Nurses' Intentions to Initiate an Antipsychotic or Behavioral Intervention with Nursing Home Residents: The Role of Norms and Being Evaluated.

OBJECTIVES: To examine whether exposure to a message to avoid antipsychotic medications and a salient sense of managerial oversight influenced nurses' treatment intentions. METHODS: 158 nurses from 28 long-term care facilities were randomized to one of four conditions within a 2 × 2 between-participants design. The nurses responded to a case study depicting a resident with dementia-related behavioral problems with their intent to initiate an antipsychotic or a psychosocial intervention. Self-efficacy, descriptive norms, and attitudes were measured via self-report. RESULTS: Perceived local antipsychotic prevalence was related to the nurses' treatment intentions. There were no main or interactive effects of the avoid antipsychotic or manager oversight conditions on the nurses' treatment intentions. However, there was a significant interaction of actual facility antipsychotic prevalence and the avoid antipsychotics message on intentions to initiate an antipsychotic. CONCLUSIONS: Nurses' perceptions of local antipsychotic prevalence were positively associated with intentions to initiate an antipsychotic and negatively associated with intentions to initiate a psychosocial intervention. However, a salient message to avoid antipsychotics had limited influence on nurses' treatment intentions and was associated with increased intentions to initiate antipsychotics in facilities with higher rates of antipsychotic use. The oversight condition did not demonstrate adequate internal validity, which may have caused its lack of effect on treatment intentions. CLINICAL IMPLICATIONS: Nurses' perceptions of the local prevalence of antipsychotic use is associated with their treatment intentions. However, increasing the visibility of a message discouraging antipsychotic use may have limited utility in influencing nurses' intentions to initiate an antipsychotic or psychosocial intervention.

Psychological factors related to nurses' intentions to initiate an antipsychotic or psychosocial intervention with nursing home residents.

This study examined the validity of a psychological model for understanding nursing home providers' treatment choices when managing challenging dementia-related behaviors. Ninety-nine nurses from 26 long-term care facilities responded to a case study with their intentions to initiate an antipsychotic or psychosocial intervention and completed self-report measures of their attitudes, descriptive norms, self-efficacy, and outcome expectancies. The multi-level modeling results demonstrated that nurses with more positive outcome expectancies for the effect of an antipsychotic on resident behavior, and those with more positive attitudes towards antipsychotics, had greater intentions to initiate an antipsychotic. Intentions to initiate a psychosocial intervention were greater when nurses perceived a lower prevalence of antipsychotics and in facilities with nurses who collectively had higher self-efficacy to implement such interventions. The findings offer partial support for the proposed model and possible intervention targets to improve psychosocial intervention use and antipsychotic prescribing.

Program Evaluation of Group-based Cognitive Behavioral Therapy for Insomnia: a Focus on Treatment Adherence and Outcomes in Older Adults with Co-morbidities.

OBJECTIVE: To describe a program evaluation of the interrelationship of adherence and treatment outcomes in a sample of veteran older adults with co-morbidities who participated in group-based cognitive behavioral therapy for insomnia. METHODS: Retrospective data extraction was performed for 14 older adults. Adherence measures and sleep outcomes were measured with sleep diaries and Insomnia Severity Index. Demographic and clinical information was extracted through chart review. RESULTS: Adherence with prescribed time in bed, daily sleep diaries, and maintaining consistent time out of bed and time in bed was generally high. There were moderate, though not significant, improvements in consistency of time in bed and time out of bed over time. Adherence was not significantly associated with sleep outcomes despite improvements in most sleep outcomes. CONCLUSIONS: The non-significant relationship between sleep outcomes and adherence may reflect the moderating influence of co-morbidities or may suggest a threshold effect beyond which stricter adherence has a limited impact on outcomes. CLINICAL IMPLICATIONS: Development of multi-method adherence measures across all treatment components will be important to understand the influence of adherence on treatment outcomes as monitoring adherence to time in bed and time out of bed had limited utility for understanding treatment outcomes in our sample.

The BE-ACTIV Project: How Research, Professional Training, Education, and Practice Were Integrated in a Single Clinical Trial.

This article describes how research, practice, and education were integrated in a National Institutes of Mental Health-funded clinical trial for treating depression in nursing homes. Involving undergraduate and doctoral students in this clinical trial supported the development of key competencies, expanded the professional pipeline, and provided an avenue for disseminating the treatment to other settings. The clinical trial served as a teaching laboratory for sixteen undergraduate and six doctoral students to (1) observe the culture of older adults in nursing homes, (2) develop and adapt clinical skills to a challenging patient population, (3) refine skills for collaborating in multidisciplinary teams, and (4) appreciate the relationship between science and practice. Dissemination of the intervention to nonresearch settings was served when the students took their skills to the settings where they launched their careers. Involvement of trainees in clinical trial research expands and enriches the capacity of the health care workforce in evidence-based practice and practice-informed research.

Addressing Behavioral Symptoms of Dementia Through STAR-VA Implementation: Do Outcomes Vary by Behavior Type?

OBJECTIVES: The STAR-VA program in Veterans Health Administration Community Living Centers (CLCs, nursing home settings) trains teams to implement a psychosocial intervention with residents with behavioral symptoms of dementia (BSD). METHODS: Across 71 CLCs, 302 residents selected as training cases had target behaviors categorized into one of 5 types: physically aggressive (PA), physically nonaggressive, verbally aggressive, verbally nonaggressive, and behavior deficit (BD). RESULTS: Across all groups, there were significant declines in team-rated behavior frequency (36%) and severity (44%), agitation (10%), distress behaviors (42%), depression (17%), and anxiety (20%). The magnitude of changes varied across behavior category. For example, those with a PA target behavior experienced a greater percentage decline in agitation and distress behavior scores, and those with a BD target behavior experienced a greater percentage decline in depressive and anxiety symptoms. CONCLUSIONS: STAR-VA, a multicomponent intervention, is generally effective across various types of behavioral symptoms associated with dementia.

A Workshop for Interprofessional Trainees Using the Geriatrics 5Ms Framework.

BACKGROUND/OBJECTIVES: Interprofessional trainees need geriatrics training to prepare them to care for our aging population. Team-based care will help them be ready to work in an Age-Friendly Health System. The Geriatrics 5Ms provides a framework to engage learners in five main domains of caring for older adults from an interprofessional perspective: Mobility, Mind, Medications, Multicomplexity, and what Matters Most. DESIGN: We created a half-day workshop for interprofessional trainees using the Geriatric 5Ms framework to increase their preparedness in caring for older adults as part of an interprofessional team. SETTING: The New England Geriatric Research Education and Clinical Center. PARTICIPANTS: A total of 66 trainees from 10 professions. INTERVENTION: After introductory sessions on careers in aging, participants engaged in an interactive session to learn about the professions represented. They then formed interprofessional groups to discuss a patient case using the Geriatrics 5Ms framework with a modified jigsaw format. MEASUREMENTS: Trainees were surveyed before and after the workshop on their attitudes toward careers in aging, understanding of skills and training paths of other professions, and familiarity with the Geriatrics 5Ms framework. RESULTS: Overall, 97% of the trainees rated the workshop highly. Trainee ratings significantly increased in the areas of understanding of other professions, and familiarity and applicability of the Geriatrics 5Ms, particularly for nonphysicians. CONCLUSION: A workshop for interprofessional trainees using the Geriatrics 5Ms framework increased the readiness of trainees to care for older adults as part of an interprofessional team. This workshop offers a promising model for needed interprofessional geriatrics education. J Am Geriatr Soc 68:1857-1863, 2020.

Falls as Adverse Events in Psychosocial Treatment of Depression: Findings from a Clinical Trial in Nursing Homes.

Falls pose a significant health risk for nursing home residents and are associated with depression and medical treatments for depression. Data on falls as an adverse event to psychosocial treatments are lacking. We examined risk of falls as an adverse event in a clinical trial of a behavioral treatment for depression. Participants were 82 depressed nursing home residents. Adverse events were recorded at each research contact. We used the rate ratio based on the respective incidence densities in the treatment and control groups to measure association between fall rate and treatment. The treatment group had almost six times higher risk of falls than the control group, a statistically significant association. Findings suggest that it may be of value to include statistical analysis of falls as adverse events in trials of behavioral interventions for depression.