RESUMO
Older veterans are vastly underrepresented in studies that shape national suicide prevention strategies. This is of great concern because factors that impact younger veterans may not be as robust in later life. Although younger veterans have higher rate of suicide, the highest counts of death by suicide are in older veterans. However, it remains unclear from the extant literature what factors may influence increased or decreased risk of late-life suicide in veterans. The objective of this systematic review was to identify risk and protective factors related to suicide outcomes (i.e., ideation, attempt, death, or suicide-related behavior [SRB]) among older veterans. Furthermore, it offers data regarding future study directions and hypothesis generation for late-life suicide research and for informing potential intervention and prevention efforts in this area. We searched 4 databases from inception up to May 5, 2022. We screened 2,388 abstracts for inclusion and 508 articles required full text review. The final sample included 19 studies published between 2006 and 2022. We found five domains of factors studied (i.e., neuropsychiatric, social determinants of health, aging stereotypes, residential and supportive housing settings, and multifactorial-neuropsychiatric/mental health and physical health) with more risk factors than protective factors reported. Across the three suicide outcomes only neuropsychiatric factors were consistently identified as risk factors. Neuropsychiatric factors also comprised the largest group of risk factors studied. More innovative targets to consider for intervention and more innovative methods to predict suicide in late-life are needed. There is also continued necessity to design suicide prevention interventions for older veterans given lethality trends.
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Suicídio , Veteranos , Humanos , Idoso , Veteranos/psicologia , Ideação Suicida , Prevenção do Suicídio , Fatores de RiscoRESUMO
OBJECTIVES: There are no evidence-based interventions for reducing loneliness in family caregivers of people with dementia (ADRD caregivers), despite heightened risk. We examined feasibility, acceptability, and potential efficacy of a brief behavioral intervention, Engage Coaching for Caregivers, to reduce loneliness and increase social connection for older ADRD caregivers experiencing stress and loneliness. METHODS: A single-arm clinical trial of 8 individual sessions of Engage Coaching delivered remotely. Outcomes assessed 3-months post-intervention included loneliness and relationship satisfaction (co-primary) and perceived social isolation (secondary). RESULTS: Engage Coaching was feasible to deliver, with n = 25 of 30 enrolled completing at least 80% of sessions. 83% indicated the program met expectations and 100% reported the program was suitable and convenient. Improvements were observed in loneliness (standardized response mean [SRM] = 0.63), relationship satisfaction (SRM = 0.56), and perceived social isolation (SRM = 0.70). CONCLUSION: Engage Coaching is a promising behavioral intervention to enhance social connection for older ADRD caregivers.
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Demência , Tutoria , Humanos , Cuidadores , Solidão , Projetos PilotoRESUMO
OBJECTIVES: We describe two robotic pet demonstration projects during the COVID-19 pandemic. METHODS: Key project components are stakeholders (settings), inputs (activities), and outputs (interest in programs and participant benefit). RESULTS: Stakeholders are an aging services organization in western NY (Lifespan) which served community-dwelling older adults, and a Veteran's Dementia Care Neighborhood (nursing home) that served 14 older Veterans. Project activities: both sites used commercially available robotic pets, with setting-specific deployment procedures. Outputs: 289 pets were distributed by Lifespan; nine Veterans selected pets and four engaged more actively. Community-dwelling older adults reported high satisfaction; satisfaction with the program in Veterans is evidenced by ongoing engagement via staff observation. CONCLUSIONS: Procedures used by our programs may be useful for agencies and care programs interested in implementing robotic pet programs for community-dwelling older adults and those residing in long-term care. CLINICAL IMPLICATIONS: Robotic pets were sought by individuals and care providers in community and long-term care settings to provide companionship for older adults during the COVID-19 pandemic and may be of benefit to older adults.
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COVID-19 , Procedimentos Cirúrgicos Robóticos , Idoso , Humanos , Vida Independente , Pandemias , SARS-CoV-2RESUMO
Older age and medical comorbidity are factors associated with more severe illness and risk of death due to COVID-19 infection. Social distancing is an important public health strategy for controlling the spread of the virus and minimizing its impact on the older adult population. It comes at a cost, however. Loneliness is associated with myriad adverse health outcomes, one of which is impaired immune functioning, which adds even greater risk for coronavirus infection, complications and death. Older adults, therefore, are at compound risk, making effective management of loneliness and social isolation in our older patients a high priority target for preventive intervention. In this paper, the authors describe a cognitive-behavioral framework for social connectedness, including evidence-informed strategies clinicians can use to help patients develop a "Connections Plan" to stay connected and promote their social, mental, and physical health during "social distancing" restrictions. This set of strategies can be provided during brief (30 minute) telephone sessions and is analogous to creating a "Safety Plan" for suicide risk. The approach is illustrated with three case examples.
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COVID-19/psicologia , Solidão/psicologia , Isolamento Social/psicologia , Idoso , Ansiedade/etiologia , Ansiedade/terapia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Depressão/etiologia , Depressão/terapia , Feminino , Humanos , Masculino , Distanciamento Físico , Psicoterapia , SARS-CoV-2RESUMO
Objectives: Suicide Awareness for Veterans Exiting Community Living Centers (SAVE-CLC) is a brief intervention to standardize suicide-risk screening and clinical follow-up after VA nursing home discharge. This paper examines the outcomes of SAVE-CLC compared to care as usual.Methods: A quasi-experimental evaluation was conducted (N = 124) with SAVE-CLC patients (n = 62) matched 1:1 to a pre-implementation comparison group. Data were obtained through VA Corporate Data Warehouse resources and chart reviews. Outcomes examined (within 30/90 days of discharge) included mortality rates, frequency of outpatient mental health visits, emergency department visits, rehospitalizations, depression screens (PHQ-2), and the latency period for outpatient mental health care.Results: A greater portion of SAVE-CLC patients received a depression screen after discharge, n = 42, 67.7% versus n = 8, 12.9%, OR = 14.2 (5.7, 35.3), p < .001. The number of days between discharge and first mental health visit was also substantially shorter for SAVE-CLC patients, M = 8.9, SD = 8.2 versus M = 17.6, SD = 9.1; t = 2.47 (122), p = .02. Significant differences were not observed in emergency department visits, hospitalizations, or mortality.Conclusions: SAVE-CLC is a time-limited intervention for detecting risk and speeding engagement in mental health care in the immediate high-risk post-discharge period.Clinical Implications: Care transitions present an important opportunity for addressing older adults' suicide risk; brief telephone-based interventions like SAVE-CLC may provide needed support to individuals returning home.
Assuntos
Alta do Paciente , Prevenção do Suicídio , Assistência ao Convalescente , Idoso , Seguimentos , Humanos , Casas de SaúdeRESUMO
OBJECTIVES: The goal of this study was to examine psychosocial adjustment following transition from the nursing home (NH) to community and understand the ways in which adjustment intersects with social connection. METHODS: We conducted interviews with community-dwelling older male Veterans after they were discharged from an NH. Interviews focused on Veterans' experience during the transition process. We utilized conventional content analysis to inductively code the interviews. We reviewed evidence in each identified domain for common themes. RESULTS: We interviewed 13 NH residents after recent transitions from the NH back to the community. Four themes were identified: (1) access to and quality of social support network are important for social connection, (2) engagement in meaningful activities with family and friends improves well-being, (3) service providers form link to social connection, and (4) external stressors affect the quality of social connections. CONCLUSIONS: Identified themes aligned with respondents' social connectedness and perceived psychosocial and physical well-being. Our results suggest that social connectedness is one part of the larger milieu of healthy aging including the importance of engagement with social opportunities and having a purpose. CLINICAL IMPLICATIONS: Social connectedness is critical to assess for older adults transitioning between care settings. Developing screening tools and other interventions focused on social isolation are needed.
Assuntos
Veteranos , Idoso , Humanos , Vida Independente , Masculino , Casas de Saúde , Isolamento Social , Apoio SocialRESUMO
OBJECTIVES: Fear of falling (FoF) is common and associated with poorer functional outcomes after hip fracture. We sought to differentiate patterns of FoF at 4 and 12 weeks after surgical repair for hip fracture and examine predictors of FoF. METHODS/DESIGN: Secondary analysis of existing data from a 52-week prospective study examining recovery after hip fracture. Participants (N = 263) were aged 60 and older with recent hip fracture recruited from eight hospitals. FoF was measured 4 and 12 weeks postfracture with the Short Falls Efficacy Scale-International. Latent class mixed models were constructed to identify distinct patterns of FoF from 4 to 12 weeks postfracture and predictors of FoF. Predictors examined included age, gender, neuroticism, depression, negative affect, perceived social support, medical comorbidity, functional ability, cognition, and pain. RESULTS: Three latent classes of FoF were identified: a group with minimal FoF at weeks 4 and 12 (72%), a group with high FoF that decreased (17%), and a group with high FoF that increased from week 4 to 12 (11%). In a multivariate model, higher neuroticism was associated with greater risk for high FoF (increasing or decreasing), whereas higher premorbid medical comorbidity was associated with increasing FoF, poorer premorbid functional ability was associated with decreasing FoF, and social support was not significantly associated. CONCLUSIONS: Older adults with higher neuroticism are more likely to have FoF in the first 12 weeks after a hip fracture. Screening for neuroticism in health care settings might identify individuals who would benefit from interventions to improve outcomes during recovery.
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Acidentes por Quedas/prevenção & controle , Depressão/psicologia , Medo , Fraturas do Quadril/psicologia , Neuroticismo , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Cognição , Comorbidade , Depressão/epidemiologia , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Apoio SocialRESUMO
BACKGROUND/AIMS: Age-related cognitive decline is a pervasive problem in our aging population. To date, no pharmacological treatments to halt or reverse cognitive decline are available. Behavioral interventions, such as physical exercise and Mindfulness-Based Stress Reduction, may reduce or reverse cognitive decline, but rigorously designed randomized controlled trials are needed to test the efficacy of such interventions. METHODS: Here, we describe the design of the Mindfulness, Education, and Exercise study, an 18-month randomized controlled trial that will assess the effect of two interventions-mindfulness training plus moderate-to-vigorous intensity exercise or moderate-to-vigorous intensity exercise alone-compared with a health education control group on cognitive function in older adults. An extensive battery of biobehavioral assessments will be used to understand the mechanisms of cognitive remediation, by using structural and resting state functional magnetic resonance imaging, insulin sensitivity, inflammation, and metabolic and behavioral assessments. RESULTS: We provide the results from a preliminary study (n = 29) of non-randomized pilot participants who received both the exercise and Mindfulness-Based Stress Reduction interventions. We also provide details on the recruitment and baseline characteristics of the randomized controlled trial sample (n = 585). CONCLUSION: When complete, the Mindfulness, Education, and Exercise study will inform the research community on the efficacy of these widely available interventions improve cognitive functioning in older adults.
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Disfunção Cognitiva/terapia , Exercício Físico , Educação em Saúde/métodos , Atenção Plena/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Idoso , Cognição , Envelhecimento Cognitivo , Disfunção Cognitiva/psicologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Memória , Projetos Piloto , Resultado do TratamentoRESUMO
Objectives: Functional impairment and social disconnection are risk factors for suicide in later life. This paper examines associations between domains of functional impairment and two forms of social disconnection that are empirically linked to suicide in later life - low (or thwarted) belonging and perceived burden on others.Methods: Participants are 62 older primary care patients (67.68% female, mean age = 72.05) who endorsed feeling lonely or like a burden. Participants completed self-report measures of low belonging and perceived burden (INQ-R) and domains of functional impairment (WHODAS 2.0) at a single time point.Results: Greater perceived burden was associated with greater impairment in activities of daily living ("self-care"), while greater thwarted belonging was associated with greater impairment in social functioning, when controlling for depressive symptoms and age. Domains of mobility, cognition and social participation were not associated with either belonging or perceived burden.Conclusions: Impairment in self-care (ADLs) and social functioning may be more strongly associated with perceived burden and thwarted belonging than other domains of functional impairment.Clinical Implications: Considering specific domains of functional impairment - rather than functioning more broadly - may facilitate tailored interventions to target suicide risk.
Assuntos
Atividades Cotidianas , Pessoas com Deficiência/psicologia , Relações Interpessoais , Solidão , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Ideação SuicidaRESUMO
Objective: We describe the development and implementation of a telephonic intervention (SAVE-CLC) piloted at three VA sites for Veterans returning to the community from VA nursing facilities (Community Living Centers or "CLCs"). Care transitions present a known period of medical risk for older adults and may pose increased risk for suicide. Veterans discharging from CLCs are at elevated risk compared to age and gender matched controls.Methods: Using a quality improvement approach, input was gathered from key stakeholders to aid in the development of the intervention. Veterans were screened for depressive symptoms and need for additional support by phone.Results: Of the Veterans who received the SAVE-CLC intervention, 87.9% had at least one prior mental health diagnosis, though only 19.7% had an outpatient mental health appointment arranged at CLC discharge. Results suggest that the intervention is feasible across multiple outpatient settings and is generally well-received by Veterans and caregivers, with 97% of those contacted reporting that the telephone calls were helpful.Conclusion: This flexible, telephone-based intervention addresses the unmet need of integrating mental health care into discharge planning during care transitions.Clinical Implications: SAVE-CLC offers a feasible and acceptable solution to suicide risk in older Veterans exiting a CLC.
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Alta do Paciente , Intervenção Psicossocial/métodos , Instituições Residenciais , Prevenção do Suicídio , United States Department of Veterans Affairs , Veteranos/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estados UnidosRESUMO
OBJECTIVE: Increased levels of worry, age, and presence of the apolipoprotein-E (ApoE)-ε4 allele are associated with the risk of developing cognitive declines and Alzheimer's disease (AD). Odor memory performance has been shown to vary as a function of age and ApoE genotype, and odor memory tests are sensitive to preclinical AD. Worry is known to influence verbal memory; however, its effects on odor memory are unknown. This study aimed to assess the relationships between worry, age, and ε4 status on odor memory. METHOD: Worry was evaluated for young (n = 53) and older (n = 45) adults using the Penn State Worry Questionnaire. Odor memory was assessed using the California Odor Learning Test, an olfactory analogue to the California Verbal Learning Test. RESULTS: A significant main effect of worry on long-delay free recall was found, such that increasing worry was associated with better recall across age and ε4 status. A significant interaction effect between ε4 status and worry on both short-and long-delay cued recall was found, such that across age, higher worry was associated with increased cued recall scores among ε4-negative adults, and decreased scores among ε4-positive adults. CONCLUSIONS: Findings demonstrated that worry influences odor memory and exerts a particular effect on cued recall among ε4 carriers who are at a greater risk of developing AD. Worry is a modifiable predictor of cognitive decline and risk of dementia in aging. Future studies on the effects of treatments aimed at reducing worry (e.g., cognitive behavioral therapies for anxiety) on changes in cognitive functioning are warranted.
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Envelhecimento/fisiologia , Ansiedade/fisiopatologia , Apolipoproteína E4/genética , Disfunção Cognitiva/fisiopatologia , Rememoração Mental/fisiologia , Percepção Olfatória/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/genética , Doença de Alzheimer/fisiopatologia , Feminino , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Odorantes , Adulto JovemRESUMO
OBJECTIVES: To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise, exposure therapy, cognitive restructuring, and a home safety evaluation, conducted by a physical therapist, in reducing fear of falling and activity avoidance. To collect preliminary evidence of efficacy. DESIGN: Randomized pilot study comparing the intervention to time- and attention-equivalent fall prevention education. SETTING: Participants' homes. PARTICIPANTS: 42 older adults with disproportionate fear of falling (high fear, low to moderate objective fall risk). MEASUREMENTS: Falls Efficacy Scale-International, modified Activity Card Sort, satisfaction, falls. RESULTS: Relative to education, the intervention reduced fear of falling (d = 1.23) and activity avoidance (d = 1.02) at 8 weeks, but effects eroded over a 6-month follow-up period. The intervention did not increase falls, and participants rated the exercise, exposure therapy, and non-specific elements as most helpful. CONCLUSIONS: An integration of exercise and exposure therapy may help older adults with disproportionate fear of falling, but modifications to the intervention or its duration may be needed to maintain participants' gains.
Assuntos
Acidentes por Quedas/prevenção & controle , Aprendizagem da Esquiva , Terapia Cognitivo-Comportamental , Terapia por Exercício , Medo/psicologia , Terapia Implosiva , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Vida Independente , Masculino , Satisfação do Paciente , Projetos Piloto , Cooperação e Adesão ao Tratamento , Resultado do TratamentoRESUMO
OBJECTIVES: The effect of fear of falling (FoF) on recovery 1 year after hip fracture is not well known. Furthermore, the potential influence of premorbid function has not been explored. We aimed to describe rates of FoF after hip fracture, to assess the association of FoF with functional recovery 1 year post-fracture, and to evaluate the potential moderating effect of premorbid function on the relationship between FoF and functional recovery. DESIGN: Secondary analysis of data from a prospective, longitudinal observational study to assess genetic factors influencing functional and psychological outcomes after hip fracture over 52 weeks. SETTING: Eight area hospitals in St. Louis, MO. PARTICIPANTS: 241 cognitively intact individuals 60 years of age or older requiring surgical repair for hip fracture. MEASUREMENTS: Fear of falling was measured by the short Falls Efficacy Scale-International 4 and 12 weeks post-fracture. The primary outcome was probability of full recovery 52 weeks post-fracture assessed with the Functional Recovery Score. RESULTS: High rates of FoF were seen at 4 (60.5%) and 12 weeks (47.0%) post-fracture. Week 12 FoF was associated with lower odds of recovery for those with high function pre-fracture (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.72, 0.93), but not for those with impaired activities of daily living performance (OR: 1.04, 95% CI: 0.91, 1.19). CONCLUSIONS: Fear of falling is common after hip fracture and is associated with poorer functional recovery 1 year after fracture, particularly in patients with high premorbid function. Fear of falling is a modifiable problem that represents a potential target for interventions to improve functional outcomes after hip fracture.
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Acidentes por Quedas , Medo , Fraturas do Quadril/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Recuperação de Função FisiológicaRESUMO
OBJECTIVE: The purpose of this study was to examine age differences in response to different forms of psychotherapy for chronic pain. METHODS: We performed a secondary analysis of 114 adults (ages 18-89 years) with a variety of chronic, nonmalignant pain conditions randomly assigned to 8 weeks of group-administered acceptance and commitment therapy (ACT) or cognitive behavioral therapy (CBT). Treatment response was defined as a drop of at least three points on the Brief Pain Inventory-interference subscale. RESULTS: Older adults were more likely to respond to ACT, and younger adults to CBT, both immediately following treatment and at 6-month follow-up. There were no significant differences in credibility, expectations of positive outcome, attrition, or satisfaction, although there was a trend for the youngest adults (ages 18-45 years) to complete fewer sessions. CONCLUSIONS: These data suggest that ACT may be an effective and acceptable treatment for chronic pain in older adults.
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Terapia de Aceitação e Compromisso , Dor Crônica/terapia , Terapia Cognitivo-Comportamental , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Psicoterapia de Grupo/métodos , Adulto JovemRESUMO
OBJECTIVE: Fear of falling is an important problem among older adults, even those with relatively low rates of objective fall risk, who are often overlooked as targets for intervention. METHOD: We developed and pilot tested a new intervention, Activity, Balance, Learning, and Exposure (ABLE), in a sample of 10 older adults with excessive fear of falling. The ABLE intervention integrates exposure therapy and cognitive restructuring with a home safety evaluation and an exercise program and is conducted in the home. In this pilot project, ABLE was jointly conducted by a physical therapist and a psychologist with expertise in geriatric anxiety disorders. RESULTS: The intervention was feasible and acceptable and resulted in decreases in fear and activity avoidance for most participants. One participant experienced an injurious fall. DISCUSSION: We learned a number of important lessons resulting in modifications to the inclusion criteria, assessments, and intervention over the course of this pilot study. Results suggest that ABLE has promise for treating excessive fear of falling in the elderly and support testing the intervention in a larger randomized trial. Copyright © 2016 John Wiley & Sons, Ltd.
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Acidentes por Quedas , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Medo , Terapia Implosiva/métodos , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/psicologia , Exercício Físico , Feminino , Humanos , Aprendizagem , Masculino , Satisfação do Paciente , Projetos Piloto , Equilíbrio PosturalRESUMO
BACKGROUND: Although fear of falling is prevalent among older adults recovering from hip fracture, current instruments are inadequate due to focus on specific situations and measurement of self-efficacy rather than fear. METHODS: The authors revised and tested a form of the Fear of Falling Questionnaire with three groups of older adults: 405 recovering from hip fracture, 89 healthy community dwelling, and 42 with severe fear of falling. Test-retest reliability was evaluated in a subsample of 16 hip fracture patients. Internal consistency was compared across all groups. Construct validity was established through factor analysis, convergent validity with a measure of fall-related self-efficacy, and discriminant validity with measures of depression and affect. RESULTS: A revised two-factor, six-item scale appears to have adequate psychometric properties. Scores were lower in the healthy comparison group relative to the hip fracture and fear of falling groups. Cronbach's α ranged from 0.72-0.83, with test-retest reliability of 0.82. Correlations with a measure of fall-related self-efficacy were moderate for the hip fracture group (0.42) and high with the healthy comparison (0.68) and fear of falling (0.70) groups. Correlations with depression and negative and positive affect were low to moderate. CONCLUSIONS: The Fear of Falling Questionnaire - Revised shows promise as a self-report measure of fear of falling, and is one of the first to be tested in older adults recovering from hip fracture. Advantages are that it is global rather than situation-specific and measures fear rather than self-efficacy. Future research on this scale is recommended in other older adult samples for whom fear of falling is relevant.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Medo/psicologia , Fraturas do Quadril/psicologia , Escalas de Graduação Psiquiátrica/normas , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Autoeficácia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The Veterans Health Administration (VA) STAR-VA program is a person-centered, interdisciplinary intervention for managing distress behaviors in dementia in VA nursing homes, called Community Living Centers (CLCs). Teams often struggle to sustain STAR-VA after site-lead partner turnover. The STAR-VA Sustainment Coaching Program was developed to support a new local STAR-VA behavioral coordinator and/or nurse champion (ie, site-leads) and engage the team to implement sustainment strategies. The aims of this evaluation were to document sustainment needs, barriers and facilitators, and effective strategies used during a sustainment intervention. DESIGN: We describe qualitative and quantitative findings of a program evaluation of the STAR-VA Sustainment Coaching pilot program. SETTING AND PARTICIPANTS: Eight CLC teams participated in the pilot program, 5 training a new nurse champion, 2 a new behavioral coordinator, and 1 both new site-leads. METHODS: CLC teams completed a needs assessment, developed sustainment goals and plans, tracked sustainment interventions implemented, and reported case outcomes. Outcome assessment and tracking reports were summarized and themes identified using a qualitative inductive approach. RESULTS: Common sustainment needs were to train a new nurse champion, promote staff understanding of dementia and distress behaviors, and promote a culture of person-centered dementia care. Most sites selected sustainment goals of implementing training procedures and behavioral rounds. Sustainment barriers included limited staff time, staff turnover, lack of supportive routines and tools, and limited awareness of STAR-VA. Facilitators included leadership support, staff interest, and training resources. Most sites reported successful implementation of STAR-VA behavior rounds, whereas strategies to achieve training-related goals had variable success. CONCLUSIONS AND IMPLICATIONS: The STAR-VA Sustainment Coaching Program helped CLC teams identify and implement strategies to support sustained STAR-VA implementation. The results of this project are informing ongoing efforts to integrate STAR-VA components into usual care processes for CLC residents with dementia.
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Demência , Tutoria , Humanos , Casas de Saúde , Avaliação de Resultados em Cuidados de Saúde , Demência/terapia , Avaliação de Programas e Projetos de SaúdeRESUMO
OBJECTIVE: This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning. DESIGN: A qualitative study design was used in addition to administration of standardized depression and mental status screens. SETTING AND PARTICIPANTS: Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York. METHODS: Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge. RESULTS: Thematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23). CONCLUSIONS AND IMPLICATIONS: This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.
Assuntos
Veteranos , Assistência ao Convalescente , Humanos , Masculino , New York , Casas de Saúde , Alta do Paciente , Transferência de Pacientes , Estados Unidos , United States Department of Veterans AffairsRESUMO
Social functioning is defined as how a person operates in their unique social environment (ie, engagement in activities, connectedness with others, and contributions to social roles). Healthy social functioning is important for nursing home residents as they are at increased risk for loneliness and isolation. Social functioning has long been an underacknowledged aspect of nursing home residents' health, but now, with the COVID-19 pandemic, residents' risk for decreased social functioning is increased. Several reliable and well-validated tools are available to supplement routine care planning and delivery and track and improve changes in social functioning over time. The overarching aim of this article is to provide resources and recommendations for interdisciplinary team assessment related to social functioning for nursing home residents. We describe 2 domains of social functioning measures, care-planning measures and outcome measures, and provide recommendations for how to integrate said measures into practice. Healthy social functioning is needed to maintain nursing home residents' well-being and quality of life. Measures and recommendations outlined in this article can be used by nursing home staff to understand residents' social preferences and address social functioning during COVID-19 and beyond.
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COVID-19 , Qualidade de Vida , Humanos , Casas de Saúde , Pandemias , SARS-CoV-2 , Interação SocialRESUMO
This study examined how having a history of sexual, physical, or emotional abuse is related to overall functioning as assessed by the Addiction Severity Index during short-term opioid maintenance treatment with either buprenorphine/naloxone or methadone. Furthermore, the relation between abuse history and overall functioning by sex was explored. Participants (N = 268) were opioid-dependent adults entering an outpatient randomized clinical trial with buprenorphine/naloxone and methadone. Latent growth modeling indicated that females with an abuse history entered treatment with more problems in the psychiatric and family domains as compared with females without an abuse history. Over the course of treatment, a history of abuse predicted problems in the psychiatric and alcohol domains. Furthermore, a history of abuse predicted slower recovery times and less recovery overall for females in some domains. Males with an abuse history entered treatment with more severe psychiatric and family problems as compared with males with no history of abuse. Victims of abuse may present to substance abuse treatment with weaknesses in the areas of family relations, psychiatric status, and alcohol use. The nature of these problems and their trajectory over time differed by sex.