Effectiveness of mindfulness meditation-based interventions on anxiety in older adults: a systematic review; and, An investigation of the relationship between carer burden and depression and anxiety in older kinship carers

Abstract

OBJECTIVE: This thesis had two objectives. The first was to examine the effectiveness of mindfulness-meditation interventions on anxiety in older adults. This was addressed through undertaking a systematic review, providing a comprehensive and up-to-date critique of the literature. The second objective was to explore the relationships between carer burden and depression and anxiety in older kinship carers. The empirical study also aimed to use conditional process analysis to explore how the psychological resources of self-compassion, dispositional mindfulness and mastery affect the relationship between carer burden and psychological wellbeing.

METHOD: In relation to the first research objective, a search strategy was devised and eight electronic databases were searched to identify potential articles. Studies were screened according to specific inclusion and exclusion criteria, with the included reviews undergoing a narrative synthesis, quality assessment and RE-AIM analysis. An independent reviewer was utilised to conduct a quality assessment and RE-AIM analysis on half of the included studies. In relation to the second research objective, a cross-sectional online study was conducted with kinship carers over the age of 55. Participants completed five quantitative self-report questionnaires measuring carer burden, anxiety, depression, self-compassion, mindfulness and mastery.

RESULTS: In the systematic review, 11 studies met eligibility criteria and were included in the narrative synthesis, quality appraisal and RE-AIM analysis. Reduction in levels of anxiety were found to be significant in seven of the studies, showing potential benefits in a variety of older adult populations. However, there were a number of studies demonstrating mixed or non-significant results. The RE-AIM analysis highlighted that clinical implementation of mindfulness meditation interventions was often not well considered. In the empirical study, 113 kinship carers completed the study. Results indicated that carer burden was positively associated with depression and anxiety. Dispositional mindfulness and mastery were found to mediate the relationship between carer burden and depression. In the relationship between carer burden and anxiety, dispositional mindfulness was found to be a mediator, whilst self-compassion was found to moderate the relationship.

CONCLUSIONS: The findings of the systematic review are promising for the effectiveness of mindfulness meditation interventions on anxiety in the older adult population. Further research is needed to clarify the strength of effects, by ensuring studies follow strict protocols to ensure consistency and allow replication. The findings of the empirical study provide evidence that self- compassion, dispositional mindfulness and mastery serve as potential protective factors between levels of carer burden and psychological wellbeing, in older kinship carers. This has important clinical implications in terms of the treatment of psychological difficulties in this population, as well as highlighting the role of preventative interventions. Additional research is required to better understand the interactions between these variables in older kinship carers.