Medical Cannabis Use: Exploring the Perceptions and Experiences of Older Adults with Chronic Conditions.

Objectives: Although the rate of cannabis use by older adults is increasing more quickly than all other age groups, little is known about the reasons older adults use cannabis and the outcomes they experience. With this research, we investigated older adults' perceptions and experiences of medical cannabis use to treat and/or manage chronic conditions, specifically as a substitute for prescription drugs. Methods: Researchers relied on qualitative inquiry in the form of semi-structured, one-on-one interviewing to investigate the phenomenon of medical cannabis use for the management of chronic conditions. Results: Our findings suggest that older adults are open to medical cannabis as an alternative to pharmaceutical drugs, hopeful with regard to the management of symptoms and pain, and aware of and astute at managing issues related to stigma both from their physicians and family and friends. Furthermore, older adults describe the frustrations with education, awareness, and lack of support with dosing. Conclusions: Participations found medical cannabis use to be beneficial in managing chronic conditions and alleviating symptoms such as chronic pain. Findings are presented as an interpretation of the participants' perceptions of their medical cannabis use. Implications for putting medical cannabis use into everyday practice as well as policy implications are considered. Clinical Implications: This information will help clinicians better support older adults desiring to use medical cannabis. This research will help clinicians learn more about factors impacting medical cannabis use, and the types of information and assistance that may aid older adults in their health and well-being with the use of medical cannabis to treat chronic conditions.

Encounters with adversity: A framework for understanding resilience in later life.

Background and objectives: We explore the internal and external resources that older adults use to negotiate adversity and related to later life. We investigated the experiences older adults had with adversity and explored the factors that promote and protect resilience and the how these factors shaped the process of managing adversity related to aging.Research design and methods: Semi-structured interviews were conducted with 64 resilient adults ranging in age from 53 to 94 years of age, with an average of 71. Participants were defined as resilient on the basis of their willingness to identify as such. Grounded Theory coding techniques were applied to identify themes reflecting distinct ways in which participants dealt with what they indicated were the most significant hardships and adversities in their lives.Results: What emerged from the narratives about resilience and adversity were accounts of expressions of resilience that reflected the importance in having a resilient identity. Three major themes reflecting psychological and behavioral factors were derived from the data: 1. having vital components of resilience, or behaviors and beliefs in place, that encompass resilience as a way of being; 2. a broad but articulate set of strategies that participants actively engaged with to manage adversity, and 3. a set of protective practices used to prevent risk and prevail in the face of hardship.Discussion and implications: Findings suggest that dealing with adversity in later life requires the use of substantial internal and external resources in what can characterized as a proactive fashion. The results are presented as an interpretation of the participants' perceptions of their resilience and the role it plays in self-concept, strategic planning, and proactive practices. Implications for helping to put resilience into everyday practice are considered.

Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: Practical Applications and Clinical Impact.

IMPORTANCE: Opioid use disorder is increasingly common in the United States and affects many pregnancies. Given the rise in pregnancies complicated by opioid use, providers should understand the diagnosis and management of opioid use disorder in pregnancy. OBJECTIVE: This article focuses on screening for opioid misuse, selecting appropriate treatment for patients, initiating medication-assisted treatment in the inpatient setting, and providing appropriate peripartum care. EVIDENCE ACQUISITION: A PubMed search was undertaken using the following search terms: "opioid use disorder", "pregnancy," "medication assisted treatment," "buprenorphine," "methadone," "heroin," "addiction," "neonatal abstinence syndrome," and "detoxification." The search was limited to the English language publications, with most being published after 2000. RESULTS: All women should be screened for opioid use disorder during pregnancy. Opioid use has profound effects on the mother and infant. Medication-assisted treatment is the standard of care for pregnant women with opioid use disorder. Patients will require a multidisciplinary approach to management in the intrapartum and postpartum period. CONCLUSIONS: Opioid use disorder is a common, chronic condition with significant implications during pregnancy. Recognition and appropriate treatment of this disorder can optimize maternal and fetal outcomes. CONCLUSIONS: Obstetricians are increasingly being challenged to manage pregnancies complicated by opioid use disorder and should be proficient in providing safe and effective care.

Spiritual resilience: Understanding the protection and promotion of well-being in the later life.

Spirituality is important to a large percentage of the older adult population and serves as a key factor of resilience. Using qualitative research, we conducted and analyzed interviews with 64 participants willing to discuss their experiences with adversity; ranged in age from 52 to 93 with a mean age of 74. For the purposes of this study, we analyzed 46 of the 64 interviews selecting participants who indicated that spirituality was an important resource for managing hardship. The researchers examined the connections between spirituality and resilience. Using in-depth interviews, we explored the interplay between spirituality and resilience and the importance spirituality plays in dealing with adversity and hardship. A grounded theory analysis of the 46 interviews was performed. Major findings include participants' use of spirituality as a tool to promote and maintain resilience in late life in five key domains: reliance on relationships, spiritual transformation, spiritual coping, power of belief, and commitment to spiritual values and practices. Results are presented as an interpretation of the participants' perceptions of their spirituality, and indicate their reliance on spirituality to overcome hardship. In addition, we discuss the connections between spirituality and resilience and how these connections play out in the lives of older adults when considering their generational and cohort status. The roles these two constructs play in the lives of older adults are considered.

Who self-identifies as disabled? An examination of impairment and contextual predictors.

PURPOSE/OBJECTIVE: According to Social Identity Theory, minority group members, like people with disabilities, manage stigma by either "passing" as majority group members or identifying with their minority group. Approximately 15% of the world's population has a disability, but only a fraction of those individuals identify themselves as people with disabilities. Disability identification has been associated with positive outcomes including psychosocial well-being, self-advocacy, and political engagement. The International Classification of Functioning (ICF) recognizes that "disability" is constructed through the intersection of impairment and context (i.e., personal and environmental factors). This is the first study to examine ICF impairment factors (duration, noticeability, presence congenital impairment, pain, severity, and total number of impairments), personal factors (age, ethnicity, gender, income, and psychological distress), and environmental factors (social support and stigma) that predict disability self-identification. Research Method/Design: Participants living in the United States completed an online survey measuring the factors listed above. To avoid selection bias, disability was not mentioned in recruitment materials. Those who reported at least 1 impairment (n = 710) were retained for analysis. RESULTS: Supporting the ICF proposition that disability results from a combination of impairment and contextual factors, disability identification was predicted by severity, age, income, and stigma. Stigma partially mediated the relationship between severity and identification. CONCLUSIONS/IMPLICATIONS: Stigma and severity were the strongest predictors of disability identification. Future work should examine ways to foster positive disability identity such as cross-impairment connections through support groups, mentoring, and collective action against stigma. (PsycINFO Database Record