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--- - |2 Abstract During the 2016 U.S. presidential election, Trump supporters expressed that they believed Trump was a moral candidate because of his past successes. Such statements are consistent with our argument that people judge others’ morality based on their success and failure‐related outcomes, even though these outcomes are usually associated with judgments of competence. Moreover, we argue that these outcome‐based perceptions of morality play a crucial role in responses to political candidates, independent of perceived competence. In three experiments, we manipulated a hypothetical candidate's outcomes (past successes vs. failures, or success in light of past misfortune vs. good fortune). We examined the effect of the manipulation on perceptions of the candidate's morality and competence, as well as support for the candidate (e.g., voting intentions). Across the three experiments, candidates’ outcomes affected not only perceptions of their competence, but also their morality. In turn, outcome‐based perceptions of competence and morality independently predicted candidate support. Our findings have implications for how people responded to the campaigns in the 2016 U.S. presidential election, especially the campaign run by Donald Trump. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Although national flags arguably reflect a unified nation, support for a particular flag design may vary across ideological cleavages within the electorate. Here, we examined the impact of system‐challenging and system‐justifying ideologies, as well as political party support, on support for flag‐change in a large (N = 13,559) nationally representative sample of New Zealand adults. As hypothesized, system‐justifying ideologies (e.g., conservatism, right‐wing authoritarianism, historical negation, and symbolic exclusion) correlated negatively with flag change support, whereas system‐challenging ideologies (e.g., support for multiculturalism) correlated positively with support for change. Yet, consistent with an identity politics perspective, support for the National Party—the center‐right/conservative party in New Zealand whose leader advocated change—correlated positively (rather than negatively) with support for changing the flag. These results demonstrate the countervailing effects of system‐justifying and system‐challenging ideologies on support for change, and identify a boundary condition of conservatives’ opposition to change (namely, party support). - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract According to a 2017 U.S. Department of Agriculture (USDA) survey, 12.3% of households face food insecurity (FI)—the economic and social condition of limited or uncertain access to adequate food. Given the pervasiveness of the problem, there is surprisingly little research examining how the general population perceives FI. Is FI expected in all societies? Is it a societal disgrace for individuals in the United States to go hungry? When it occurs, who is responsible? This research drew from existing surveys and practitioner expertise to develop a comprehensive instrument to assess attitudes toward FI. Data were collected in two studies to test a multidimensional model developed through examination and categorization of FI‐related items. We examined dimensionality of attitudes through exploratory (Study 1, N = 503) and then confirmatory (Study 2, N = 510) factor analysis of representative samples of Amazon Mechanical Turk (MTurk) participants. Seven dimensions were identified and related to reported contributions to food organizations and demographic characteristics (e.g., gender, age, and political orientation). Our findings help understanding of attitudes toward FI and can provide antipoverty organizations with information to shape policy, challenge inaccurate perceptions, and develop approaches to address FI. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract Following 9/11 and the wars in Iraq and Afghanistan, anti‐Muslim antipathy dramatically escalated in the United States. We argue that a major contributor to this hostility is endorsement of Right‐Wing Authoritarianism (RWA) because people high in RWA tend to respond aggressively toward groups that they view as threatening particularly when they perceive that such aggression is supported by authority figures. We posit that Americans high in RWA view Muslims as threatening traditional American norms and perceive that the U.S. government is at war with Islam. Across three studies, we present consistent support for our hypothesis that RWA is associated with endorsing and engaging in hostile behavior toward Muslims. In addition, this hostility is mediated by the perception that Muslims threaten societal norms and that the government is actively at war with Islam (Study 3). The implications for the reduction of aggression toward Muslims and the impact of RWA on hostility toward other outgroups are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The first known university food pantry started at Michigan State University in 1993. Since then, campus food pantries are more widespread, although little is known about them. The current study examined how college pantries best serve students and foster their success. Twenty‐eight food pantry directors and staff from across sixteen Michigan college campuses engaged in concept mapping, a technique used to examine the interrelationships among concepts understood by stakeholders. Analyses identified six concepts, examined importance of each concept as assigned by participants, and evaluated variation among institutions. Implications for findings and future research directions are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract Increasingly, individuals identify with two or more racial or cultural, yet are sometimes externally misclassified, contributing to experiences of invisibility within U.S. society. Using computational techniques, we examined the transmission of cultural identity terms through time, providing some evidence for the changing representation of social identity. We examined the usage patterns of identity terms with the prefixes (mono‐, bi‐, multi‐), modifying the social identity terms: culture, ethnicity, and race (e.g., comparing monocultural, monoethnic, and monoracial). For bicultural and multicultural terms, those with ‐racial suffixes were the earliest used terms, while those with ‐cultural and ‐ethnic suffixes gained more popularity in recent years. We examined the evolution of the higher frequency social identity terms in lay sources (the NY Times, Reddit), and found that interracial and multicultural were the most popular over time, peaking recently. We examined the potential time lag in the sequence of identity terms among academic (PsycINFO, NIH, and NSF Databases), lay (the NY Times), and mixed sources (Google Books N‐Grams), demonstrating that newer terms (e.g., multicultural) are first used and gain prevalence in lay sources, then mixed sources, and eventually academic sources. The implications of these findings for research, public policy, and psychosocial experiences of individuals are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The Internet represents a powerful tool for racist groups to build a sense of group consciousness and promote their cause. In the current study, we examined the language used by racist (n = 87), anti‐racist (n = 50), and nonactivist (n = 1379) groups when describing their self‐defining beliefs online. We used computerized linguistic analysis software to measure psychological indicators and antecedents of group consciousness and to examine the persuasive techniques used in online group communication. Racist and anti‐racist groups were similar on some linguistic indicators of group consciousness (e.g., use of words reflecting perceived injustice), but differed on others (e.g., use of words reflecting group identification). Linguistic indicators of antecedents of group consciousness (moral foundations and focus on religion) differed across groups, with racist groups focused more on purity, respect for authority, and religion, and less on fairness than anti‐racist groups. Racist groups also used less cognitively complex language than nonactivist groups (but similar levels to anti‐racist groups). Our results contribute to understanding how racist groups promote their self‐defining beliefs online, and identify several key factors that should be considered when designing policies to reduce racist groups’ growth and impact. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract In 2002, Care Not Cash/Proposition N was introduced to respond to public concern over San Francisco's chronic homeless epidemic. The controversial initiative, which significantly reduced General Assistance (cash aid) to unhoused people, diverted funds to direct services such as shelter, food, medical assistance, and substance abuse programs. To investigate the underlying attitudes and beliefs that framed homelessness and the Care Not Cash policy in the months leading up to the citywide vote articles from the San Francisco Chronicle were analyzed. Of particular interest was assessing the prevalence of individualistic framing, constructions of dependency, and the problems Care Not Cash was presented as solving. Our analysis found that homelessness was framed as a threat to businesses, tourism, and residents of San Francisco and welfare as enabling deviant behavior (e.g., substance abuse) among people experiencing homelessness. Similar to federal welfare reform, Care Not Cash was portrayed as a compassionate solution that would both solve the problem of homelessness and address problematic behaviors associated with people who are unhoused (Stryker & Wald, 2009). Implications for economic justice are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract In the wake of the 2016 election, which surprised pundits and voters on both the left and the right, there has been renewed interest in understanding what predicts American voters’ choices. In this article, we investigate the roles of personality and issue importance in how people voted in the 2016 U.S. election. In this longitudinal study of 403 MTurk workers who voted in the election, we assessed the relations between personality (openness, social dominance orientation, and national identity importance) and issue importance (group rights and social justice, economic rights, and individual and national rights), and voting for Clinton or Trump. Our results indicate that both individual differences and issue importance as measured in July 2016 predicted votes in November. We also found that the links between personality and voting were mediated by issue importance. Implications for political psychology and the study of personality, campaign issues, and voting behavior are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The aim of the study was to investigate levels of posttraumatic stress due to the recent economic crisis in a Greek community sample and identify particularly vulnerable demographic groups. A sample of 1,208 residents of a western Athens borough completed the Impact of Events Scale—Revised. According to the findings, almost 60% of respondents reported severe and 28% moderate symptoms. Individuals in employment presented similar levels as the unemployed, while caring for dependants, having lower educational attainment, and being female and older were associated with greater posttraumatic stress. The present findings suggest a high prevalence of posttraumatic stress in a community sample, indicating that policymakers in Greece, Europe, and worldwide need to take very seriously the growing evidence for the detrimental effects of austerity politics on both individual and collective well‐being. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Donald Trump's 2017 inaugural address was scored with a content analysis measure of implicit motives. The results show that compared to other 20th and 21st century U.S. presidents, he scores very high in achievement and power motive imagery, but only about average in affiliation imagery. Based on previous research on presidents’ motive imagery, this profile suggests some predictions about the Trump presidency and possible problems for it. In political leaders, high achievement motivation often leads to frustration with the political process. Power motivation, while associated with rated greatness, is related to polarization of public opinion and war. The effects of motives are further channel by temperament and traits—in Trump's case, high extraversion and low agreeableness. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract When judging a voter's decision, does that voter's reason for casting their vote influence moral and interpersonal judgments about them? In the context of the 2016 U.S. Presidential Election, past research suggests two competing predictions. First, people regularly account for an actor's intentions when forming judgments of the actor, indicating that judgments may vary according to a voter's motives. However, people are unlikely to see nuance among outgroups, especially amid divisive political partisanship, suggesting that judgments would ignore information about voters’ motives. In Study 1, results supported the first prediction, showing that both Hillary Clinton and Donald Trump supporters distinguished between different voting motives when making moral and interpersonal judgments of outgroup voters. In Studies 2 and 3, when some voters’ motives became more extreme, Clinton and Trump supporters again distinguished between voting motives for outgroup and ingroup voters, respectively, albeit in a different pattern of results. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Hillary Clinton was the first woman nominated for President by a major political party in the United States. Like most women in politics, she faced negative evaluations, in part, due to the inconsistency between the traits typically associated with leaders (competence) versus women (warmth). Because understanding the categorization of an individual female politician is essential to the development of successful bias interventions, we examined the extent to which Hillary Clinton and a novel female politician were categorized as women versus female politicians. In three studies we investigated how the warmth and competence stereotypes associated with women and female politicians contributed to the warmth and competence traits associated with Hillary Clinton and a novel female political candidate. Consistent with a subtyping account, the warmth and competence stereotypes associated with female politicians, but not women, predicted Hillary Clinton's warmth and competence traits (Studies 1–3). However, consistent with a subgrouping account, the warmth and competence stereotypes associated with both women and female politicians predicted a novel female politician's warmth and competence traits (Study 3). Implications for bias reduction interventions are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract Are female politicians disadvantaged by adverse economic conditions in ways their male counterparts are not? To examine this issue, we had participants read a news article about the current economic situation. The article emphasized either economic stability or volatility. Afterward, they evaluated an advertisement for either a female or a male candidate for the U.S. Senate. Exposure to news depicting economic instability caused devaluation of the female but not the male candidate. A second study provided a direct replication of this finding with a larger sample.  An omnibus analysis (N = 535) showed that this devaluation pattern occurred primarily among male participants. Study 2 also examined whether gender stereotypes play a role in this process.  Indeed, men's confidence in the female candidate's ability to handle stereotypically masculine issues decreased under economic instability and this tendency mediated their devaluation of the female candidate. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The 2016 U.S. Presidential Election provided a unique opportunity to examine how ageism and sexism may impact attitudes (perceived presidential qualities and endorsement of positive and negative age stereotypes) toward Hillary Clinton and Donald Trump. Community participants (N = 875) indicated their attitudes and voting intentions 3 weeks before the election. Endorsement of positive and negative age stereotypes and perceived presidential qualities for Clinton and Trump varied based on participants’ attitudes toward women, political stance (conservative/liberal), and demographic characteristics (racial/ethnic identification, education, gender identification). Individuals who perceived sexism to be more prevalent and perceived women as more competent in general had more positive attitudes toward Clinton, in contrast, only perceptions of lower prevalence of sexism (and not competence of women) predicted attitudes toward Trump. Individuals who perceived sexism as less prevalent viewed Clinton as less presidential and endorsed stronger negative age stereotypes for Clinton, while they viewed Trump as more presidential and endorsed stronger positive and weaker negative age stereotypes for Trump. Our findings suggest that both ageism and sexism present barriers for qualified women when pursuing positions of power. Implications for future research are discussed. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract The present study investigated preference for linguistically biased characterization of events attributed to Hillary Clinton and Donald Trump during the 2016 Presidential election cycle. The linguistic intergroup bias (LIB) reflects abstract characterization of positive events attributed to ingroup members and negative events attributed to outgroup members; conversely, it also reflects concrete characterization of negative events attributed to outgroup members and positive events attributed to outgroup members. University students (N = 117) who preferred Hillary Clinton completed on‐line measures before and after the 2016 Presidential election, including liberal‐conservative ideology and measures of LIB. Participants showed clear preference for characterizations consistent with LIB (e.g., Clinton is intelligent; Trump is quick‐tempered). This pattern was more pronounced as strength of liberal ideology increased; it also was more pronounced immediately following the election than after time had passed. A smaller sample of Trump supporters also showed LIB favoring Trump. This study is the first to demonstrate that members of the electorate gravitate towards linguistic characterizations that favor their preferred political candidates and that this tendency is exacerbated by a relevant individual difference. Findings have implications for the continued polarization of the American electorate. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract White women's general failure to vote for Hillary Clinton in the 2016 United States presidential election (only 43% of White women did so) was largely unexpected. We tested the hypothesis that White women's gender‐related attitudes and beliefs, including their (i) feminist identification, (ii) views of societal gender discrimination, (iii) personal experiences with gender discrimination, and (iv) beliefs about female role models, were related to their levels of support for Hillary Clinton and her opponents (Sanders, Trump). A sample of White women (N = 314; 18–75 years, M = 32.71, SD = 13.37) recruited during June and July of 2016 from MTurk and college campuses completed surveys of their gender‐related attitudes and beliefs, as well as political preferences. Results indicated that women's gender‐related attitudes and beliefs predicted their views of both Clinton and Trump, after accounting for political ideology. For example, feminist identification was positively related to support for Clinton. Additionally, stronger endorsement of the notion that societal gender discrimination persists in the United States predicted both more favorable ratings of Clinton and less favorable ratings of Trump. More frequent personal experiences with discrimination, in contrast, predicted weaker support for Clinton. - Analyses of Social Issues and Public Policy, EarlyView.

--- - |2 Abstract Social psychological models of group identity and collective action should be particularly adept at providing psychological explanations for growing rates of populism in the Western World. Because populism tends to arise in times of societal shifts that reflect both economic and cultural changes, populist attitudes are likely grounded in perceptions of intergroup relations and collective attitudes. We surveyed 95 demonstrators at the 2016 Republican National Convention and 108 demonstrators at the Democratic National Convention. Results support the idea that relative anger prototypicality, in this case, the extent to which people believe that their own anger toward politicians is representative of most Americans’ anger, predicts feelings of group‐based relative deprivation. Importantly, these feelings of deprivation mediate the relationship between prototypical anger and populist attitudes. These findings provide a unique picture of current political engagement, motivated by feelings of shared anger and collective feelings of lacking representation and voice. - Analyses of Social Issues and Public Policy, EarlyView.

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--- - |2 Abstract A defining feature of American politics, including party identification, is the question of the proper role of government. Partisanship is a prevailing way that individuals organize their attitudes. Democrats should take the Democratic Party's positions, and Republicans should take the Republican Party's positions. Instead, people have conflicting considerations that shape their opinions. Given that gender is integral in structuring individuals’ positions in society, it is reasonable to expect that gender differences might produce intraparty differences. This article establishes a gender gap in scope of government that transcends partisanship. Using the cumulative American National Election Study Data 1994–2008, I find strong evidence that for a number of issue areas, women are more supportive of an activist government than men of the same party. Preferences regarding the scope of government provide a coherent explanation for these observed gaps. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 379-405, December 2017.

--- - |2 Abstract Numerous recent encounters between police officers and Black citizens have resulted in the deaths of African American men and have drawn renewed public scrutiny of police practices. We examine the public's attributions about these encounters. Does the public perceive violent confrontations between police officers and Black citizens as a result of broader problems in police practices or simply as isolated incidents? We employ attribution theory and social identity theory to understand how social and political identities influence beliefs about police use of force against African Americans. We argue that racial and political identities predispose individuals to believe certain attributional perspectives over others. We test several hypotheses using individual level survey data from two national surveys. Our findings suggest that racial and political identities strongly shape attributions, and these patterns have implications for public trust in government institutions and the ability of police to operate effectively. We conclude with recommendations for police and policymakers. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 358-378, December 2017.

--- - |2 Abstract Support for presidential candidate Donald Trump increased in the aftermath of the 2015 terrorist attacks in Paris, France, and San Bernardino, California, similar to Americans’ greater enthusiasm for President George W. Bush after the September 11, 2001 terrorist attacks on the Pentagon and World Trade Center. According to terror management theory (Greenberg, Pyszczynski, & Solomon; Solomon, Greenberg, & Pyszczynski), people are prone to embrace charismatic politicians in times of historical upheaval to mitigate existential terror. Consistent with this view, previous research has demonstrated that reminders of death (relative to an aversive control condition) increased support for a charismatic leader in a hypothetical gubernatorial election, and support for President Bush and his policies in Iraq prior to the 2004 presidential election. The present Study 1 hypothesized and found that a death reminder increased support for Donald Trump. Study 2 found that while Hillary Clinton was viewed more favorably than Donald Trump in an aversive control condition, Mr. Trump was viewed more favorably in response to a death reminder while impressions of Mrs. Clinton were unaffected. Study 3 demonstrated that asking people to think about immigrants moving into their neighborhood increased the accessibility of implicit death thoughts. These findings suggest that electoral outcomes and public policy can be affected when existential concerns are aroused. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 339-357, December 2017.

--- - |2 Abstract To inform current public policy regarding suicide prevention, this study examined the longitudinal relationships between four resources (public insurance, primary care services, school‐based mental health treatment, and family support) and depression and suicidality in a nationally representative sample of suicidal adolescents (n = 1,355). Longitudinal regression analyses were conducted using data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Parental support at Wave I was predictive of lower levels of depression across all three waves, but not significantly associated with the suicide‐specific outcomes. While type of insurance was not significantly associated with any of the outcomes, receipt of public assistance was associated with a higher likelihood of suicidal ideation and higher levels of depression at all three waves. Neither receipt of a routine physical nor access to school‐based mental health treatment were associated with any of the outcomes. Intervention points for future policy that are discussed include the following: integrating family interventions into current screening and referral protocols, targeted screening and outreach for those youth and young adults receiving public assistance, the inclusion of integrated behavioral health in primary care settings, and the inclusion of suicide‐specific evidence‐based treatments in the school setting. - Analyses of Social Issues and Public Policy, Volume 17, Issue 1, Page 319-338, December 2017.

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Aim To cross‐culturally adapt and validate the Comprehensive Frailty Assessment Instrument (CFAI) among Chinese community‐dwelling older adults. Methods The Chinese CFAI was developed through forward–backward translations. An urban sample of 1235 community‐dwelling older adults received face‐to‐face interviews to examine the validity (construct validity and criterion validity) and reliability (internal consistency and test–retest reliability). Results The Chinese CFAI achieved semantic and idiomatic equivalence, and showed acceptable reliability and an expected factor structure, except for the social support domain. The exploratory factor analysis extracted five factors explaining 53.8% of the total variance of frailty. The confirmatory factor analysis showed that the data fit well to the second‐order factor theoretical model, with a root mean square error of approximation of 0.05, Tucker‐Lewis Index of 0.93 and Comparative Fit Index of 0.95. The receiver operating characteristic analysis presented an acceptable criterion validity using the Rockwood Frailty Index as an external criterion (area under the curve 0.80), with balanced sensitivity (65.31%) and specificity (81.19%) at the optimal 39‐point frailty cut‐off of the CFAI. Conclusions The Chinese CFAI has good validity and reliability as a practical frailty measure in Chinese community‐dwelling older adults.

Aim The aim of the present study was to investigate the relationship between physical activity (PA) and depressive symptoms in community‐dwelling older Japanese adults. Methods A cross‐sectional study design was used to obtain data from 3191 community‐dwelling older Japanese adults aged 70–95 years. Depressive symptoms were assessed using self‐reported scores on the Geriatric Depression Scale‐15. PA was objectively measured using an accelerometer worn for a maximum of 40 days, and average daily durations of light‐intensity PA (LPA), moderate‐to‐vigorous intensity PA (MVPA) and step count were calculated. PA was compared between participants with and without depressive symptoms by carrying out analysis of covariance and multivariable logistic regression analysis adjusted for all covariates by using propensity scores. Results Depressive symptoms were present in 598 participants (19.6%). A comparison of propensity‐score adjusted PA showed that step count (5059.6 ± 53.7 vs 5003.0 ± 112.1 count/day; P = 0.652) and moderate‐to‐vigorous intensity PA duration (23.0 ± 0.4 vs 23.8 ± 0.7 min/day; P = 0.358) were not significantly different between participants with and without depressive symptoms, respectively. However, participants without depressive symptoms had a significantly higher LPA duration than those with depressive symptoms (39.4 ± 0.3 vs 37.3 ± 0.7 min/day, respectively; P < 0.01). Conclusions The present results suggest that individuals with lower LPA have a higher risk of depressive symptoms. These findings imply that PA recommendations, especially for older adults, should emphasize LPA, which appears to be especially effective at preventing depressive symptoms.

Aim To evaluate the relationship between kidney function without diabetes and components of the frailty phenotype in community‐dwelling Japanese older adults. Methods Participants were 8343 residents who completed baseline assessments, classified into four categories according to eGFR. Frailty status was defined using five criteria: (i) slow gait speed; (ii) muscle weakness; (iii) low physical activity; (iv) exhaustion; and (v) unintentional weight loss. Results After multivariate adjustment, participants with the lowest kidney function were at higher risk of frailty (OR 1.57, 95% CI 1.02–3.50) than those with normal kidney function. In addition, after adjustment for multiple confounders, estimated glomerular filtration rate <30 was associated with a greater risk of the individual frailty components of weight loss (OR 2.14, 95% CI 1.11–4.12), low physical activity (OR 1.35, 95% CI, 1.01–2.54) and slowness (OR 1.82, 95% CI 1.36–3.77) compared with estimated glomerular filtration rate ≥60. Conclusions Lower kidney function was associated with a higher risk of weight loss, low physical activity and slowness among community‐dwelling Japanese older adults.

Objective To examine associations among substance use disorder (SUD) and measures of length of stay (LOS) and non‐psychiatric medical comorbidity (MEDCO) in older‐adult inpatients with serious mental illness (SMI), hypothesizing SUD would be related to worse clinical outcomes. Methods A cross‐sectional study analyzed medical records from 2010 to 2016 of 7258 inpatients with SMI ≥ age 50, obtained from a 274‐bed psychiatric hospital. Descriptive analyses examined prevalence rates for SUD status (+/−), individual drug classes, and total number of SUDs (polysubstance use disorders). Regression models examined the influence of 2 independent variables of interest: (1) SUD status (+/−) and (2) type of SUD (ie, specific drug), controlling for demographic factors and additional (non‐SUD) psychiatric disorders. Two dependent (outcome) variables were examined: LOS and MEDCO. Results The overall SUD rate was 26%; cocaine was the most common SUD (≈ 10%). SUD status and additional (non‐SUD) psychiatric diagnoses were significantly associated with longer LOS (both P < 0.001). For individual SUDs, cocaine, marijuana, opiates, and alcohol were all significantly associated with LOS (all P < 0.01). SUD status, age, sex, admission status, and race were significantly associated with MEDCO (all P < 0.002). For individual SUDs, barbiturates, opiates, and alcohol were all significantly associated with MEDCO (P < 0.01). Conclusions The prevalence of SUD in this sample underscores concerns related to treating older adults presenting providers with comorbid SUD and SMI. This combination may increase the burden and complexity of care, warranting further investigation into mechanisms and long‐term consequences.

Aim The aim of the present study was to evaluate whether the effect of one‐time brief additional counseling in periodic health examinations (PHE) through the National Screening Program for the Translational Ages in Korea is sustained after 2 years. Methods We collected data from National Screening Program for the Translational Ages participants in 2007 and 2008. To evaluate behavior change after 2 years, we collected the participants’ health behavior data 2 years later (2009 and 2010). We defined the basic group as participants who only received PHE, and the additional group as received PHE and counseling. We carried out propensity score matching to ensure that additional counseling was the only different variable affecting health behavior between the two groups. Results After propensity score matching, 50 630 remaining matched participants were matched for each group. Of these participants, 26.5% (26 855/101 260) were aged 66 years, and 60.9% (61 653/101 260) were men. The additional group showed a significant increase in odds of smoking cessation among the 66‐year‐olds (adjusted OR 1.173, 95% CI 1.003–1.372). This effect was significant, especially when the participants did not have hypertension or hypercholesterolemia (adjusted OR 1.193, 95% CI 1.000–1.423 for hypertension and adjusted OR 1.188, 95% CI 1.009–1.398 for hypercholesterolemia). However, there was no significant association for alcohol drinking and regular exercise. Conclusions The effect of one‐time brief counseling added to a PHE in cigarette smoking was observed only among the 66‐year‐olds. However, the effect was so small that it is doubtful to be clinically relevant. Repeated counseling is required to sustain the effect of the initial motivation of counseling. Geriatr Gerontol Int 2017; ••: ••–••

Many people believe that the abortion debate will end when at some point in the future it will be possible for fetuses to develop outside the womb. Ectogenesis, as this technology is called, would make possible to reconcile pro‐life and pro‐choice positions. That is because it is commonly believed that there is no right to the death of the fetus if it can be detached alive and gestated in an artificial womb. Recently Eric Mathison and Jeremy Davis defended this position, by arguing against three common arguments for a right to the death of the fetus. I claim that their arguments are mistaken. I argue that there is a right to the death of the fetus because gestating a fetus in an artificial womb when genetic parents refuse it violates their rights not to become a biological parent, their rights to genetic privacy and their property rights. The right to the death of the fetus, however, is not a woman's right but genetic parents’ collective right which only can be used together.

Objective To investigate the impact on patient waiting times of a role substitution model introducing an advanced allied health practitioner as the first point of contact within a geriatric outpatient context. Methods A pre‐ to postintervention design was used to determine impact over a five‐year period (2008–2012). All patients referred to the geriatric specialist outpatient department were included (n = 1514). Data relating to waiting times were analysed using one‐way ANOVA and post hoc Tukey tests to determine effects on patient waiting times. Results Waiting times were reduced from an average of 82 to as low as 35 days, in a context of increasing referral rates. Medical specialist capacity was increased through improvements to available outpatient times and reduced appointment lengths. Patients seen within their designated triage category timeframe increased from 47 to 86%. Conclusion Health professional substitution in geriatrics can be an effective intervention for reducing patient waiting times and improving access to care.

Aim To investigate whether being part of a community organization interfered with older adults’ overall functionality. The magnitude of responses to a community exercise program based on functional circuits in socially active and socially non‐active older adults was also investigated. Methods A total of 200 older adults aged ≥60 years from Requinoa, Chile, participated in the study. Participants were separated into two groups according to the level of social participation: socially active (SA) and socially non‐active (SNA). During an evaluation, data regarding the presence of comorbidities (Charlson Comorbidity Index), disability level (Modified Health Assessment Questionnaire), dynamic balance (Timed Up and Go test), muscle force (handgrip dynamometry) and sociodemographic conditions were collected. Participants followed an exercise program consisting of a functional exercise circuit including balance, resistance and aerobic exercises, twice a week, for 12 weeks. Results Both the Charlson Comorbidity Index and disability were higher in SNA compared with SA participants on inclusion. Both groups improved disability (Δ–0.25 patients [−0.5 – −0.0625 patients] for SNA and (Δ–0.125 patients [−0.5–0 patients] for SA) and balance (Δ–2 s [−3–0 s] for SNA and (Δ–1 s [−3–0 s] for SA) after training (P < 0.05 for all). Changes from baseline were statistically higher in the SNA group. Handgrip force improved only in participants in the SNA group (Δ1.7 kg [0.6–2.8 kg], P = 0.0001). No differences, however, were observed between the magnitude of improvements of handgrip between groups. Conclusions Although socially non‐active older adults had more comorbidity and disability than their socially active counterparts, they showed a higher response to a community exercise program. Geriatr Gerontol Int 2017; ••: ••–••.

Introduction Neuropsychiatric symptoms (NPS) are common at all stages of Alzheimer disease (AD). Delusions in AD are associated with negative clinical consequences and may signal rapid disease progression. Hence, we sought to determine the prevalence of delusions in drug‐naïve (no cholinesterase inhibitor or neuroleptic medications) AD patients. Methods In this meta‐analysis, a search of the EMBASE, MEDLINE, and PsycINFO databases was performed. We selected studies reporting delusion prevalence measured by the Neuropsychiatric Inventory (NPI) in drug‐naïve AD patients. An aggregate delusion event rate with 95% confidence interval (CI) was calculated. The I2 statistic was used to assess the magnitude of between‐study heterogeneity. Single variable meta‐regressions allowed examination of the effect of moderating factors and heterogeneity. Quantitative measures were used to appraise for publication bias. Results We identified 6 studies with 591 participants allowing calculation of the aggregate delusional prevalence rate. Irrespective of dementia severity, the aggregate event rate for delusions was 29.1% (95% CI: 20–41%; I2 = 84.59). No publication bias was observed. Conclusion This meta‐analysis calculates a 29.1% prevalence rate of delusions in AD patients. There is a trend towards increasing delusion prevalence in concordance with increasing severity of dementia. Given delusions are associated with poorer outcomes, the obtained prevalence should motivate clinicians to screen carefully for delusions. Current literature limitations warrant future studies, with sub‐analyses on dementia severity, and other neurobiological factors known to influence the presence of delusions.

In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a policy RCT, policy experts must either (1) reasonably disagree about whether the trial arms are more effective than this policy, or (2) know that they are.

Objective Despite the benefits of physical activity (PA) in older people with depression, many do not comply with the International PA guidelines. Thus, we investigated what factors influence PA participation among 915 community‐dwelling older adults (aged ≥65 years) with depression in 6 low‐income and middle‐income countries (LMICs). Methods Cross‐sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. The sample was restricted to those with DSM‐IV depression or receiving depression treatment in the last 12 months. PA was assessed by the Global Physical Activity Questionnaire. Participants were dichotomized into low (ie, not meeting 150 minutes of moderate PA per week) and moderate‐to‐high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions. Results The prevalence of low PA was 40.4% (95%CI = 34.8%–46.1%). After adjusting for age, sex, and country, larger household size and unemployment were significant sociodemographic correlates of low PA. Former smoking (vs never), anxiety, mild cognitive impairment (MCI), lower body mass index, bodily pain, asthma, chronic back pain, chronic obstructive pulmonary disease, hearing problems, stroke, slow gait, poor self‐rated health, higher levels of disability, and lower levels of social cohesion were identified as significant negative correlates of PA. Conclusions The current data provide guidance for future interventions across LMICs to assist older people with depression engage in regular PA. The promotion of social cohesion may increase the efficacy of future public health initiatives, while from a clinical perspective, somatic co‐morbidities, MCI, pain, and slow gait need to be considered. Key points More than 40% of older people with depression in low‐income and middle‐income countries do not meet physical activity guidelines. Somatic co‐morbidities, lower body mass index, pain, and slow gait need to be considered. The promotion of social cohesion may increase the efficacy of future public health initiatives.

Objective To determine how older people with dementia and their family caregivers experience dementia assessment services and preferences for future configuration of diagnostic services. Methods Qualitative, semistructured in‐depth interviews were conducted with nine individuals with dementia. In seven instances, the caregiver also took part in the interview, and on two occasions, the interview was with the person with dementia only. Results An important contact during assessment of dementia was the general practitioner, in particular working in a way or timeframe which provides clarity and comfort to the person with dementia and their family members. A problematic factor in clear diagnosis was when probable dementia was suspected during hospitalisation for another complaint. Participants expressed a wide range of views in terms of preferred settings for diagnostic services. Conclusion These findings highlight some key considerations, which should be included in future research leading to decisions about the design of dementia client services.

Objective To identify which specific depressive symptoms predict remission to aripiprazole augmentation in late‐life treatment resistant depression. Methods This is a secondary analysis of data from a late‐life treatment resistant depression trial examining the safety and efficacy of aripiprazole augmentation. Participants aged 60 and above were randomized to aripiprazole augmentation (N = 91) versus placebo (N = 90). The main outcome was depression remission. Clinical predictors included individual Montgomery‐Asberg Depression Rating Scale (MADRS) item scores categorized as symptomatic (scores >2) or nonsymptomatic (scores ≤2). Results Three MADRS items predicted depression remission with aripiprazole augmentation: symptomatic scores on sleep disturbance and nonsymptomatic scores on apparent sadness and inability to feel. The 2‐way and 3‐way interaction terms of these MADRS items were not significant predictors of remission; therefore, the models' ability to predict remission was not improved by combining the significant MADRS items. Conclusions The identification of specific depressive symptoms, which can be clinically assessed, can be used to inform treatment decisions. Older adults with treatment resistant depression that present with sleep disturbances, lack of apparent sadness, or lack of inability to feel should be considered for aripiprazole augmentation.

Objective The purpose of this study was to examine the impact of being exposed to a multimedia campaign on stigmatic beliefs towards a person with Alzheimer's disease (AD). Methods A cross‐sectional posttest online survey was conducted immediately after the campaign among 510 Jewish participants aged 40 and above. Results Most the participants reported being exposed to the campaign. The campaign elicited significantly higher positive than negative emotions. Exposure to the campaign was not significantly associated with any of the stigmatic beliefs as a direct or moderating variable. Worry about developing AD was associated with increased stigmatic beliefs. Conclusions More research is needed to better understand which types of media campaigns work best to increase awareness and reduce stigma associated with AD.

Objective As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. Methods We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014–2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. Results Seventy‐one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen‐Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. Conclusions Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia‐friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes.

Objective The purpose of this study was to analyze the age and sex‐related differences in socio‐demographic factors that influence suicide ideation and attempts in the elderly. Methods The total number of subjects was 93 151, of whom 8441 belonged to the high suicide‐risk group (2064 male; 6377 female). Following this identification, we investigated their socio‐demographic information, health status, and depressive symptoms, which might have influenced their suicide ideation and attempts. Results Residence in an urban area was identified as a risk factor for both male and female elderly in their 60s and 70s and female elderly in their 80s. Marital status showed a different influence on suicide ideation depending on age and sex. A negative perception of one's own health status was a significant risk factor that increased the likelihood of suicide ideation in all ages, except the female elderly in their 60s. No factor was identified that significantly influenced suicide attempts in the male elderly. However, in the female elderly, residence in an urban area and a negative perception of one's own health status were identified as significant risk factors. Conclusions This study revealed that factors known to influence suicide ideation in the elderly from previous studies, such as residence area, separation from a spouse, education level, religion, and drinking, show changed influence as the elderly reach their 70s and 80s. However, a negative perception of one's own health status was a risk factor that encompassed most ages and sexes.

Objective First, to evaluate the outcome of 2 transdiagnostic day treatment programs. A 20‐week psychotherapeutic day treatment (PDT) and an activating day treatment (ADT) program delivered in blocks of 4 weeks with a maximum of 24 weeks with respect to depression, anxiety, and hypochondriasis. Second, to explore the impact of cognitive impairment and personality pathology on treatment outcome. Methods The course of depression (Inventory of Depressive Symptoms), anxiety (Geriatric Anxiety Inventory), and hypochondriasis (Whitley Index) were evaluated by linear mixed models adjusted for age, sex, level of education, and alcohol usage among 49 patients (mean age 65 years, 67% females) receiving PDT and among 61 patients (mean age 67.1, 61% females) receiving ADT. Pre‐post effect‐sizes were expressed as Cohen's d. Subsequently, cognitive impairment (no, suspected, established) and personality pathology (DSM‐IV criteria as well as the Big Five personality traits) were examined as potential moderators of treatment outcome. Results Among patients receiving PDT, large improvements were found for depression (d = 1.1) and anxiety (d = 1.2) but not for hypochondriasis (d = 0.0). Patients receiving ADT showed moderate treatment effects for depression (d = 0.6), anxiety (d = 0.6), as well as hypochondriasis (d = 0.6). Personality pathology moderates treatment outcome of neither PDT nor ADT. Cognitive impairment negatively interfered with the course of depressive symptoms among patients receiving PDT. Conclusions Transdiagnostic day treatment is promising for older adults with affective disorders with high feasibility.

Objective Apathy is one of the most frequent neuropsychiatric symptoms encountered in dementia. Early diagnosis and timely treatment of apathy in dementia are crucial because apathy has been associated with poor disease outcome, reduced daily functioning, and caregiver distress. Design Extensive electronic search from the databases included in the National Library of Medicine as well as PsychInfo and Google Scholar for studies which have investigated the effect of non‐pharmacological treatments of apathy in dementia. Quality of the studies was appraised. Results A total of 1303 records were identified and 120 full‐texts assessed. Forty‐three unique studies were reviewed. A variety of interventions were found to be effective in reducing apathy in demented patients, particularly when provided in a multidisciplinary manner. However, quantification of the effect was limited by the marked methodological heterogeneity of the studies and the small number of studies where apathy was the primary outcome measure. Conclusions Treatment of apathy in dementia is a complex and underexplored field. Certain studies suggest promise for a variety of non‐pharmacological interventions. Standardized and systematic efforts primarily focusing on apathy may establish a benefit from individualized treatments for specific disease groups. Key points Apathy is one of the most frequent neuropsychiatric symptoms encountered in dementia. A variety of nonpharmacological interventions, when provided in a multidisciplinary manner, were found to be effective in reducing apathy in demented patients. Standardized and systematic efforts primarily focusing on apathy may establish a benefit from individualized treatments for specific disease groups.

Objective To investigate the relationship between anxiety symptoms and sleeping medication use among a nationally representative sample of US older adults. Design Cross‐sectional design using data from the 2011 National Health and Aging Trends Study to examine the relationship between anxiety symptoms as rated by the Generalized Anxiety Disorder‐2 and self‐reported sleeping medication use. Survey weights were applied to account for complex survey design. Logistic regression was used to measure the association between anxiety symptoms and sleeping medication use after adjusting for sociodemographic factors, physical health, and other sleep‐related issues. Results In 2011, 13.1% of respondents experienced high anxiety symptoms and 29.0% reported taking a sleeping medication at least once a week during the last 30 days. Results estimate that approximately 4 million US older adults have clinically significant anxiety symptoms and approximately 10 million US older adults used a sleeping medication in the last 30 days. Adjusted results revealed that high anxiety symptoms are significantly associated with sleeping medication use compared to low anxiety symptoms (AOR = 1.57; 95% CI, 1.29‐1.91). Depression symptoms were also associated with sleeping medication (AOR = 1.29; 95% CI, 1.08‐1.55). Conclusions Results demonstrated that anxiety symptoms are significantly associated with sleeping medication use among US older adults. We also found that depressive symptoms, chronic conditions, and worse self‐rated health are associated with sleeping medication use. As sleeping medications are associated with adverse health events, these results have clinical implications for treating anxiety symptoms among older patients.

Objective Several potentially modifiable risk factors for cognitive decline and dementia have been identified, including low educational attainment, smoking, diabetes, physical inactivity, hypertension, midlife obesity, depression, and perceived social isolation. Managing these risk factors in late midlife and older age may help reduce the risk of dementia; however, it is unclear whether these factors also relate to cognitive performance in older individuals without dementia. Method Data from 14 201 non‐demented individuals aged >50 years who enrolled in the online PROTECT study were used to examine the relationship between cognitive function and known modifiable risk factors for dementia. Multivariate regression analyses were conducted on 4 cognitive outcomes assessing verbal and spatial working memory, visual episodic memory, and verbal reasoning. Results Increasing age was associated with reduced performance across all tasks. Higher educational achievement, the presence of a close confiding relationship, and moderate alcohol intake were associated with benefits across all 4 cognitive tasks, and exercise was associated with better performance on verbal reasoning and verbal working memory tasks. A diagnosis of depression was negatively associated with performance on visual episodic memory and working memory tasks, whereas being underweight negatively affected performance on all tasks apart from verbal working memory. A history of stroke was negatively associated with verbal reasoning and working memory performance. Conclusion Known modifiable risk factors for dementia are associated with cognitive performance in non‐demented individuals in late midlife and older age. This provides further support for public health interventions that seek to manage these risk factors across the lifespan.

Aim To examine the longitudinal association between dentition status and incidence of frailty in older adults. Methods The present prospective cohort study included community‐dwelling Japanese adults aged 75 years at baseline (n = 322). Dental examinations, biochemical blood examinations, physical performance and anthropometric measurements, and structured questionnaires were carried out at baseline. The presence of ≥20 teeth with nine or more occluding pairs of teeth was defined as functional dentition. Annual follow‐up examinations, including physical performance, anthropometric measurements and structured questionnaires, were carried out over a 5‐year period to determine the incidence of frailty, defined as three or more of the following five components derived from the Cardiovascular Health Study: weight loss, weakness, slowness, poor energy and low physical activity level. Adjusted hazard ratios of frailty incidence according to dentition status were calculated from Cox proportional hazards regression analyses. Results At baseline, 118 participants (36.6%) were defined as having functional dentition. During the follow up, 48 participants (14.9%) developed frailty. The adjusted hazard ratio for frailty in participants with functional dentition was 0.50 (95% confidence interval 0.25–0.98) compared with participants without functional dentition, after adjusting for sex, income, education, smoking status, body mass index, serum biomarkers and comorbidities. Conclusions Functional dentition was significantly associated with a lower risk of frailty defined by the Cardiovascular Health Study frailty index in older Japanese adults. These results suggest that maintaining healthy and functional dentition into later life is important for frailty prevention. Geriatr Gerontol Int 2017; ••: ••–••.

Objective Cognitive fluctuations (CFs) occur commonly in dementia of all types. While it is generally accepted that CFs can affect the clinical rating of dementia severity and neuropsychological performance, little is known about their impact on patients' activities of daily living (ADLs) and quality of life (QOL). Our study aims to explore the impact of CFs on ADLs and QOL among institutionalized patients with dementia. Methods The present study examined the nature and frequency of CFs in 55 institutionalized dementia patients. We used the Dementia Cognitive Fluctuation Scale (DCFS) to assess the presence and severity of CFs. The Alzheimer's Disease Functional Assessment of Change Scale (ADFACS) was used to assess patients' ADLs, and the Quality of Life in Late Stage Dementia scale (QUALID) was used to assess QOL. Linear regression models were used to assess the relationships between CFs, ADLs, and QOL. Results The mean age of the patients was 90.41 years (SD = 2.84). Their mean Aggressive Behavior Scale score was 1.13 (SD = 1.59), mean Severe Impairment Battery total score was 86.65 (SD = 13.77), and mean DCFS score was 10.07 (SD = 3.04). The mean ADFACS‐ADL score was 10.88 (SD = 6.37), mean ADFACS‐IADL score was 16.61 (SD = 9.54), and mean QUALID total score was 18.25 (SD = 5.70). DCFS significantly predicted ADFACS‐ADL score (R2 = 0.39, β = 0.30, P = .011) although the relationship between ADFACS‐IADL score and DCFS score was not significant (R2 = 0.16, P = .111). DCFS significantly predicted QUALID score (R2 = 0.08, β = 0.29, P = .033). Conclusion More severe CFs in patients with dementia were significantly associated with impaired ability to engage in ADLs and poorer QOL.