Stress, strength, and respect: Viewing direct care staff experiences through a trauma-informed lens.

Trauma-informed approaches may promote the well-being of CNAs and disrupt organizational practices that perpetuate inequities. There is a dearth of literature addressing evidence-based, trauma-informed training for direct care staff, yet CMS now requires trauma-informed care in nursing homes. Five focus groups exploring trauma and resilience-related concepts were conducted using an expressive-collaborative model with 18 CNAs at four nursing homes. A thematic analysis was conducted and themes were identified related to identity, relationships with residents, organizational values, and personal wellness. CNAs voiced frustration at limited time and support to implement well-being or stress management practices. Relationships with residents were sources of strength and, conversely, sources of emotional injury due to disrespect, disregard, and hostile behavior directed at CNAs. Central to health and well-being, CNAs called for change within facility cultures experienced as disrespectful, inequitable, and contrary to work-life balance. Trauma-informed training can be used to give particular attention to direct care staff. Administrators would benefit from learning about trauma and resilience among CNAs and precipitating organizational factors such as reasonable care ratios, equitable benefits, and peer support that impact CNA well-being, job satisfaction, and quality of care. The development and implementation of a trauma-informed training curriculum for CNAs are warranted.

Over-the-counter medication use in residents of senior living communities: A survey study.

BACKGROUND: Self-medication with over-the-counter (OTC) products is common among older adults. Although OTC self-medication is a convenient way to manage some health issues, older persons may be at higher risk of experiencing medication-related problems. This study examines the prevalence, practices, and preferences associated with OTC medication use in older adult residents of senior living communities. OBJECTIVES: The study aimed to examine the characteristics of OTC medication users and to quantify the prevalence, attitudes, perceptions, preferences, and practices regarding OTC medication use and decision-making in 2 senior living communities in central Virginia. METHODS: The study used survey methodology. A 51-item semistructured questionnaire was designed by the research team of geriatrics specialists, and mixed-methods and evaluation researchers. The questionnaire was administered in-person to participants (N = 88). Descriptive analyses were conducted using SAS 9.4. Characteristics of those using OTC medications as directed by a health professional were compared with those of whom were self-medicating with OTC medications. RESULTS: Most of the sample were women (55%), black (61%) and had less than or equal to a high school education (55%). Analgesics were the most (76%) prevalent OTC therapeutic category used, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of respondents reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician recommended use (18%). A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most (80%) considered OTC medications safe and effective. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source for OTC medications. CONCLUSION: Considering the high percentage of self-reported self-medication, inappropriate use, and experiences of adverse effects, steps should be taken to develop consumer education and relationships with pharmacists to encourage the responsible use of OTC medications in this population.

A qualitative study to understand over-the-counter medication use and decision-making among residents of senior-living communities.

INTRODUCTION: OTC medications are generally considered safe and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers' perceptions, beliefs, and their decision-making about OTC medication use. This study uses a qualitative approach to explore the knowledge, beliefs, and practices associated with OTC medication use and decision-making in adults aged 65 years and older. METHODS: A set of focus groups (N = 10) were conducted in a sample of independently living older adult residents of senior apartment buildings (N = 80) using purposeful sampling. All focus groups were recorded, transcribed verbatim, and analyzed qualitatively. RESULTS: Most participants considered OTC medications safe and effective to use if following the drug label instructions appropriately. Brand name products were perceived as equally or more effective compared to generic products by participants. Two approaches to OTC treatment decision-making were observed: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow their physician's recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person's financial and healthcare resources, the severity of the symptoms, experiences with the medication, and relationship with the physician. Maximum and fast relief was mentioned as the most important attribute in the final OTC purchase decision, followed by the lower cost, and easy to swallow dosage forms. Aspirin and ibuprofen were the two most frequently reported OTC medications associated with adverse effects and inappropriate use. CONCLUSIONS: Older adults, in general, feel positive about OTC medications and are satisfied with using them. Considering the self-reported malpractices and side effects associated with OTC medications, older adults should be encouraged to make safe and responsible decisions about self-medication.

"How Old Do You Feel?" The Difficulties and Ethics of Operationalizing Subjective Age.

This article provides an integrative presentation regarding ageism within the professional culture of gerontological research by examining the operationalization of subjective age, a construct most commonly assessed by asking an individual to report how "old" they feel. According to the life span perspective [Baltes, P. B. (1987). Theoretical propositions of lifespan developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23, 611-626] and the life course perspective [Elder Jr, G. H. (1975). Age differentiation and the life course. Annual Review of Sociology, 1(1), 165-190.], growing older represents a complex, multidirectional process that encompasses maintenance, growth and decline as well as cultural factors that influence development. Viewing the construct of subjective age from these perspectives casts doubt on the validity of its operationalization. This article argues that operationalizing subjective age in this manner contributes to the dominant societal view of aging as decline by perpetuating the use of the term "old" as an undesirable state. As well, we purport that as gerontological researchers and scholars our professional code of ethics requires us to examine the unintentional communication and perpetuation of ageism by focusing attention on our own use of language.

A Theory of Relational Ageism: A Discourse Analysis of the 2015 White House Conference on Aging.

PURPOSE: The widespread use of ageist language is generally accepted as commonplace and routine in most cultures and settings. In order to disrupt ageism, we must examine the use of ageist language and sentiments among those on the front line of providing advocacy, services, and policy for older adults; the professional culture of the aging services network. The recorded video segments from the sixth White House Conference on Aging (WHCOA) provided a unique opportunity to examine discourse used by professionals and appointed representatives in the field of aging within a professional sociocultural context. DESIGN AND METHODS: A qualitative discourse analysis of video recordings was used to analyze the 15 video fragments that comprised the recorded sessions of the 2015 WHCOA. RESULTS: About 26 instances were identified that captured statements expressing personal age, aging or an age-related characteristic negatively in regard to self or other (microageism), and/or statements expressing global negative opinions or beliefs about aging and older adults based on group membership (macroageism). A theoretical pathway was established that represents the dynamic process by which ageist statements were expressed and reinforced (relational ageism). IMPLICATIONS: Numerous instances of ageism were readily identified as part of a live streamed and publically accessible professional conference attended and presented by representatives of the aging services network. To make meaningful gains in the movement to disrupt ageism and promote optimal aging for all individuals, we must raise awareness of the relational nature, expression, and perpetuation of ageism.

Lessons Learned From a Program Evaluation of a Statewide Continuing Education Program for Staff Members Working in Assisted Living and Adult Day Care Centers in Virginia.

The number of older adults residing in assisted living facilities (ALF) and utilizing adult day care services is expanding with the increasing population of older adults. Currently, there are no standardized requirements for continuing education for assisted living and adult day care service staff at a national level. Given that 62% of states within the United States require continuing education for ALF staff and/or administrators, a more formalized system is needed that provides evidence-based gerontological training to enhance the quality of care and services provided to older adults. This article describes the challenges and lessons learned from conducting a program evaluation of a Statewide Training and Continuing Education Program for Assisted Living Facility and Adult Day Care Service staff in Virginia. Survey evaluation data from a 6-year period was examined and a formative program evaluation was conducted. The findings from the survey evaluation and formative evaluation are discussed as are the lessons learned.

The Thin-Youth Ideal: Should We Talk About Aging Anxiety in Relation to Body Image?

College students' attitudes about the pervasive thin ideal have been well-studied, but the relationship between the thin ideal and youth ideal in young adults forming life-long health attitudes is understudied. This cross-sectional study examined body image, aging anxiety, ageism, and gender in a sample of 485 undergraduate students. Results from this study demonstrate associations among components of objectified body consciousness (surveillance, shame, and control), body image avoidance, aging anxiety (fear of older people, psychological concerns, physical appearance, and fear of losses), ageism, and gender. Educational efforts that address body image in relation to aging anxiety and ageism are discussed.

Catch a Glimpse of Me: The development of staff videos to promote person-centered care.

Catch a Glimpse of Me is an ongoing project that uses video to help staff deliver more person-centered care for people with dementia living in long-term care. Focus groups consisting of residents, family and staff members were conducted to develop a template for the development of the videos. The five themes they identified as being important to include are: family; interests and hobbies; memories and moments; life space and getting personal. The article describes the process of developing the videos and discusses the ongoing potential of the Catch a Glimpse of Me project.

The Language of Ageism: Why We Need to Use Words Carefully.

PURPOSE: Language carries and conveys meaning which feeds assumptions and judgments that can lead to the development of stereotypes and discrimination. As a result, this study closely examined the specific language that is used to communicate attitudes and perceptions of aging and older adults. DESIGN AND METHODS: We conducted a qualitative study of a twitter assignment for 236 students participating in a senior mentoring program. Three hundred fifty-four tweets were qualitatively analyzed to explore language-based age discrimination using a thematic analytic approach. RESULTS: Twelve percent of the tweets (n = 43) were found to contain discriminatory language. Thematic analysis of the biased tweets identified 8 broad themes describing language-based age discrimination: assumptions and judgments, older people as different, uncharacteristic characteristics, old as negative, young as positive, infantilization, internalized ageism, and internalized microaggression. IMPLICATIONS: The language of ageism is rooted in both explicit actions and implicit attitudes which make it highly complex and difficult to identify. Continued examination of linguistic encoding is needed in order to recognize and rectify language-based age discrimination.

Promoting the development of professional identity of gerontologists: an academic/experiential learning model.

Graduate education in gerontology has an essential role in providing the foundational knowledge required to work with a diverse aging population. It can also play an essential role in promoting best-practice approaches for the development of professional identity as a gerontologist. The primary goal of this study was to determine what factors predict the professional identity and career path of gerontologists. In addition, the study explored how experiential learning influenced professional identity for newcomers to the field and for those experienced in an aging-related field ("professional incumbents"). Graduates (N = 146) of Association for Gerontology in Higher Education-affiliated graduate programs participated. Professional identity as a gerontologist was predicted by length of time in the field, age, satisfaction with coworkers, and satisfaction with opportunities for advancement. Experiential learning contributed to professional identity in important but different ways for newcomers to the field and for professional incumbents. The inclusion of an academic/experiential learning model within graduate gerontology programs promotes the development of professional identity and career path for all graduate students.