Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia.

OBJECTIVES: Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period. METHODS: Qualitative directed content analysis of retrospective EMR data. RESULTS: Assessment of known risk factors or subjective concerns for unsafe driving were documented in fewer than half of observed cases; specific recommendations for driving safety were evident for a minority of patients, with formal driving evaluation the most frequently documented recommendation by providers. CONCLUSION: Utilizing data from actual clinical encounters provides a unique snapshot of how driving risk and safety concerns are addressed for veterans with dementia. This information provides a meaningful frame of reference for understanding potential strengths and possible gaps in how this important topic area is being addressed in the course of clinical care. CLINICAL IMPLICATIONS: The EMR is an important forum for interprofessional communication, with documentation of driving risk and safety concerns an essential element for continuity of care and ensuring consistency of information delivered to patients and caregivers.

An MDS 3.0 Distressed Behavior in Dementia Indicator (DBDI): A Clinical Tool to Capture Change.

BACKGROUND/OBJECTIVES: Persons with dementia frequently demonstrate distress behaviors in dementia (DBD), associated with poorer outcomes. This study aimed to create a measure of DBD from routinely administered Minimum Data Set (MDS 3.0) behavior section items that demonstrated sensitivity to change, for evaluation of intervention efforts for VA Community Living Center (CLCs) residents exhibiting DBD. SETTING: 72 VA nursing home settings, or Community Living Centers (CLCs). PARTICIPANTS: CLC residents with DBD (n = 302) were enrolled in an interdisciplinary behavioral intervention between 2013 and 2017. DESIGN: A factor analysis of MDS behavior section items from assessments closest to baseline was conducted. Internal consistency, hypothesized associations between MDS factors and clinical measures, and sensitivity to detect change over time was explored. MEASUREMENTS: Residents were assessed at baseline and post-intervention using the MDS behavior section items and a validated clinical measure of DBD. RESULTS: The Distress Behavior in Dementia Indicator (DBDI) was created as a consistent factor with internal consistency, and was related to a validated measure as predicted at baseline and post-intervention. Sensitivity to change was demonstrated by using change score correlations (r = 0.40-0.50), effect size (d = 0.63), and reliable change indices. CONCLUSION: The DBDI is recommended for routine use in CLCs to evaluate impact of intervention effectiveness and provide quality improvement feedback.

Predictors of Mental Health Care Utilization in Veterans With Post-Traumatic Stress Disorder Symptoms and Hazardous Drinking.

OBJECTIVES: Describe outpatient mental health service use in a sample of recent combat Veterans with post-traumatic stress disorder (PTSD) symptoms and hazardous alcohol use and investigate predictors of mental health care utilization. METHODS: In this prospective study, 126 Veterans with full or subthreshold PTSD and hazardous alcohol use completed a baseline assessment and reported mental health service use through a 12-month follow-up period. Logistic regressions were used to identify factors predicting mental health care utilization. RESULTS: Veterans who were employed were 63% less likely to use outpatient mental health care in the 12 months following baseline. Additionally, for each 1-point increase in negative mental health care beliefs, participants were 70% less likely to use outpatient mental health care. For each 1-point worsening in social support and leisure functioning, participants were 2.2 times more likely to use outpatient mental health care. CONCLUSIONS: The current study indicates that negative mental health beliefs are barriers to mental health care while unemployment and poor social support/leisure functioning are predictors of mental health care utilization for recent combat Veterans with PTSD symptoms and hazardous alcohol use. Patient and system level interventions for these factors are discussed to guide efforts to improve mental health care among this high-need population.