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.

Outpatient health care utilization in a sample of cognitively impaired veterans receiving care in VHA geriatric evaluation and management clinics.

Within the Veterans Health Administration (VHA), Geriatric Evaluation And Management (GEM) clinics are designed specifically to address the needs of older veterans with complex age-related concerns, including dementia and comorbid medical and mental health conditions. Previous literature describes aging veterans as having greater health care needs compared with age-matched nonveteran samples, and multimorbidity is of particular concern in this population. Using data extracted from electronic medical records (EMRs), the present study describes the demographic characteristics, mental health diagnoses, and health care utilization of a sample of 476 VHA GEM patients with diagnosed cognitive impairment or dementia seen in clinics across Upstate New York. Examination of EMR data demonstrated that in addition to diagnosed cognitive impairment and dementia, over 66% of the sample had at least 1 additional mental health diagnosis coded during the study period. Many were prescribed dementia medications and/or other psychotropic medications, predominantly antidepressants. These veterans utilized a variety of outpatient services, including high rates of mental health consultation subsequent to GEM evaluation, though low rates of mental health follow-up were observed. Results from the current study provide insight into the important role mental health providers such as psychologists and psychiatrists can play as collaborators in interdisciplinary geriatrics care for veterans.

When rejection stings: how self-esteem constrains relationship-enhancement processes.

Three experiments examined how needs for acceptance might constrain low versus high self-esteem people's capacity to protect their relationships in the face of difficulties. The authors led participants to believe that their partner perceived a problem in their relationship. They then measured perceptions of the partner's acceptance, partner enhancement, and closeness. Low but not high self-esteem participants read too much into problems, seeing them as a sign that their partner's affections and commitment might be waning. They then derogated their partner and reduced closeness. Being less sensitive to rejection, however, high self-esteem participants affirmed their partner in the face of threat. Ironically, chronic needs for acceptance may result in low self-esteem people seeing signs of rejection where none exist, needlessly weakening attachments.