WHO Violence cuts short the lives of millions of people across the world each year, and damages the lives of millions more. It knows no boundaries of geography, race, age or income. It strikes at children, young people, women and the elderly. It finds its way into homes, schools and the workplace. Men and women everywhere have the right to live their lives and raise their children free from the fear of violence. We must help them enjoy that right by making it clearly understood that violence is preventable, and by working together to identify and address its underlying causes.

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World report on violence and health

Depression is less prevalent among older adults than among younger adults, but it can have serious consequences. More than half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and are more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are depressed younger adults. Risk factors leading to the development of late-life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late-life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but are too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support.

Depression in Older Adults

OBJECTIVE: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia. METHOD: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria. RESULTS: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients’ behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the tre...

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Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia

During the last decade it has become more widely accepted that pet ownership and animal assistance in therapy and education may have a multitude of positive effects on humans. Here, we review the evidence from 69 original studies on human-animal interactions (HAI) which met our inclusion criteria with regard to sample size, peer-review, and standard scientific research design. Among the well-documented effects of HAI in humans of different ages, with and without special medical, or mental health conditions are benefits for: social attention, social behavior, interpersonal interactions, and mood; stress-related parameters such as cortisol, heart rate, and blood pressure; self-reported fear and anxiety; and mental and physical health, especially cardiovascular diseases. Limited evidence exists for positive effects of HAI on: reduction of stress-related parameters such as epinephrine and norepinephrine; improvement of immune system functioning and pain management; increased trustworthiness of and trust toward other persons; reduced aggression; enhanced empathy and improved learning. We propose that the activation of the oxytocin system plays a key role in the majority of these reported psychological and psychophysiological effects of HAI. Oxytocin and HAI effects largely overlap, as documented by research in both, humans and animals, and first studies found that HAI affects the oxytocin system. As a common underlying mechanism, the activation of the oxytocin system does not only provide an explanation, but also allows an integrative view of the different effects of HAI.

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Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin

SUMMARY Objectives: To update previous systematic reviews of 12-month prevalence of complementary and alternative medicine (CAM) use by general populations; to explore trends in CAM use by national populations; to develop and apply a brief tool for assessing methodological quality of published CAM-use prevalence surveys. Design: Nine databases were searched for published studies from 1998 onwards. Studies prior to 1998 were identified from two previous systematic reviews. A sixitem literature-based tool was devised to assess robustness and interpretability of CAM-use estimates. Results: Fifty-one reports from 49 surveys conducted in 15 countries met the inclusion criteria. We extracted 32 estimates of 12-month prevalence of use of any CAM (range 9.8‐76%) and 33 estimates of 12-month prevalence of visits to CAM practitioners (range 1.8‐48.7%). Quality of methodological reporting was variable; 30 ⁄51 survey reports (59%) met four or more of six quality criteria. Estimates of 12-month prevalence of any CAM use (excluding prayer) from surveys using consistent measurement methods showed remarkable stability in Australia (49%, 52%, 52%; 1993, 2000, 2004) and USA (36%, 38%; 2002, 2007). Conclusions: There was evidence of substantial CAM use in the 15 countries surveyed. Where national trends were discernable because of consistent measurement, there was no evidence to suggest a change in 12-month prevalence of CAM use since the previous systematic reviews were published in 2000. Periodic surveys are important to monitor population-level CAM use. Use of governmentsponsored health surveys may enhance robustness of population-based prevalence estimates. Comparisons across countries could be improved by standardising approaches to data collection.

https://midus.wisc.edu/findings/pdfs/1422.pdf

Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update

Background Previous short-term work reported fewer suicides among elderly users of a telephone helpline and emergency response service (the TeleHelp-TeleCheck Service).

Aims To examine long-term effects of the service on suicide in an elderly population of northern Italy.

Method The service provided twice-weekly support and needs assessment telephone calls and a 24h emergency alarm service. Data from 1988 to 1998 allowed comparison of 18 641 service users with a comparable general population group of the Veneto region in Italy.

Results Significantly fewer suicide deaths ( n OBSERVED=6) occurred among elderly service users (standardised mortality ratio (SMR) 28.8%) than expected ( n EXPECTED=20.86; χ2=10.58, d.f.=1, P <0.001) despite an assumed overrepresentation of persons at increased risk. The service performed well for elderly females ( n OBSERVED=2, SMR=16.6%, n EXPECTED=12.03; χ2=8.36, d.f.=1, P <0.001).

Conclusions The study confirms the initial promise of the TeleHelp—TeleCheck service over a much longer time period. Further research will clarify the apparent lack of benefit for elderly males.

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Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy.

Pet therapy and institutionalized elderly: A study on 144 cognitively unimpaired subjects

Objective

This study measures and compares use of and satisfaction with medical and social services in addition to subjectively perceived needs of family supporters of patients with probable or possible Alzheimer's disease (AD) and family supporters of non-demented elderly people. Differences in judgement of services within the subpopulation of families of AD patients are also assessed by gender and burden level.



Methods

The main family supporters of 60 community-dwelling elderly (aged over 65) with Alzheimer's disease and of 60 age- and sex-matched controls were tested with a detailed questionnaire on use and satisfaction with services, any unmet needs and kinds of intervention perceived to be helpful.



Results

Supporters of elderly people with AD were significantly more involved in providing care than supporters of non-demented people. Judgement on the health, social relations and financial status of their families was significantly worse in AD supporters than in supporters of non-demented elderly people. Although the former made more use of available health and social services than the control population, they did appear to make little use of such services, not only because of lack of information but also for logistic reasons or because they would prefer a service with more specifically trained operators or more tailored intervention. AD family supporters would like to receive more information and support from their general practitioner, which confirms the importance of this figure in management of this pathology. They were less satisfied with the care provided than the control population, particularly those with a moderate–high burden. Irrespective of burden level, they also expressed a need for financial and psychological support and adequate intervention schemes, especially within the home. These should be provided by specially trained personnel and be tailored to specifically manage the individual patient's problems, especially in relation to behavioural disorders. This would help alleviate caregiver burden and allow patients to continue to be managed at home. Copyright © 1999 John Wiley & Sons, Ltd.

Community care for patients with Alzheimer's disease and non-demented elderly people: use and satisfaction with services and unmet needs in family caregivers.

The presence of dissatisfaction with life or thoughts of death or suicide has been variously surveyed in adolescent samples and in the general population, but there is a paucity of research on the elderly The aim of this study was to assess, in an elderly community-dwelling population: a) the prevalence of death and/or suicidal feelings and thoughts and any attempted suicides; and b) factors associated with these experiences A total of 611 over-65-year-old subjects were interviewed at home Seventeen percent of the total (F:M = almost 2:1) responded affirmatively to at least one of the questions on suicidality Elderly people reporting suicidal feelings presented markedly higher levels of physical and psychological distress, such as depression, anxiety, and hostility Results indirectly confirm that depressive symptomatology is not adequately treated Greater attention is warranted in psychological evaluation of the elderly to take into account those risk factors that, if identified and managed, could reduce the frequency of suicidal thoughts and, probably, associated actions

Marirosa Dello Buono

Papers

Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy.

Pet therapy and institutionalized elderly: A study on 144 cognitively unimpaired subjects

Community care for patients with Alzheimer's disease and non-demented elderly people: use and satisfaction with services and unmet needs in family caregivers.

Death ideation and its correlates: survey of an over-65-year-old population.

Alternative medicine in a sample of 655 community-dwelling elderly