Sleep problems among older adults

MacLeod, S., et al. Practical non-pharmacological intervention approaches for sleep problems among older adults. Geriatric Nursing. In Print. Full article

Abstract. Poor sleep is common among older adults, often caused by multiple underlying factors such as chronic stress. Poor sleep is subsequently associated with negative health outcomes including higher morbidity and mortality.

Our primary purpose is to explore practical non-pharmacological intervention approaches integrating stress management to improve sleep quality among older adults. In doing so, we highlight approaches that appear to hold promise in real-world settings with older individuals.

We conducted a tailored literature review specifically on approaches to improve sleep quality among older adults, with emphasis on those integrating stress management. Online search engines were reviewed to identify research in these areas.

Various non-pharmacological intervention approaches, such as mindfulness and cognitive behavioral therapy, have shown promise in improving sleep quality and health outcomes within this population. Those integrating chronic stress management appear to be particularly successful. Thus further development of multidimensional sleep interventions integrating stress management with seniors is warranted.

Online mindfulness intervention to decrease caregiver burden

Tkatch, R., et al. “A Pilot Online Mindfulness Intervention to Decrease Caregiver Burden and Improve Psychological Well-Being.” Journal of Evidence-Based Complementary & Alternative Medicine, 2017, 2156587217737204. Full text.

Abstract: Interventions to reduce caregiver burden are of great interest as the number of informal family caregivers continues to grow. The purpose of this study was to test the feasibility of an online mindfulness meditation intervention for community-dwelling older adult caregivers and to evaluate its impact on quality of life, caregiver burden, and psychological well-being. A total of 40 caregivers were recruited from 2 community center support groups to participate in an 8-week online mindfulness intervention.

Pre and post surveys were administered. Retention rates were high with 55% completing the post surveys and attending at least 5 out of 8 sessions. Matched pairs t test indicated that the intervention reduced caregiver burden, perceived stress, anxiety, and loneliness and improved mental well-being.

Online interventions offer flexibility for caregivers regardless of their responsibilities. Future research should expand this opportunity and explore the scalability of online mindfulness interventions.

Improvement in sleep quality among older adults

man sleepingBlack, D. S., et al. (2015). Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Internal Medicine. Published online February 16, 2015.

From the Abstract: Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep. The objective of this study was to determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances.

Conclusions and Relevance: The use of a community-accessible mindful awareness practices resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured sleep hygiene education intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life.

Mindfulness training to improve cognitive control in older adults (review)

Prakash, R. S., et al. (2014). Mindfulness and the aging brain: A proposed paradigm shift. Frontiers in Aging Neuroscience, 6, 120. Full text.

Abstract. There has been a proliferation of cognitive training studies investigating the efficacy of various cognitive training paradigms as well as strategies for improving cognitive control in the elderly. While some have found support for the transfer of training, the majority of training studies show modest to no transfer effects. When transfer effects have been observed, the mechanisms contributing to enhanced functioning have been difficult to dissociate.

In this review, we provide a theoretical rationale for the study of mindfulness in older adults as a particular type of training program designed to improve cognitive control by capitalizing on older adults’ acquired behavioral orientation toward higher socioemotional goals. Given the synergistic relationship between emotional and cognitive control processes, the paradoxical divergence in older adults’ functional trajectory in these respective domains, and the harmonious interplay of cognitive and emotional control embedded in the practice of mindfulness, we propose mindfulness training as an opportunistic approach to cultivating cognitive benefits in older adults.

The study of mindfulness within aging, we argue, capitalizes on a fundamental finding of the socioemotional aging literature, namely the preferential change in motivational goals of older adults from ones involving future-oriented wants and desires to present-focused emotion regulation and gratification.

Worry symptoms and cognitive dysfunction with older adults

Lenze, E. J., et al. (February, 2014). Mindfulness‐based stress reduction [MBSR] for older adults with worry symptoms and co‐occurring cognitive dysfunction. International Journal of Geriatric Psychiatry. Published online before inclusion in an issue. From the Abstract.

In this treatment development project, we examined MBSR in older adults with worry symptoms and co-occurring cognitive dysfunction. We examined (i) acceptability of MBSR, (ii) whether MBSR needs to be lengthened providing more repetition, (iii) MBSR’s benefits for worry reduction and cognitive improvements, and (iv) continued use of MBSR techniques during follow-up.

Methods. Two sites enrolled individuals aged 65 years or older with significant anxiety-related distress plus subjective cognitive dysfunction, into traditional 8-session MBSR groups and 12-session groups that had the same content but more repetition of topics and techniques. We examined measures of mindfulness, worry, and a neuropsychological battery focused on memory and executive function before and after the MBSR program, and we followed up participants for 6 months after the completion of MBSR regarding their continued use of its techniques.

Results. Participants (N = 34) showed improvements in worry severity, increases in mindfulness, and improvements in memory as measured by paragraph learning and recall after a delay, all with a large effect size. Most participants continued to use MBSR techniques for 6 months post-instruction and found them helpful in stressful situations. There was no evidence that the extended 12-week MBSR produced superior cognitive or clinical outcomes, greater satisfaction, or greater continuation of MBSR techniques than 8-week MBSR.

Conclusions. These preliminary findings are promising for the further testing and use of MBSR in older adults suffering from clinical worry symptoms and co-occurring cognitive dysfunction. These are common problems in a broad range of older adults, many of whom have anxiety and mood disorders; therefore, stress reduction intervention for them may have great public health value.

Group MBCT for older people with depression

Meeten, F., Whiting, S., & Williams, C. M. (2014). An Exploratory Study of Group Mindfulness-Based Cognitive Therapy for Older People with Depression. Mindfulness, 1-8.

From the Abstract: The benefits of a Mindfulness-Based Cognitive Therapy (MBCT) group for older people with recurrent and/or chronic depression were explored using a measure of mood and well-being. Thirteen participants started the study and outcome measures were recorded at baseline, post-MBCT group and at a 6-month follow-up.

Although there was only a small sample size that had complete pre- and post-group data, improvements in depression and anxiety severity were noted and there was a significant improvement on ‘purpose in life’ and marginally significant improvement of ‘personal growth’, two of six domains on a measure of well-being. Participants were satisfied with the structure of the course but were less confident about committing to the daily practice after the group than pre-group.

At 6 months follow-up, none of the group had relapsed into a major depressive episode. Further research with larger sample sizes and a control group to control for nonspecific therapeutic group factors is recommended.

Biologic and emotional outcomes among older adults

Gallegos, A. M., et al. (2013). Toward Identifying the Effects of the Specific Components of Mindfulness-Based Stress Reduction on Biologic and Emotional Outcomes Among Older Adults. (Abstract). Journal of Alternative and Complementary Medicine. Feb 5. [Epub ahead of print]

Objectives: The objectives of this study were to examine the effects of specific Mindfulness-Based Stress Reduction (MBSR) activities (yoga, sitting and informal meditation, body scan) on immune function, circulating insulin-like growth factor (IGF)-1 concentrations, and positive affect among older adults.

Design: The study design comprised longitudinal analyses of data from subjects in an 8-week MBSR program. Setting: The study was conducted at a University-affiliated health center.

Subjects: This study involved 100 community-dwelling older adults. Inclusion criteria were as follows: ≥65 years of age and English-speaking. Intervention: This was an 8-week MBSR program. Outcome measures: Interleukin (IL)-6 and IGF-1 levels were assayed from blood collected at postintervention assessments. Participants were immunized postintervention with keyhole limpet hemocyanin (KLH), and immunoglobulin (Ig)M and IgG KLH-specific antibody responses were measured prior to immunization as well as 3 weeks and 24 weeks postintervention. Participants completed a 10-item measure of positive affect at study entry and postintervention.

Results: Participants maintained weekly practice logs documenting participation in yoga, sitting meditation, informal meditation, and body scan. More practice of yoga was associated with higher post-treatment IGF-1 levels and greater improvement in positive affect from study entry to postintervention. Sitting meditation was positively associated with post-treatment IGF-1. Greater use of body scanning was associated with reduced antigen-specific IgM and IgG 3 weeks postintervention but not 24 weeks. No associations were found between MBSR activities and IL-6 levels.

Conclusions: Practice of MBSR activities, particularly yoga, could provide benefits for specific aspects of physiologic function and positive affect. Changes in adaptive immunity in older adult MBSR practitioners warrant further study.