Mindfulness for anxiety and depression
The significant role of mental health in overall health and wellbeing is being increasingly recognised, along with the contribution of holistic non-pharmacological approaches to their management. In this quasi-experimental study, Fort-Rocamora et al (2024) evaluated the effectiveness of a group mindfulness intervention in the management of anxiety and depression.
The study took place in a community mental health centre in Spain between March 2015 and December 2019. The study included 128 people aged over 18 years, who were being treated at the Les Corts Adult Mental Health Center in Barcelona, and each intervention group included 10–15 people. Of these, 103 were women, with a mean age of 52.23 years (SD=12.78). In addition to the primary outcomes of anxiety and depression symptoms, quality of life and adherence to the intervention were evaluated as secondary outcomes.
Inclusion criteria consisted of having symptoms of anxiety as measured by scoring >10 points on the Hamilton Anxiety Rating Scale and signing informed consent. The intervention was made up of 9 weekly sessions lasting 75 minutes and the variables collected on were:
- Depression (as measured by the Beck Depression Inventory)
- Quality of life (as measured by the EuroQoL health-related quality-of-life measure, the 5 dimension 5 level (EQ-5D-5L))
- Adherence to the intervention.
Comparisons between baseline and post-intervention data revealed improvements in anxiety, depressive symptoms and general quality of life (p<0.001), and in its anxiety-depression dimensions (p=0.003). The mean number of sessions attended by participants was 6.17 (SD=2.31), which the authors note were statistically significant and positively correlated with improved anxiety (p<0.001) and depressive symptoms (p=0.021). However, no significant differences between age groups were observed.
Based on the above results, Fort-Rocamora et al (2024) concluded that the group mindfulness intervention improves symptoms of anxiety and depression, as well as quality of life – although, as might be expected, these improvements are associated with greater adherence to the intervention.
Ther ‘power’ of walking towards health in older age
The benefits of regular physical activity are well established. However, this is especially true for older people. The seemingly simple act of walking holds a lot of power and is often grossly underestimated.
In the POWER Study, Grade et al (2024) investigated whether or not volunteer-assisted walking improves the health and physical performance of older people. People aged 65 years and over with restricted mobility resulting from physical limitations in nursing homes and in the community were approached to participate in the German multicentre randomised controlled trial.
Participants who agreed to participate (n=224) were randomly assigned to either the intervention group or the control group. Those in the intervention group walked for 30-50 minutes, accompanied by a volunteer companion, up to 3 times a week for 6 months. Participants in the control group received two lectures covering health-related topics.
The primary endpoint was physical function as measured by the Short Physical Performance Battery (SPPB) at baseline, and at 6 and 12 months. The secondary and safety endpoints were quality of life (as with the previous study summarised above, measured by the EQ-5D-5L), fear of falling (Falls Efficacy Scale), cognitive executive function (the Clock Drawing Test), falls, hospitalisations and death.
Of the 224 participants recruited, the majority (79%) were female. The intervention did not demonstrate its superiority in terms of physical function (as measured by the SPPB) or other health outcomes in the intention-to-treat analysis. However, further exploratory study did indicate benefits for those who completed the walking group intervention.
Importantly, the authors note that the study ended up with less participants, and thus, lower power than anticipated, in large part due to the interference of the COVID-19 pandemic. This may well explain the unremarkable results and the researchers suggest that low-threshold community-based interventions merit further exploration.
A current look at the global burden of chronic respiratory diseases
Chronic respiratory diseases (CRDs) were the third leading cause of global mortality in 2019, resulting in substantial human and financial cost. CRDs encompass conditions affecting the lungs and airways such as chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis.
Nurses working across community settings are no strangers to this burden and the Global Burden of Disease Study 2017 provided extensive data on this. However, with the United Nations aiming to reduce premature mortality from non-communicable diseases by one-third with a target date of 2030, up-to-date information is vital.
Therefore, the GBD Chronic Respiratory Disease Collaborators have recently published an update of global, regional and national estimates of burden of CRDs and their attributable risks from 1990–2019. Making use of data from the GBD 2017, the collaborators estimated the prevalence, morbidity and mortality that can be attributed to CRDs. They analysed deaths, disability-adjusted life years (DALYs) and years of life from 1990 through to 2017 by super region (of which there are seven, made up of 204 countries and territories), and stratified these data by age and sex.
In 2019, CRDs led to 4 million deaths and 454.6 prevalent cases globally, with COPD being the primary cause of death, and asthma having the highest prevalence. From 1990–2019, total deaths from CRDs have increased by 28.5% and prevalence has increased by 39.8%. However, the authors note that the age-standardised rates of all burden measures of COPD, asthma and pneumoconiosis have reduced (though those of interstitial lung disease and pulmonary sarcoidosis increased over this period).
Low and low-middle countries on the socio-demographic index (SDI) had the highest age-standardised death and DALYs rates, which the collaborators point out highlights the urgent need for improvements in prevention, diagnosis and treatment. The highest global deaths and DALYs were attributed to smoking, followed by environmental pollution and occupational risks. Non-optimal temperature was an additional risk factor for COPD, pointing to the potential role of climate change in disability and deaths resulting from CRDs. Furthermore, high body mass index (BMI) was a risk factor for asthma, and this is the first report to describe the attributable burden of CRDs to BMI.
The authors urgently call for global strategies to control tobacco, enhance air quality, reduce occupational hazards and foster clean cooking fuels to facilitate the global reduction of CRD burden, particularly in low and low- to middle-income countries.
Reducing Alzheimer's and related dementia in rural and diverse populations
Many older people in community settings are living with Alzheimer's disease and other forms of dementia. In this recently published review, Wiese et al (2023) set out to answer the question: ‘What recent advances in Alzheimer's disease and related dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?’
Interestingly, the work is grounded in the life story of a rural resident, which is shared within the paper. The authors describe ADRD risk factors and highlight gaps in USA-based research, as well as suggest policy actions and interventions, which may help to alleviate rural, ADRD-related disparities.
Factors identified as being of relevance to rural groups include lack of built environment, periodontitis, poor air quality and sensory loss. Important contributors to brain health were highlighted, such as the harmful effects of ultra-processed food, and the benefits of social engagement and even minimal physical exercise – particularly in underserved communities, who face the largest disparities in preventive care.
The authors call healthcare providers to play their part in partnership with community stakeholders to identify and adapt upstream approaches that are culturally specific. They also emphasise the need to focus on resident-led initiatives to create change at the community level.