Incorporating Spirituality into Cognitive Stimulation Therapy Groups for Persons with Dementia: An Exploratory Study.

Cognitive Stimulation Therapy (CST) is an evidence-based, non-pharmacological intervention for older adults with mild to moderate dementia. While CST has been adapted in various ways, this study explored the impact of adding a spiritual dimension to CST. Participants (N = 34) were divided into spiritual and traditional CST groups based on their residence. After a 14-session intervention involving interactive conversations, the spiritual CST group showed significantly lower depression scores (M = 2.7) compared to traditional CST (M = 6.5). With the global increase in dementia-related disorders, non-pharmacological interventions like CST offer crucial support for addressing memory loss. Social workers are uniquely positioned to deliver CST to diverse populations who value spirituality or faith in their daily lives.

Perceptions and knowledge of older adults: An analysis of interprofessional education and medically underserved populations.

This study explored an academic Interprofessional Geriatric Case Competition (IGCC) experience with a focus on medically underserved populations. Our aims were to assess: the perceptions of and knowledge of older adult populations; and the overall IPE (Interprofessional Education) experience of the IGCC participants. A multi-method study approach was used, the Facts on Aging Quiz assessed knowledge and the Carolina Opinions on Care of Older Adults (COCOA) assessed perceptions. A qualitative thematic approach was utilized to explore the themes of the IPE experience. There was a moderate correlation (0.37, p < .001) between perception and knowledge data of the respondents (N = 94), current professionals (54%) and enrolled students (46%). The three emerged themes were as follows: interprofessional/holistic practice; culturally responsive/older adult centered practice; and the impact of Covid-19. The implementation of IPE that centers medically underserved populations has the potential to: enhance students learning, influence the quality of care, and provide pathways to working within these specific populations.

A student-led Geriatric Assessment Clinic: Interprofessional education with an older adult population.

Healthcare students have expressed a need for more education on the aging adult population. Interprofessional education (IPE) is a well-known educational model intended to increase students' knowledge, skill, and abilities to use evidence-based practice for improved patient outcomes. At a Midwestern, urban-based university, we have implemented an interprofessional, student-led Geriatric Assessment Clinic in order to allow students in six health professions (including medicine, nutrition, occupational therapy, physical therapy, social work, and speech language pathology) to practically apply their skills in the aging adult population while learning to work with other healthcare professionals. This holistic clinic is free of cost to the aging adults who participate in it. The following article discusses the purpose, implementation, benefits, and limitations of such a clinic as it relates to both the patients who attend and the students who participate.

Interprofessional competencies of students in a geriatric case competition.

This paper presents a valuable activity to teach health professions students - the interprofessional geriatric case competition. This program brought together students from multiple health professions to design and present a comprehensive care plan using a simulated complex geriatric patient case. Student participants demonstrated beginning skills in interprofessional collaboration based on the IPEC competencies. The case competition provides a positive, engaging experience to introduce health professions students to geriatric principles and develop their readiness for collaborative interprofessional practice. The competition could be conducted virtually, providing a supplement to on-site education.

Meaningful Engagement in the Nursing Home.

Throughout her career, Rosalie Kane made a major impact in her efforts to improve quality of life for persons living in nursing homes. Near the end of her career, she suggested that it was time to "re-imagine long term care and to produce livable age-friendly nursing homes." This brief review focuses on the role of meaningful engagement and person-centered care as the next step in enhancing nursing home care. The importance of activities that strengthen cognitive and/or physical function is stressed, as well as improving socialization to reduce loneliness.

COVID-19 Pandemic: Workforce Implications for Gerontological Social Work.

The COVID-19 pandemic has been challenging for people of all ages but particularly devastating to adults 65 and older, which has highlighted the critical need for ensuring that all social workers gain the knowledge and skills necessary to work with this population. While there is a critical shortage of gerontological social workers and we must continue to increase that number, we cannot wait for this to occur. In this commentary, the authors call for infusing the current social work curricula with aging content; providing current social workers with trainings on aging practice; and all social work practitioners, faculty, and researchers to address four specific areas that have gained prominence due to the impact of COVID-19: ageism, loneliness and social isolation, technology, and interprofessional practice, in their respective areas.

Training the Next Generation of Gerontological Social Worker Scholars.

The rapid growth of the aging population in the United States has produced concern over whether the social work profession will be able to meet the needs of elders and their caregivers. Currently, a shortage of gerontological social workers trained specifically to work with this population exists, and based on projections, this shortage will only become more critical over the next few decades. In order to address this shortage, one approach has been adopted that seeks to increase the number of gerontological social work faculty, who can then encourage Bachelor and Master of Social Work students to consider working with older adults, and prepare them with the knowledge and skills necessary for doing so. In this commentary, we describe a program that adopts this approach and the measures used to determine its success, and conclude with a brief description of three articles included in this issue of the JGSW that analyze and report the results of these measures.

Non-Pharmacologic Interventions for Persons with Dementia.

Affecting over 100,000 older Missourians, cognitive impairment is of concern for all health care providers. With no available pharmacologic treatments to eradicate/diminish symptoms, professionals and families need non-pharmacologic behavioral interventions to enhance individuals' quality-of-life and decrease the number and intensity of dementia-related behavioral symptoms. This paper provides an overview of available evidence-based non-pharmacologic interventions and strategies that can be delivered in both the community and facility setting, including reminiscence, validation, and cognitive stimulation therapies.

Making a Difference: A Study of Cognitive Stimulation Therapy for Persons with Dementia.

Affecting nearly 5.4 million older adults in the United States and 35.6 million individuals worldwide, dementia is one of the greatest public health crises of our time. As a result, helping professionals, clients, and care partners seek effective and affordable treatment. Developed in the United Kingdom by Spector and colleagues, Cognitive Stimulation Therapy (CST) is a non-pharmacologic psychosocial group intervention for persons with dementia. To expand upon and fill the gaps within existing research, the authors developed a descriptive study to assess the impact of CST on cognition, quality of life, and depression, among six CST groups (n = 40). A paired sample t-test was run among pre- and post-test measures. There was a statistically significant difference in Saint Louis University Mental Status Exam (SLUMS) scores after CST (t = 2.80, p = 0.008). There was also a statistically significant difference in Cornell Scale for Depression in Dementia scores (t = -3.36, p = 0.002). There was no statistically significant difference in Quality of Life scores.

The instructional impact of the American Medical Association's Older Drivers Project online curriculum.

The Older Drivers Project (ODP) of the American Medical Association has provided evidence-based training for clinicians since 2003. More than 10,000 physicians and other professionals have been trained via an authoritative manual, the Physician's Guide to Assessing & Counseling Older Drivers, and an associated continuing medical education five-module curriculum offered formally by multidisciplinary teams from 12 U.S. States from 2003 to 2008. An hour-long, online version was piloted with medical residents and physicians (N = 259) from six academic and physician office sites from 2010 to 2011. Pre/postsurveys were completed. Most rated the curriculum of high quality and relevant to their practice. A majority (88%) reported learning a new technique or tool, and 89% stated an intention to incorporate new learning into their daily clinical practice. More than one half (62%) reported increased confidence in addressing driving. This transition from in-person to online instruction will allow the ODP to reach many more clinicians, at all levels of training, in the years to come.

A Qualitative Examination of a Reminiscence Intervention for Older Adults Using Three-Dimensional (3D) Printed Objects.

Reminiscence has been found to be an effective therapy for older adults and researchers and practitioners have identified a range of benefits, from cognitive stimulation to the reconciliation of past experiences. In this qualitative study, the authors explore the experiences of older adults engaged in a technology-enhanced form of reminiscence therapy (RT) using three-dimensional (3D) printed objects from peoples' past. Content analysis of individual interviews with seven participants (n = 7) revealed three themes: (1) positive experiences with the RT intervention; (2) reflections on the use of 3D printed objects; and (3) the development of relationships between participants and researchers. These findings suggest that RT using 3D printed objects can be effective, but only if objects are accurate and if it suits participants' personalities. Researchers and practitioners may find that the use of 3D printed objects can enhance their RT interventions and thereby enrich the lives of older adults.

Caregiver health: health of caregivers of Alzheimer's and other dementia patients.

Alzheimer's disease (AD) is the most common type of dementia and is a significant public health problem that will intensify as the population ages. The behavioral and psychological symptoms of dementia (BPSD) present a significant burden to patients, their families, and their caregivers. The majority of care is provided at home by family caregivers. Caring for a person with AD and other dementias is associated with significant risk to the caregiver's health and well-being. Healthcare providers must recognize that family caregivers often present as secondary patients. Given the importance of these caregivers to patients with AD and other dementias, it is vital to understand the risk factors that impact caregiver health and well-being. Non-pharmacological interventions can reduce the negative impact of caregiver burden on caregiver health, reduce premature institutionalization of patients, and improve quality of life for patients, their families, and their caregivers. This article summarizes recent relevant research concerning AD and dementia caregiver health and psychosocial interventions.

Addressing individual differences in mobility transition counseling with older adults.

In the final phase of a 3-phase project, the Assessment of Readiness for Mobility Transition (ARMT) was clinically validated, emphasizing assessment/intervention. ARMT and coping, health/vision status, and social support measures were administered to 133 community-dwelling older adults. Concurrent validity is supported. Higher readiness to cope with mobility transition and self-confidence related to fall risk, higher self-rated health/vision, and fewer maladaptive behaviors, but not social support/adaptive coping, suggesting that those at risk can benefit from person-centered intervention to mobilize strengths for transportation/mobility planning. Older drivers may harbor unrealistic expectations regarding nonfamily mobility support. Implications for practice, education, research, and policy are presented.

Falls across Health Care Settings: Findings from a Geriatric Screening Program.

Falls are a major public health problem for older adults, resulting in injuries and mortality. Screening is recommended to identify the multifactorial fall risks that can be addressed with interventions to prevent future falls. This study examined the utility of using the Rapid Geriatric Assessment (RGA) tool to identify fall risks across multiple settings. RGA data was collected at primary care sites, hospitals, long-term care settings, and community events (n = 8686, 65% female, mean age 77.6). Multinomial logistic regression was used to determine predictors of falls using the RGA. The FRAIL, SARC-F, Rapid Cognitive Screen and SNAQ measures all significantly predicted history of falls. The RGA provides a brief screening that can be used in any setting by multiple providers to identify fall risk.

Comparisons of Cognitive Stimulation Therapy Between Community Versus Hospital-Based Settings: A Multi-Site Study.

BACKGROUND: Non-pharmacological interventions such as Cognitive Stimulation Therapy (CST) have been shown to help persons living with dementia in improving cognitive function and recall. While previous CST interventions have been conducted largely with community populations, none have explored the outcomes of CST in larger healthcare settings. Our study explored differences of cognitive function, mood, and quality-of-life from CST groups both community and residential-based groups. METHOD: Participants (N = 258) from academic and rural, hospital-based settings in Missouri engaged in 14-session psychosocial groups to aid reminiscence for enhanced cognitive function and recall. RESULTS: Post-intervention cognitive function improvements occurred for community (t = -7.48, p < .001) and residential samples (t = -2.46, p < .05). Community groups showed significant improvement in overall mood related to their dementia (t = 6.37, p < .001). CONCLUSION: Healthcare providers should consider CST as a supplemental intervention for older patients receiving usual care for dementia-related symptoms.

Decoding the Miss Daisy Syndrome: an examination of subjective responses to mobility change.

The subjective responses associated with personal life space and mobility status were explored. Thirty individuals participated in focus groups based on self-rated disability status, current places visited, and availability. Qualitative analyses revealed that most participants equated personal mobility with driving a vehicle. Attitudes concerning mobility status and preparedness for change varied based on disability level and personal experience. Fear of dependence from future mobility loss was prominent in all groups. Few participants acknowledged significant planning for future retirement from driving or other mobility challenges. An understanding of common attitudes, perceptions and meanings can inform professionals who intervene and support older adults experiencing mobility changes.

An Age-Friendly Health System.

BACKGROUND/OBJECTIVES: To describe a screening and intervention program for geriatric syndromes instituted at a rural healthcare system that utilizes the 4Ms of an age-friendly health system, and to provide exercise and cognitive stimulation therapy (CST) as part of an age-friendly health program. DESIGN: Retrospective evaluation of clinical data. SETTING: Rural primary healthcare system. PARTICIPANTS: Older adults aged 65 years and older in Perry County, Missouri. MEASUREMENTS: Screening for geriatric syndromes was done using the Rapid Geriatric Assessment (RGA), which includes the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS). Outcomes for exercise and CST included the Five Times Sit to Stand (FTSS) and Timed Up and Go (TUG) tests, Cornell Scale for Depression in Dementia (CSDD), Saint Louis University Mental Status Examination (SLUMS), and Quality of Life in Alzheimer's Disease (QoL-AD) measures. RESULTS: The RGA was administered to 1,326 individuals of which 36.5% were frail, 42.1% were sarcopenic, 26.1% were at risk for anorexia, and 20.8% had dementia. Of these receiving exercise therapy, both the FTSS and the TUG were improved at 3 months and 12 to 24 months. In the CST group, SLUMS, QoL-AD, and CSDD were improved at 7 weeks and 6 to 12 months. CONCLUSION: It is feasible to introduce a screening program for geriatric syndromes and respond to the results with successful exercise and cognitive stimulation therapy programs.

Effects of Older Adult Driving Resumption on All-Cause Mortality.

OBJECTIVES: Driving cessation is associated with adverse social and health outcomes including increased mortality risk. Some former drivers resume driving. Do resumed drivers have a different mortality risk compared to former drivers or continued drivers? METHOD: We analyzed National Health and Aging Trends Study (2011-2015) data of community-dwelling self-responding ever drivers (n = 6,189) with weighted stratified life tables and discrete time logistic regression models to characterize mortality risk by driving status (continued, resumed, former), adjusting for relevant sociodemographic and health variables. RESULTS: Overall, 14% (n = 844) of participants died and 52% (n = 3,209) completed Round 5. Former drivers had the highest mortality (25%), followed by resumed (9%) and continued (6%) drivers. Former drivers had 2.4 times the adjusted odds of mortality compared with resumed drivers (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI] = 1.51, 3.83), with no difference between continued and resumed drivers (aOR = 1.22; 95% CI = 0.74, 1.99). DISCUSSION: Those who resumed driving had better survival than those who did not. Practice implications include driver rehabilitation and retraining to safely promote and prolong driving.

High prevalence of geriatric syndromes in older adults.

INTRODUCTION: The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, they are frequently under-recognized. At Saint Louis University, the Rapid Geriatric Assessment (RGA) was developed as a brief screening tool to identify these four geriatric syndromes. MATERIALS AND METHODS: From 2015-2019, the RGA, comprised of the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS) tools and a question on Advance Directives, was administered to 11,344 individuals ≥ 65 years of age across Missouri in community, office-based, hospital, Programs of All-Inclusive Care for the Elderly (PACE), and nursing home care settings. Standard statistical methods were used to calculate the prevalence of frailty, sarcopenia, weight loss, and dementia across the sample. RESULTS: Among the 11,344 individuals screened by the RGA, 41.0% and 30.4% met the screening criteria for pre-frailty and frailty respectively, 42.9% met the screening criteria for sarcopenia, 29.3% were anorectic and at risk for weight loss, and 28.1% screened positive for dementia. The prevalence of frailty, risk for weight loss, sarcopenia, and dementia increased with age and decreased when hospitalized patients and those in the PACE program or nursing home were excluded. CONCLUSIONS: Using the RGA as a valid screening tool, the prevalence of one or more of the geriatric syndromes of frailty, sarcopenia, weight loss, and dementia in older adults across all care continuums is quite high. Management approaches exist for each of these syndromes that can improve outcomes. It is suggested that the brief RGA screening tool be administered to persons 65 and older yearly as part of the Medicare Annual Wellness Visit.