for social contact. TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov 18.02.2021, with the identification number NCT04792086.
The Impact of Clean Water Access on Older Adults' Cognitive Function: A Quasi-Experiment in Rural China.
Sheng L, Ma J
Int J Geriatr Psychiatry · 2025 May · PMID 40325608 · Publisher ↗
OBJECTIVES: The long-term effect of clean water access on cognitive function of rural older adults is little known. In this paper, we use the implementation of the rural drinking water program in China as a quasi-experim...
OBJECTIVES: The long-term effect of clean water access on cognitive function of rural older adults is little known. In this paper, we use the implementation of the rural drinking water program in China as a quasi-experiment to explore the impact of clean water access on cognitive function. METHODS: Using longitudinal data from the 2010 to 2020 China Family Panel Studies (CFPS), cognitive function is measured through word tests, math tests, delayed memory, and number series tests. The staggered difference-in-difference (DID) and event study methods are used to test the causal effect of clean water access on cognitive function among rural older adults (aged 60 and above) in China. RESULTS: We find that clean water access resulting from this program has a significant positive impact on the cognitive function of rural older adults. Specifically, clean water access increases the scores on the word test, the math test, the delayed memory, and the number series test by 0.104, 0.071, 0.096, and 0.111 standard deviations, respectively. Mechanism analysis shows that clean water access promotes cognitive function through physical health (Including improved self-rated health, increased labor market participation), household income and social participation. Heterogeneity analysis indicates that respondents who are female, older, higher education level and higher income level benefit more from this drinking water program. CONCLUSIONS: Clean water access significantly improves the cognitive function of rural older adults through physical health, household income, and social participation. This study suggests that the establishment of sustainable rural drinking water program by governments can alleviate cognitive impairment in older adults and promote health equity.
Experiences and Management of Distress and the Use of Music, Including Music Therapy, on NHS Inpatient Mental Health Dementia Wards: A Qualitative Study.
Thompson N, Hunt R, Odell-Miller H … +8 more , Olawale A, Pickering L, Pointon C, Underwood BR, Wilkinson A, Wise C, Wolverson E, Hsu MH
Int J Geriatr Psychiatry · 2025 May · PMID 40317755 · Full text
BACKGROUND: Inpatient mental health dementia wards in the National Health Service (NHS) provide specialist care for people with dementia experiencing acute levels of distress. There is little research exploring how best...
BACKGROUND: Inpatient mental health dementia wards in the National Health Service (NHS) provide specialist care for people with dementia experiencing acute levels of distress. There is little research exploring how best to manage and prevent distress. Music therapy may be feasible to deliver and reduce the prevalence of distress behaviours. AIMS: To further understanding of experiences of distress in inpatient mental health dementia NHS wards, how distress is managed and ways music and music therapy is used. METHODS: Semi-structured focus groups and interviews were co-designed and conducted with people with dementia, families, staff, music therapists and managers with experience of this setting. Data were transcribed and analysed using reflexive thematic analysis, with findings corroborated with participants, a co-design group and experts-by-experience. RESULTS: 49 people took part from 17 wards. Three overarching themes were identified, with 10 subthemes. The first theme highlighted the complex physical and mental health care needs of people on these wards, including high levels of distress. Secondly, staff and families aimed to personalise care to manage and prevent distress. Thirdly, music, including music therapy, could support the delivery of personalised care and help prevent and deescalate distress behaviours, potentially reducing the need for restrictive interventions. However, managers, staff, families and patients reported that care provision did not always meet patient need and resource limitations often prevented delivery of personalised care. CONCLUSIONS: NHS mental health dementia wards provide specialist care for people with dementia experiencing high levels of distress. Personalised care, including the use of music, was essential for preventing and managing distress, and could be enhanced through specialist support from a music therapist. Findings should inform best practice guidelines for NHS inpatient mental health dementia wards, including the use of music and music therapy, to support the prevention and management of distress for this client group.
All-Cause Acute Illness Hospitalisations in the Preceding Two Years Are Associated With Cognitive Decline in Older Adults: The Sydney Memory and Ageing Study.
Chinnappa-Quinn L, Lam BCP, Harvey L … +5 more , Kochan NA, Crawford JD, Makkar SR, Brodaty H, Sachdev PS
Int J Geriatr Psychiatry · 2025 May · PMID 40312128 · Full text
OBJECTIVES: Emerging evidence suggests all-cause acute hospitalizations are associated with cognitive decline, rather than being associated only with specific inpatient contexts (surgery, critical care and delirium). Thi...
OBJECTIVES: Emerging evidence suggests all-cause acute hospitalizations are associated with cognitive decline, rather than being associated only with specific inpatient contexts (surgery, critical care and delirium). This study clarifies this association in an Australian context. METHODS: This study is a secondary analysis of four biennial waves of prospective population-based neuropsychological measures from 1026 functionally independent Sydney Memory and Ageing Study participants aged 70-90 years at baseline, and contemporaneous probabilistically-linked hospitalization data. The outcome measures were global cognition baseline (intercept) and change (slope) and their associations with hospitalization episodes and cumulative length of stay (cLOS) variables in five consecutive 2-year time intervals. RESULTS: One thousand twenty-six individuals had a mean age of 78.8 years, a mean Mini-Mental State Examination score of 28.7, a mean of 3.3 hospitalizations and 18.9 days in hospital over 10 years. Mean global cognition z-score change/year was -0.133, adjusted for age, sex and education. Hospitalizations and cLOS in the final time interval were associated with a change in slope of -0.012 global cognition z-score/hospitalization/year (Standard Error [SE] = 0.005, p = 0.014) and -0.002 z-score/day-in-hospital/year (SE = 0.001, p < 0.001). Further investigation of these associations with time-lagged models showed that pooled recent hospitalizations were associated with accelerated cognitive decline of -0.036 change in cognition/year/episode-of-hospitalization (SE = 0.012, p = 0.004) and -0.008 change in cognition/year/day-in-hospital (SE = 0.002, p < 0.001) rather than non-recent hospitalizations (Wald test for difference between pooled recent and non-recent effects had p-values of 0.011 and < 0.001 for hospitalization episodes and days respectively). CONCLUSIONS: This study confirms and adds nuance to international findings that overnight hospitalization is associated with accelerated cognitive decline. This association was dose-dependent, had a recency effect and was independent of illness severity in the case of cLOS. These findings suggest that all-cause acute hospitalization may be a reversible risk factor for cognitive decline. This needs further clarification and the development of interventions to minimise the impact of acute illness hospitalization on cognitive trajectory. To this end, broadening the scope of acute care in the home and the prevention and treatment of neuroinflammation are priorities for further investigation.
Longitudinal Association of Conversion Patterns of Functional Disability With Risk of Depressive Symptoms in Older Chinese Adults.
Huang J, Peng D, Gou Y … +6 more , Luo Y, Yao H, Zhang H, Zhang H, Mei J, Wang X
Int J Geriatr Psychiatry · 2025 May · PMID 40302132 · Publisher ↗
BACKGROUND: Functional disability has been identified as a risk factor for depressive symptoms (DS). However, most studies have measured functional disability at only one time point, and functional disability is dynamic...
BACKGROUND: Functional disability has been identified as a risk factor for depressive symptoms (DS). However, most studies have measured functional disability at only one time point, and functional disability is dynamic and changeable over the life course, and can vary between individuals. Therefore, we aimed to examine the longitudinal association between conversion patterns of functional disability and the risk of DS. METHODS: Based on the China Health and Retirement Longitudinal Study (CHARLS) participants in 2013, we retrospectively assessed their functional disability from 2011 to 2013 through activities of daily living ability (ADLs) and instrumental activities of daily living ability (IADLs), which were categorized as ten conversion patterns. A total of 2057 participants who met the inclusion criteria were included in the final analysis and were followed from 2013 to 2018 to determine the incidence of DS, measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cox proportional hazards regression models were applied to estimate association between conversion patterns of functional disability and the risk of DS. RESULTS: Over the 61 months follow-up period, 508 incident DS cases were identified. Three conversion patterns of functional disability were more likely to develop DS than those with never both ADLs and IADLs disabilities: relieved both ADLs and IADLs disabilities (adjusted HR = 2.01, 95% CI = 1.21-3.32), persistent only IADLs disability (adjusted HR = 1.81, 95% CI = 1.04-3.12), and persistent both ADLs and IADLs disabilities (adjusted HR = 4.75, 95% CI = 2.19-10.31). CONCLUSIONS: Older adults with persistent both ADLs and IADLs disabilities may be at a greater risk of DS. Meanwhile, those with relief should not be ignored for functional disability. Attention should be paid to psychological monitoring of older adults with a history of or current functional disability.
The Association of Ambient Air Pollution With Dynamic Transitions of Cataract and Dementia: A UK Biobank Study.
Yuan K, Song C, Zhong J … +4 more , Xie M, Liu R, Sun W, Liu X
Int J Geriatr Psychiatry · 2025 May · PMID 40296199 · Publisher ↗
BACKGROUND AND OBJECTIVES: Air pollution has a detrimental effect on the risk of dementia and cataract. This study aimed to investigate the association of air pollution with the dynamic transitions of cataract and dement...
BACKGROUND AND OBJECTIVES: Air pollution has a detrimental effect on the risk of dementia and cataract. This study aimed to investigate the association of air pollution with the dynamic transitions of cataract and dementia. RESEARCH DESIGN AND METHODS: We enrolled 409,608 participants (mean age: 56.4 years; 45.9% male) free of cataract and dementia at baseline from the UK Biobank with follow-up until 30 September 2023. We estimated the annual average concentrations of particulate matter (PM) with aerodynamic diameter ≤ 2.5 μm (PM), ≤ 10 μm (PM), nitrogen dioxide (NO), and nitrogen oxides (NO) at 2010. We employed multi-state models to assess the association between air pollution and the dynamic transitions of cataract and dementia after adjusting for potential confounders. RESULTS: During a median follow-up of 14.5 years, 51,786 participants were diagnosed with cataracts, and 6068 with dementia. PM showed the strongest association with the transitions from healthy to cataract (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.04-1.06; p < 0.001), from healthy to dementia (HR, 1.05; 95% CI, 1.02-1.09; p = 0.002), from cataract to comorbidity (HR, 1.07; 95% CI, 1.00-1.15; p = 0.048), from healthy to death (HR, 1.03; 95% CI, 1.01-1.05; p < 0.001), and from cataract to death (HR, 1.06; 95% CI, 1.02-1.10; p = 0.007). CONCLUSION AND IMPLICATIONS: Our study suggested that the long-term exposure to air pollution was associated an increased risk of the transitions from health to incident cataract, dementia or the progression of both conditions. This implied the importance of implementing air pollution control strategies to prevent cataract and dementia.
Clinical Evolution of Neuropsychiatric Symptoms in Alzheimer's Disease and Dementia With Lewy Bodies in a Post-Mortem Cohort.
Gibson LL, Skogseth RE, Hortobagyi T … +3 more , Vik-Mo AO, Ballard C, Aarsland D
Int J Geriatr Psychiatry · 2025 May · PMID 40296198 · Full text
BACKGROUND: Almost all patients with neurodegenerative dementias experience neuropsychiatric symptoms (NPS) but the timing and clinical course is highly variable. METHODS: In a prospective cohort study in Western Norway,...
BACKGROUND: Almost all patients with neurodegenerative dementias experience neuropsychiatric symptoms (NPS) but the timing and clinical course is highly variable. METHODS: In a prospective cohort study in Western Norway, patients with a new diagnosis of mild dementia were assessed annually in the Neuropsychiatric Inventory (NPI) for up to 9 years until death. Patients with post-mortem neuropathological diagnoses of Alzheimer's disease (pAD) (n = 37), Lewy body disease (pLBD) (n = 14) or meeting criteria for both AD and LBD (mixed AD+LBD) (n = 11) were included in this study. Neuropathological assessment was performed according to standardised protocols and blind to clinical information. In mixed effects logistic regression, longitudinal change in NPS was explored across neuropathological diagnoses and substrates. Additionally, the odds of NPS early and late in disease was evaluated in logistic regression. RESULTS: Early onset hallucinations were significantly more common in pLBD than pAD (OR 0.069 [95% CI 0.012-0.397], p = 0.003) or mixed AD+LBD (OR 0.09 [95% CI 0.010-0.771], p = 0.028) and there was a greater increase in the odds of hallucinations over time in pAD and AD+LBD than pLBD such that there was was no difference in the prevalence of late-onset hallucinations between pLBD, pAD or AD+LBD. Hallucinations early in disease were associated with higher LBD α-synuclein stages and neocortical LBD, in addition and sparser amyloid distribution. Higher density of amyloid plaques, tau tangles, cerebrovascular disease and increasing additional co-pathologies were associated with increasing odds of hallucinations over time. CONCLUSIONS: LBD, without significant comorbid AD pathology, is associated with hallucinations early in the course of disease while multiple other pathologies may be implicated in aetiology of late-onset hallucinations. Hallucinations increase in AD+LBD as disease progresses, a trajectory more closely aligned with AD than LBD.
Depressive Symptomatology Is Associated With Self-Reported Impaired Postural Balance in Older Adults: A Cross-Sectional Study in Primary Care in Brazil.
Didone TVN, Boffino CC, Seward N … +5 more , Nakamura CA, Shimozato IAD, Araya R, Peters TJ, Scazufca M
Int J Geriatr Psychiatry · 2025 May · PMID 40295224 · Full text
OBJECTIVES: Age-related balance deficits and depression are common among older people and challenging for public health. However, the association between postural imbalance and depression has scarcely been investigated i...
OBJECTIVES: Age-related balance deficits and depression are common among older people and challenging for public health. However, the association between postural imbalance and depression has scarcely been investigated in large samples, especially in low- and middle-income countries (LMICs) whose populations are ageing rapidly. Here, we estimated the prevalence of postural imbalance and examined its association with depressive symptomatology among older adults living in a socioeconomically deprived area of Brazil. METHODS: The analysis used screening data from the PROACTIVE cluster randomised controlled trial-specifically, socioeconomic, demographic and health information from individuals aged 60 years and older registered at one of 20 primary health clinics in Guarulhos and who provided complete data for our analyses. Self-reported postural imbalance was the outcome and it was assessed with a single question. Participants who reported postural imbalance were asked about the number of falls they had experienced in the previous 6 months. The prevalence of postural imbalance and postural imbalance with or without falls was estimated. Depressive symptomatology was assessed using the Patient Health Questionnaire-9 (PHQ-9). The association between depressive symptomatology (PHQ-9 score ≥ 10) and three ordered categories of the outcome (no postural imbalance, postural imbalance without falls and postural imbalance with falls) was investigated using adjusted mixed-effects ordered logistic regression. RESULTS: The study included 2999 individuals. Postural imbalance was reported by 1183 participants (39.4%; 95% confidence interval: 37.7%, 41.2%), comprising 792 non-fallers and 391 fallers (26.4% and 13.0% of all participants, respectively). For participants with depressive symptomatology, the odds of having postural imbalance with or without falls versus not having postural imbalance is 2.88 (95% confidence interval: 2.44, 3.40) times that of participants without depressive symptomatology. Likewise, for participants with depressive symptomatology, the odds of having postural imbalance with falls versus having postural imbalance without falls combined with not having postural imbalance is 2.88 (95% confidence interval: 2.44, 3.40) that of participants without depressive symptomatology. CONCLUSIONS: Postural imbalance is a common occurrence in a vulnerable older population in Brazil. Importantly, we found that depressive symptomatology was associated with increased odds of having postural imbalance and postural imbalance with falls experienced in the previous 6 months. Notwithstanding our analyses' exploratory nature, these issues should receive greater attention in primary care practice and research.
The Mediating Role of Formal Social Engagement in the Relationship Between Oral Health and Depressive Symptoms Among Older Adults in South Korea.
Sung P, Zhang Y, Choi JY
Int J Geriatr Psychiatry · 2025 May · PMID 40286245 · Full text
OBJECTIVES: The reciprocal relationship between oral health and mental health, and the underlying mechanisms remain underexplored. This study examined whether formal social engagement mediates the relationship between or...
OBJECTIVES: The reciprocal relationship between oral health and mental health, and the underlying mechanisms remain underexplored. This study examined whether formal social engagement mediates the relationship between oral health and mental health in both directions. METHODS: Cross-lagged panel models with two-wave mediation were applied to data from 3860 older adults, aged 65 years or above, in the two waves of the Korean Longitudinal Study of Aging conducted in 2018 and 2020. Oral health was measured using the 12-item Geriatric Oral Health Assessment Index, and mental health was assessed with the 10-item Center for Epidemiologic Studies Depression Scale. RESULTS: The analysis identified a reciprocal relationship between oral health and depressive symptoms, with depressive symptoms exerting a stronger effect on oral health than vice versa. Formal social engagement partially mediated the effect of oral health on depressive symptoms, but not the other way around. CONCLUSIONS: The findings reaffirm the interplay and interdependence of oral health and mental health among older adults. Comprehensive strategies that integrate social engagement opportunities are imperative for developing interventions targeting older adults with compromised oral health.
Incidence and Factors Associated With Cognitive Impairment 90 Days After First Ever Ischemic Stroke.
Dec-Ćwiek M, Wrona P, Homa T … +3 more , Słowik J, Bodzioch A, Słowik A
Int J Geriatr Psychiatry · 2025 May · PMID 40286199 · Publisher ↗
OBJECTIVES: Post-stroke cognitive impairment (PSCI) is prevalent among stroke survivors, negatively impacting long-term outcomes. We aimed to assess the prevalence of PSCI and its risk factors in participants from the iB...
OBJECTIVES: Post-stroke cognitive impairment (PSCI) is prevalent among stroke survivors, negatively impacting long-term outcomes. We aimed to assess the prevalence of PSCI and its risk factors in participants from the iBioStroke study (n = 1042), 90 days after their first ischemic stroke. METHODS: We prospectively analyzed data from 582 participants, without cognitive problems before stroke based on the structured interview with the patient, a family member or a caregiver, and/or clinical documentation (if available), who completed the Montreal Cognitive Assessment (MoCA) at discharge and 90 days post-stroke. Two MoCA cut-offs were used to define PSCI: a score of ≤ 25 in the first model and ≤ 22 in the second model. Multivariate logistic regression was employed to identify independent risk factors for PSCI based on 30 collected parameters. RESULTS: In the first model, PSCI was identified in 418 (71.8%) participants at day 90. Independent risk factors included older age (OR = 1.05; 95% CI:1.02-1.08), fewer years of education (OR = 0.83; 95% CI: 0.73-0.93), lower MoCA scores at discharge (OR = 0.76; 95% CI: 0.69-0.84), higher anxiety levels (HADS-A) at day 90 (OR = 1.10; 95% CI: 1.01-1.21), and larger stroke volume (OR = 1.01; 95% CI: 1.00-1.01). In the second model, PSCI was observed in 294 (50.5%) participants. Older age (OR = 1.06; 95% CI: 1.03-1.09), fewer years of education (OR = 0.87; 95% CI: 0.78-0.96), lower MoCA scores at discharge (OR = 0.83; 95% CI: 0.77-0.88), and higher depression levels (HADS-D) at day 90 (OR = 1.10; 95% CI: 1.03-1.18) were significant predictors. CONCLUSIONS: Based on our data, PSCI seems to be a common consequence of stroke. Both irreversible factors, such as age and educational level, stroke volume, and potentially modifiable factors, including post-stroke anxiety or depression and acute cognitive impairment, contribute to PSCI risk. These findings underscore the importance of early cognitive and psychiatric interventions in stroke survivors.
China's Healthy City Pilot Policy Improves Physical and Mental Health Outcomes for Middle-Aged and Older Adults: A Quasi-Natural Experiment Based on CHARLS.
Zhang Z, Xu H, Zhou J … +1 more , Cao X
Int J Geriatr Psychiatry · 2025 May · PMID 40280890 · Publisher ↗
BACKGROUND: Rapid urbanization in China has raised significant public health concerns, particularly regarding residents' physical and mental well-being. Effective interventions are urgently needed to address these issues...
BACKGROUND: Rapid urbanization in China has raised significant public health concerns, particularly regarding residents' physical and mental well-being. Effective interventions are urgently needed to address these issues. OBJECTIVE: This study evaluates the impact of China's Healthy City Pilot Policy (HCPP), introduced in 2016, on improving residents' health outcomes and examines demographic differences and mechanisms driving these effects. METHODS: Using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, a difference-in-differences (DID) approach was employed, along with propensity score matching (PSM-DID), placebo tests, and sensitivity analyses for robust results. RESULTS: The HCPP significantly enhanced residents' health in pilot cities, leading to better self-rated health, lower medical expenses, higher life satisfaction, and reduced depression. These benefits were most pronounced among the elderly, women, less-educated individuals, and residents of rural and central-western regions. Key mechanisms included increased physical exercise, social activities, and improved air quality. CONCLUSION: The HCPP positively impacts urban health, especially for vulnerable groups, highlighting the urgent need to integrate health considerations into urban planning and providing valuable insights for future policy development.
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