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Maintaining brain health and promoting healthy lifestyle strategies to manage modifiable risk factors is vital to ensuring well-being for all – not only for the individuals with memory challenges but also their family caregivers and professional providers. In this brief review paper, we highlight modifiable risk and protective factors and opportunities for dementia risk reduction (e.g., limited alcohol use and reduced exposure to air pollution, secondhand smoke, and excessive noise); provide an overview of the World-Wide FINGERS Network and its goal to adapt the original Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multidomain lifestyle approach in various settings to determine whether the protocol is effective across different populations in varied geographic, cultural, and economic settings and to optimize the model across a continuum of cognitive decline; and, comment on challenges and opportunities for researchers and clinicians including opportunities for risk reduction and intervention in primary care settings and the need to establish linkages across multiple levels of intervention to sustain behavior change in prevention, treatment, and care. [ABSTRACT FROM AUTHOR]

The relationships between social and physical activities in older adulthood deserve further attention. This study explores the relationship of social leisure activity (SLA) and the psychological construct, valuation of life (VOL), to physical activity among the young, middle, and oldest old. Significant differences and relationships were observed. Oldest old showed significant drops in ability and activity, both physical and leisure activity. VOL is connected to SLA and physical activities specific to improving flexibility. The study findings suggest SLA and VOL are important points of leverage for helping older adults forestall decreases in physical activity, especially for the oldest old. [ABSTRACT FROM AUTHOR]

The Internet of Health Things (technologies for exchanging data) is crucial in helping promote health and wellbeing. Family caregivers of people with Alzheimer's can significantly benefit from the Internet of Health Things by enabling caregivers to participate in programs from home to help manage their stress and distress in their caregiver role. This paper reports the results of a techno-economic analysis and a life cycle assessment comparing a video-communication delivered intervention designed to decrease the stress and distress of caregivers of people with Alzheimer's and related dementias to a hypothetical in-person delivery of the same intervention. Results indicated that the virtual intervention, compared to the hypothetical in-person intervention, was associated with lower participant costs yet, potentially more expensive from an organizational/provider perspective. Environmentally, the virtual intervention had lower carbon emissions than the hypothetical in-person delivery of the intervention. Furthermore, video-communication delivery of the intervention has the potential to reduce some of the hassles of looking for respite to attend caregiving interventions and allow caregivers to join from their preferred location across the country. [ABSTRACT FROM AUTHOR]

Purpose: Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown. Design: Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families. Findings: We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others. Discussion and Conclusions: Collective caregiving of MA elders warrants further investigation. Implications for Practice: Exploration of collective caregiving may provide a foundation for tailored family interventions. [ABSTRACT FROM AUTHOR]

Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the “point of reckoning” in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver. Ninety-three of 116 caregivers recognized and spontaneously reported a “reckoning point” that initiated the caregiving trajectory, while eight cited “gradual decline” into caregiving for elders in their homes. This “reckoning point,” which marks the assumption of this role, may afford a fertile opportunity for referral to community resources or initiation of formal PEOLC, thereby improving the quality of life for these older individuals and their families. [ABSTRACT FROM AUTHOR]

Only recently has research focused on families and social support systems of lesbian, gay, bisexual, and transgender (LGBT) older adults; to date, this research is limited. This article highlights new findings and insights on the changing American family, with an emphasis on LGBT families and caregiving, and explores the importance of recognizing the diversity in family types and roles-- especially when considering the care provided by and for LGBT individuals. [ABSTRACT FROM AUTHOR]

This report extends knowledge about the informal caregiving trajectory in Mexican American (MA) families, constituting the second known empirical study of the emerging phenomenon of personal care by (MA) sons for their aging mothers, previously reported by our research team. It uses life course perspective (LCP) to compare caregiving patterns over time through case-based comparative-historical methods. “Historical” within-case analysis searches for themes, while “comparative” cross-case analysis allows exploration of themes across multiple cases, enabling examination of eight cases of caregiving MA sons who were currently providing personal care or confronting the imminent need to do so. We used the comparative-historical technique of pattern matching to determine the worth of LCP for exploration of MA family caregiving, test data-derived theoretical propositions, and function as a template for combining multiple methods. Qualitative findings were buttressed in this sub-analysis of a parent study by results from a battery of variable-oriented scales. [ABSTRACT FROM AUTHOR]

Introduction Gay men with prostate cancer ( GMPCa) may have differential health-related quality of life ( HRQOL) and sexual health outcomes than heterosexual men with prostate cancer ( PCa), but existing information is based on clinical experience and small studies. Aims Our goals were to: (i) describe HRQOL and examine changes in sexual functioning and bother; (ii) explore the psychosocial aspects of sexual health after PCa; and (iii) examine whether there were significant differences on HRQOL and sexual behavior between GMPCa and published norms. Methods A convenience sample of GMPCa completed validated disease-specific and general measures of HRQOL, ejaculatory function and bother, fear of cancer recurrence, and satisfaction with prostate cancer care. Measures of self-efficacy for PCa management, illness intrusiveness, and disclosure of sexual orientation were also completed. Where possible, scores were compared against published norms. Main Outcome Measures Main outcome measures were self-reported sexual functioning and bother on the Expanded Prostate Cancer Index. Results Compared with norms, GMPCa reported significantly worse functioning and more severe bother scores on urinary, bowel, hormonal symptom scales ( Ps < 0.015-0.0001), worse mental health functioning ( P < 0.0001), greater fear of cancer recurrence ( P < 0.0001), and were more dissatisfied with their PCa medical care. However, GMPCa reported better sexual functioning scores ( P < 0.002) compared with norms. Many of the observed differences met criteria for clinical significance. Physical functioning HRQOL and sexual bother scores were similar to that of published samples. GMPCa tended to be more 'out' about their sexual orientation than other samples of gay men. Conclusions GMPCa reported substantial changes in sexual functioning after PCa treatment. They also reported significantly worse disease-specific and general HRQOL, fear of recurrence, and were less satisfied with their medical care than other published PCa samples. Sexual health providers must have an awareness of the unique functional and HRQOL differences between gay and heterosexual men with PCa. Hart TL, Coon DW, Kowalkowski MA, Zhang K, Hersom JI, Goltz HH, Wittmann DA, and Latini DM. Changes in sexual roles and quality of life for gay men after prostate cancer: Challenges for sexual health providers. J Sex Med 2014;11:2308-2317. [ABSTRACT FROM AUTHOR]

This mixed methods, multi-site, National Institute of Nursing Research (NINR)-funded, interdisciplinary, descriptive study aimed to identify expressions of worry in qualitative data obtained from caregiving Mexican American (MA) families assisting older adults. The purpose of this portion of the inquiry was to determine how worry is expressed, what happens to caregivers when they worry, and what adaptive strategies they used. We examined semi-structured interviews completed during six in-home visits with 116 caregivers. We identified 366 worry quotations from 639 primary documents in ATLAS.ti, entered them into matrices, and organized findings under thematic statements. Caregivers expressed cultural and contextual worries, worried about transitions and turning points in care, and identified adaptive strategies. Despite these strategies, worry persisted. Constant worry may be an allied, important aspect of caregiver burden. We need additional longitudinal research to better understand the experience of MA caregivers for older adults and to provide empirically supported interventions, programs, and services that reduce worry. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. A growing literature suggests relationships between erectile dysfunction medications (EDM) and riskier sexual behavior among men who have sex with men (MSM). Questions remain concerning EDM use and related HIV/sexually transmitted infections (STI) risk among older MSM, particularly those 40 years and over, for whom EDM may be medically warranted. Aim. This exploratory pilot study explores the relationship between EDM and risky sexual behavior in a convenience sample of MSM using EDM and attending historic sex-on-premises venues. Methods. We examined anonymous surveys from 139 MSM. Bivariate relationships were examined. We then fit a multiple logistic regression model to determine predictors of engaging in unprotected anal intercourse (UAI) at last EDM, using variables identified as being significantly related to UAI in the bivariate analyses. Potential predictors entered the model in a stepwise fashion. Main Outcome Measures. The primary outcome measure was engaging in UAI at last EDM use. Results. MSM participating in the study ranged from 27 to 77 years and averaged 52.0 years (standard deviation = 10.73 years). These participants were primarily older MSM; fewer were younger MSM (12.12%), under age 40. Participants reporting UAI at last EDM use (N = 41) were significantly younger ( P < 0.01). Men visiting bars within the last 6 months reported less UAI ( P < 0.01). Both variables were independent predictors of UAI in the logistic regression model ( P < 0.01). Conclusions. Similar to reports from younger MSM, our findings suggest older MSM using EDM and reporting UAI are also recreational drug users. We include recommendations for urologists and other sexual medicine physicians treating MSM who may be at elevated risk for HIV/STI infection because of joint EDM and club drug use. Goltz HH, Coon DW, Catania JA, and Latini DM. A pilot study of HIV/STI risk among men having sex with men using erectile dysfunction medications: Challenges and opportunities for sexual medicine physicians. J Sex Med 2012;9:3189-3197. [ABSTRACT FROM AUTHOR]

Family caregiving for people with dementia and grandparents raising grandchildren both remain critical issues for our increasingly diverse and aging society. Very little research has focused on the role of resilience in either of these caregiving literatures, thereby creating opportunities for researchers, practitioners, and policy makers to drive future agendas including the development, evaluation, and dissemination of caregiver interventions grounded in resilience frameworks. This chapter reviews key issues related to caregiver resilience and makes several recommendations to help move its study and application forward, including the use of mixed-methods and prospective longitudinal designs, the application and evaluation of relevant theoretical frameworks, and the examination of interventions at different levels that target both mental and physical health outcomes with diverse populations. [ABSTRACT FROM AUTHOR]

The primary purpose of this study was to examine the synchronous and temporal relations between engagement in activities and the two primary dimensions of affectnamely, positive and negative affect-using an intensive time-series design called concomitant time series analysis (CTSA). Twenty-four dementia caregivers completed 56 diary measures (4 times per day for 2 weeks) assessing their experience of positive and negative affect as well as engagement in a variety of activities. Total number of activities was significantly correlated with positive affect (r=.40), but not negative affect (r=-.12). Obtained pleasure from activities was significantly correlated with both positive (r=.42) and negative affect (r=-.17). These results may help further develop behavioral models of depression by suggesting that behavioral or self-reinforcing activities are associated primarily (or more saliently) with ones experience of positive affect. Future research examining the effect of behavioral interventions on both positive and negative affect is suggested, as is the examination of factors that may be more strongly associated with negative affect. [ABSTRACT FROM AUTHOR]

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery. [ABSTRACT FROM AUTHOR]

LGBTcaregiving for midlife and older adults facing chronic illness or disability as well as the development and evaluation of interventions targeting LGBT caregivers remains fundamentally unexplored. Caregivers regardless of their sexual orientation or gender identity often juggle multiple roles and responsibilities leading to increased stress and distress. However, largely due to discrimination and discriminatory policies, many LGBT caregivers face barriers at multiple levels of service provision that can exacerbate stress and negatively impact caregiver and care recipient quality of life. This article highlights many of these obstacles and provides examples of intervention strategies designed to assist LGBT caregivers ranging from interventions aimed at the individual and interpersonal levels of service provision to changes needed at the social policy level. As an example of an individual or interpersonal level of intervention designed to assist LGBT caregivers, the SURE 2framework is presented and more thoroughly discussed. Given the diversity of the LGBT community, the article ends with ways to extend or adapt SURE 2 as well as suggesting that the time has come to develop and test a variety of interventions for LGBT caregivers. [ABSTRACT FROM AUTHOR]

To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care-recipient characteristics predicted institutionalization. Longitudinal. San Francisco Bay area, California. Two hundred sixty-four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers. Number of days between baseline interview and institutionalization was recorded over an 18-month period. Kaplan-Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care-recipient or caregiver characteristics (e.g., care-recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization. Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care-recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more-positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less-acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more-acculturated Latinas. Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia. [ABSTRACT FROM AUTHOR]

The Northern California Chronic Care Network for Dementia brings together Northern California's major providers of managed care, community-based care, consumer education, and advocacy in new partnerships to improve the care of persons with dementia enrolled in managed care plans and their family caregivers. These partnerships are part of a national initiative entitled the Chronic Care Network for Alzheimer's Disease (CCN/AD) sponsored by the National Chronic Care Consortium and the Alzheimer's Association. This initiative selected eight promising provider-consumer partnerships across the country to implement and evaluate a new model of coordinated care for people with dementia and their families. This paper describes the Northern California network's partnerships and its intervention and challenges. The intervention is grounded in the key components of the CCN/AD model: “identification of patients with possible dementia, diagnostic assessment, care management and family caregiver information and support.” These components, in turn, are translated into protocols and pathways designed to create timely, comprehensive, appropriate, and effective systems of care services that address the unique needs of dementia patients and their caregivers over the course of the disease. [ABSTRACT FROM AUTHOR]

Purpose: This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers, and it also examines the role of specific moderator and mediator variables on caregiver outcomes. Design and Methods: Female participants (N = 169) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were randomly assigned to one of three treatment interventions: anger management, depression management, or a wait-list control group. These interventions took place over a 3- to 4-month period. The primary outcomes examined were anger or hostile mood, depressed mood, frequency of use of positive and negative coping strategies, and perceived caregiving self-efficacy. Results: Significant main effects in the expected direction were found for changes in most of these measures. Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group. Use of positive cognitive coping strategies increased in the anger management group only. Self-efficacy significantly increased for participants in both intervention groups, and it was also demonstrated to function as a mediator of intervention effects. Pre-treatment levels of depressive symptoms and anger expression style (Anger Expression-Out) moderated the relative effects of the two interventions on mood and coping. Implications: These data are consistent with a growing body of evidence supporting the effectiveness of skills training, in small... [ABSTRACT FROM AUTHOR]

Presents a study that compared the change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia. Care recipient self-care impairment; Demographic data for caregivers grouped according to treatment condition; Outcomes from the Resources for Enhancing Alzheimer's Caregiver Health initiative national collaborative study.

Describes a design for effective HIV/AIDS social and behavioral interventions for patients aged 50 years and older. Use of a comprehensive biological, psychological, and social approach to prevention; Insight from HIV prevention intervention research with younger populations.

Examines the use of cognitive behavioral therapy (CBT) with distressed older adults in various outpatient settings. Efficacy of CBT in treating variety of mental health disorders in older adults; Component of manual-based cognitive and behavioral therapies; Relationship between negative thinking and distress.

Aims: To examine how perceived balance problems are associated with self‐reported falls in the past month after controlling for known correlates of falls among older adults. Background: Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance. Design and Method: The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross‐sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self‐reported falls in the last month. Results: A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p <.001) greater for participants who self‐reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self‐rated health status, depression and anxiety scores were also associated with falling. Conclusion and Implications: Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) affects Latinos disproportionately. One of the reasons underlying this disparity may be type 2 diabetes (T2D) that is a risk factor for AD. The purpose of this study was to examine the associations of T2D and AD blood biomarkers and the differences in these associations between Mexican Americans and non-Hispanic Whites. This study was a secondary analysis of baseline data from the observational Health and Aging Brain Study: Health Disparities (HABS-HD) that investigated factors underlying health disparities in AD in Mexican Americans in comparison to non-Hispanic Whites. HABS-HD participants were excluded if they had missing data or were large outliers (z-scores >|4|) on a given AD biomarker. Fasting blood glucose and glycosylated hemoglobin (HbA1c) levels were measured from clinical labs. T2D was diagnosed by licensed clinicians. Plasma amyloid-beta 42 and 40 (Aβ42/42) ratio, total tau (t-tau), and neurofilament light (NfL) were measured via ultra-sensitive Simoa assays. The sample sizes were 1,552 for Aβ42/40 ratio, 1,570 for t-tau, and 1,553 for NfL. Mexican Americans were younger (66.6±8.7 vs. 69.5±8.6) and had more female (64.9% female vs. 55.1%) and fewer years of schooling (9.5±4.6 vs. 15.6±2.5) than non-Hispanic Whites. Mexican Americans differed significantly from non-Hispanic Whites in blood glucose (113.5±36.6 vs. 99.2±17.0) and HbA1c (6.33±1.4 vs. 5.51±0.6) levels, T2D diagnosis (35.3% vs. 11.1%), as well as blood Aβ42/40 ratio (.051±.012 vs..047±.011), t-tau (2.56±.95 vs. 2.33±.90), and NfL levels (16.3±9.5 vs. 20.3±10.3). Blood glucose, blood HbA1c, and T2D diagnosis were not related to Aβ42/40 ratio and t-tau but explained 3.7% of the variation in NfL (p <.001). Blood glucose and T2D diagnosis were not, while HbA1c was positively (b = 2.31, p <.001, β = 0.26), associated with NfL among Mexican Americans. In contrast, blood glucose, HbA1c, and T2D diagnosis were negatively (b = -0.09, p <.01, β = -0.26), not (b = 0.34, p =.71, β = 0.04), and positively (b = 3.32, p <.01, β = 0.33) associated with NfL, respectively in non-Hispanic Whites. To conclude, blood glucose and HbA1c levels and T2D diagnosis are associated with plasma NfL levels, but not plasma Aβ and t-tau levels. These associations differ in an ethnicity-specific manner and need to be further studied as a potential mechanism underlying AD disparities. [ABSTRACT FROM AUTHOR]

Ethnographic descriptions suggest that cultures differ in the extent to which they value physical touch and its acceptability in different kinds of social relationships. For example, compared to European American (EA) culture, Mexican culture is described as placing greater emphasis on warm interpersonal interactions, in which touch may play an important part. We tested this notion empirically by assessing attitudes about touch among 271 Mexican American (MA; 208 female) and 578 EA (434 female) college students. Specifically, we examined potential ethnic group differences in (1) participants' perception of the acceptability of affectionate touch (AT) within their cultures, depending on the relationship (close others vs. acquaintances) and setting (private vs. public) in which the touch occurs; and (2) participants' own personal comfort with AT. Among MAs, we examined associations between touch attitudes and acculturation. As predicted, MAs reported greater cultural acceptability of AT with acquaintances (but not close others) and in public (but not private) settings than did EAs. Participants' own comfort with AT was greater for both MA men and EA women than for EA men. Further, higher perceived cultural acceptability of AT predicted greater personal comfort with AT in both ethnic groups. Finally, among MAs, greater acculturation predicted less comfort with AT. Together, these results lend support to the notion that MA ethnocultural norms encourage AT in nonintimate contexts to a greater degree than EA norms, particularly for men, and that personal attitudes about AT are largely congruent with these norms. They also call attention to cross-cultural similarities in attitudes about touch in more intimate contexts. [ABSTRACT FROM AUTHOR]

Objectives. Guided by a Sociocultural Health Belief Model (SHBM), this study examined the roles of cultural beliefs of Alzheimer’s disease (AD) and scientific knowledge of AD in influencing the perceived threat of AD in a sample of Chinese American older adults. Method. With the input from focus groups of 17 older Chinese volunteers, survey questionnaires were refined and then delivered through face-to-face interviews to 385 participants aged 55–100 in the Phoenix metropolitan area. Results. Hierarchical regression analyses found that those aged 55–64 were more worried about AD than those aged 85 or older. Both cultural beliefs of AD and AD factual knowledge contributed to higher levels of perceived threat of AD. Education tended to moderate the effect of cultural beliefs of AD and AD knowledge on perceived threat of AD. Discussions. Findings support inclusion of key factors in the SHBM relevant to perceived threat of AD and help enrich the understanding of AD literacy from both scientific and cultural perspectives. AD education programs and interventions should help address crucial cultural beliefs related to AD and the emotional consequences (e.g., concerns or fear of AD) that might be due to the exposure to AD factual knowledge, particularly for those with limited education. [ABSTRACT FROM PUBLISHER]

Objective: The long-term effect of counseling and support on symptoms of depression was examined in spouse-caregivers of patients with Alzheimer's disease. Method: The participants were 406 spouse-caregivers of Alzheimer's disease patients who lived at home at baseline. The caregivers were randomly assigned to either a group receiving enhanced counseling and support treatment or a group receiving usual care (control group). Caregivers in the enhanced treatment group were provided with six sessions of individual and family counseling, agreed to join support groups 4 months after enrollment, and received ongoing ad hoc counseling. The Geriatric Depression Scale was administered at baseline and at regular follow-up intervals for as long as the caregiver participated in the study. Results: After baseline differences were controlled for, caregivers in the enhanced treatment group had significantly fewer depressive symptoms after the intervention than did the control subjects. These effects were sustained for 3.1 years after baseline, similar across gender and patient severity level, and sustained after nursing home placement or death of the patient. Conclusions: Counseling and support lead to sustained benefits in reducing depressive symptoms in spouse-caregivers of Alzheimer's disease patients and should be widely available to provide effective, evidence-based intervention for family caregivers. [ABSTRACT FROM AUTHOR]

Some individuals with mild cognitive impairment (MCI) experience not only cognitive deficits but also a decline in motor function, including postural balance. This pilot study sought to estimate the feasibility, user experience, and effects of a novel sensor-based balance training program. Patients with amnestic MCI (mean age 78.2 yr) were randomized to an intervention group (IG, n = 12) or control group (CG, n = 10). The IG underwent balance training (4 wk, twice a week) that included weight shifting and virtual obstacle crossing. Real-time visual/audio lower-limb motion feedback was provided from wearable sensors. The CG received no training. User experience was measured by a questionnaire. Postintervention effects on balance (center of mass sway during standing with eyes open [EO] and eyes closed), gait (speed, variability), cognition, and fear of falling were measured. Eleven participants (92%) completed the training and expressed fun, safety, and helpfulness of sensor feedback. Sway (EO, p = 0.04) and fear of falling (p = 0.02) were reduced in the IG compared to the CG. Changes in other measures were nonsignificant. Results suggest that the sensor-based training paradigm is well accepted in the target population and beneficial for improving postural control. Future studies should evaluate the added value of the sensor-based training compared to traditional training. [ABSTRACT FROM AUTHOR]

The original validation study for the Montreal Cognitive Assessment (MoCA) suggests a cutoff score of 26; however, this may be too stringent for older adults, particularly for those with less education. Given the rapidly increasing number of older adults and associated risk of dementia, this study aims to provide appropriate age- and education-adjusted norms for the MoCA. Data from 205 participants in an ongoing longevity study were used to derive normative data. Individuals were grouped based on age (70–79, 80–89, 90–99) and education level (≤12 Years, 13–15, ≥16 Years). There were significant differences between age and education groups with younger and more educated participants outperforming their counterparts. Forty-six percent of our sample scored below the suggested cutoff of 26. These normative data may provide a more accurate representation of MoCA performance in older adults for specific age and education stratifications. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia. DESIGN: This cost-effectiveness analysis examined Resources for Enhancing Alzheimer's Caregivers Health (REACH II), a multisite, randomized, clinical trial, from June 2002 through December 2004, funded by the National Institute on Aging and the National Institute of Nursing Research, of a behavioral intervention to decrease caregivers' stress and improve management of care recipient behavioral problems. SETTING: Community-dwelling dementia caregiving dyads from the Memphis REACH II site. PARTICIPANTS: Of Memphis' random sample of 55 intervention and 57 control black and white dyads, 46 in each arm completed without death or discontinuation. Family caregivers were aged 21 and older, lived with the care recipient, and had provided 4 or more hours of care per day for 6 months or longer. Care recipients were cognitively and functionally impaired. INTERVENTION(S): Twelve individual sessions (9 home sessions and 3 telephone sessions) supplemented by five telephone support-group sessions. Control caregivers received two “check in” phone calls. MEASUREMENTS: Incremental cost-effectiveness ratio (ICER), the additional cost to bring about one additional unit of benefit (hours per day of providing care). RESULTS: At 6 months, there was a significant difference between intervention caregivers and control caregivers in hours providing care ( P=.01). The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving, at a cost of $5 per day. CONCLUSION: The intervention provided that most scarce of caregiver commodities—time. The emotional and physical costs of dementia caregiving are enormous, and this intervention was able to alleviate some of that cost. [ABSTRACT FROM AUTHOR]

Objectives: An abridged version of the 25-item Male Sexual Health Questionnaire (MSHQ) was developed and validated (MSHQ-EjD Short Form) for assessing ejaculatory dysfunction (EjD). Methods: The MSHQ was administered to 1245 men in the Men’s Sexual Health Population Survey, 179 gay/bisexual men in the Urban Men’s Health Study, and 6909 men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in the BPH Registry & Patient Survey. Factor analysis, scale reliability, construct and discriminant validity, and the correlation between the MSHQ-EjD Short Form and the MSHQ ejaculatory function domain were assessed. Results: Factor loadings of greater than 0.5 were demonstrated for four ejaculatory function items (force, volume, frequency, and delay). The force and volume of ejaculation had the greatest factor loadings (range 0.77 to 0.81), followed by frequency of ejaculation (0.64 and 0.66). These three ejaculatory function items had a high degree of internal consistency (Cronbach alpha ≥0.78) and test-retest reliability (r = 0.72). The three items discriminated between men with none/mild LUTS and those with moderate/severe LUTS (P <0.001). After adjusting for age, depression, and erectile function, the odds ratio for a diagnosis of moderate/severe LUTS was 0.68 (95% confidence interval 0.49 to 0.96; P <0.05). The three items had a correlation coefficient of 0.95 with the 7-item MSHQ ejaculatory function domain. The MSHQ ejaculation bother item, an independent domain, showed moderate correlation with the three ejaculatory function items (r = −0.41 and r = −0.45). Conclusions: The results of our study have shown that the MSHQ-EjD Short Form, with three ejaculatory function items and one ejaculation bother item, has excellent psychometric properties and should be a useful instrument for assessing EjD in clinical and research settings. [Copyright &y& Elsevier]

A modified version of the Revised Memory and Behavior Problems Checklist (RMBPC; L. Teri et al., 1992) was administered across 6 different sites to 1,229 family caregivers of community-dwelling adults with dementia. The total sample was divided randomly into 2 subsamples. Principal components analyses on occurrence responses and reaction ratings from the first subsample resulted in a 3-factor solution that closely resembled the originally proposed dimensions (memory-related problems, disruptive behaviors, and depression). Confirmatory factor analyses on data from the second subsample indicated adequate fit for the 3-factor model. Correlations with other caregiver and care-recipient measures supported the convergent and discriminant validity of the RMBPC measures. In addition, female caregivers and White caregivers reported more problems, on average, than male caregivers and African American caregivers, respectively. [ABSTRACT FROM AUTHOR]

The Resources for Enhancing Alzheimer's Cargiver Health (REACH) project was designed to test promising interventions for enhancing family caregiving for persons with dementia. The purpose of this article is to describe the research design, interventions, and outcome measures used in REACH and to characterize the sample recruited for the study. Nine interventions and 2 control conditions were implemented at 6 sites; 1,222 dyads were randomly assigned to an intervention or a control condition. The caregiver sample was 18.6% male with an average age of 62.3 years (56% Caucasian, 24% Black, and 19% Hispanic). Caregivers reported high levels of depressive symptoms and moderate burden. Care recipients were older, with a mean age of 79, and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30. [ABSTRACT FROM AUTHOR]