Do nursing homes with a higher proportion of residents with dementia have greater or fewer complaints?

Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= -0.07; p < 0.05) and substantiated (AME= -0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities.

Protective roles of meditation practice and self-esteem on cognitive functions over time: findings from the Midlife in the United States study.

BACKGROUND: Cognitive function is an important component of healthy ageing. However, it is unclear whether relaxation/meditation practices provide cognitive benefits, particularly in midlife and early late life. Meditative practices are associated with higher self-esteem, and self-esteem serves as a general protective factor for many health outcomes. The current study examines associations between meditation practice, self-esteem, and change over 10 years in midlife cognitive performance. METHODS: Data were from waves 2 (2003-2004) and 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used structural equation modelling to examine whether persistent meditation practice at both waves or episodic practice at one wave is associated with better cognitive function over 10 years, compared to no meditation practice, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if self-esteem mediates the above associations. RESULTS: We included 2168 individuals (Mage = 65 ± 11). After controlling for covariates, the findings revealed that persistent meditation practice in both waves was associated with significantly less decline in episodic memory; however, no such effects were found for executive function. Further, although participants' higher self-esteem was significantly associated with less decline in executive function and episodic memory, it did not mediate the associations between meditation practice and cognitive functions. CONCLUSIONS: While both persistent meditation practice and self-esteem have associations with cognitive outcomes for middle-aged and older adults in MIDUS, self-esteem as a mediator was not supported. Thus, future investigations should examine mechanisms that underlie these protective factors on cognitive performances across adulthood.

The Impact of Assisted Living Organizational Structure and Process Characteristics on Staff Absence During COVID-19.

Quality of care in assisted living communities (ALCs) is important to consumers. The coronavirus disease of 2019 (COVID-19) pandemic and associated emergency policies have posed major challenges on staff recruitment and retention. This study aimed to examine the relationship between organizational characteristics of ALCs in Florida and challenges with staff absence during COVID-19 (N = 129 ALCs). Results indicated that structures (provision of memory care services), processes of care (challenges hiring new staff, staff sent home to comply with precautions, and staff anxiety), and local COVID-19 positivity rate were significantly associated with staff absence due to fear of infection, sickness, or family responsibilities. ALC providers and state regulatory agencies should develop policies and procedures that take these issues into consideration to prepare for future emergencies and disasters. Infection control policies should reflect whether an ALC provides memory care services and inform ways to overcome potential challenges with protocols. Efforts to reduce staff anxiety and disaster-related concerns should also be considered to ensure quality of care during emergencies.

ALCs who provided memory care services had significantly greater challenges with staff absence due to fear of infection during the COVID-19 pandemic.The administrative action of sending staff home to comply with COVID-19 precautions, difficulty hiring new staff, and staff anxiety were process characteristics of ALCs associated with greater challenges with staff absence.Policymakers should consider whether an ALC provides memory care services, faces potential challenges with infection control protocols, and addresses the mental health of staff when creating and implementing infection control policies.

Consumer Complaints in Nursing Homes: Analyzing Substantiated Single-Allegation Complaints to Deficiency Citations.

Complaints provide important information to consumers about nursing homes (NHs), but how substantiated complaints map onto deficiency citations is unknown. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Federally collected NH complaint and inspection records were obtained to identify all single allegation, substantiated complaints for NHs across the U.S. in 2017. Overall, the 369 complaint allegations in our sample resulted in a total of 585 deficiencies at the inspection stage; however, 35.2% of the allegations led to no deficiencies. Nearly two-thirds of the 369 substantiated single allegation complaints were categorized at the intake stage as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Further, 18% of the inspection deficiencies originated with complaint allegations that were prioritized as immediate jeopardy at intake, but of these, 71.4% were determined upon inspection to constitute "no actual harm with potential for more than minimal harm." These results provide evidence that complaints have the potential to provide unique valuable information on NH quality of care and draw regulatory attention to consumers' concerns. Future studies should include qualitative research concerning complaint processes by conducting interviews/surveys of complainants, NH staff/administrators, long-term care ombudsmen, and state officials.

Longevity is not an ingredient of successful aging as self-reported by community-dwelling older adults: a scoping review.

OBJECTIVES: There has been a long-standing debate in gerontology about what constitutes successful aging (SA). This scoping review investigated older adults' perspectives on longevity as part of SA to promote developing a standardized conceptual model. METHOD: The current review followed the JBI methodological guidelines and used Rowe & Kahn's SA framework and Baltes' selection, optimization, and compensation model as the foundational theoretical framework. Five electronic databases (PubMed, Scopus, PsycInfo, CINAHL, and Web of Science) were searched using specific inclusion criteria (participants, concept, and context) to identify original studies that evaluated SA. RESULTS: Eighteen studies, including 9,360 individuals (aged 60 years and older), were selected. Main indicators involved six primary domains: Psychological, physical, social, environmental, spiritual, and behavioral. Physical activity, basic aspects of wellbeing, positive outlook, satisfaction with life, interpersonal relationship, participation in meaningful activities, and financial security emerged as the most important factors. The findings suggest that older adults do not consider longevity a primary component of SA. CONCLUSION: We identified multidimensional self-reported SA components without longevity being emphasized, guiding further improvement of older adults' wellbeing. The study outlines an updated conceptual framework that can be applied to real-life scenarios to test how older adults can best adapt to the challenges of aging.

Does Perceived Generativity Mediate the Association Between Optimism and Cognitive Function Over Time? Findings from Midlife in the United States Study.

Cognitive function is a vital component of healthy aging. However, whether a persistently high optimism benefits late-life cognitive function is debatable. The current study examined associations between high optimism status, perceived generativity, and cognitive functions across adulthood. Data were from waves 2 and 3 (2004-14) of the Midlife in the United States study. We used structural equation modeling to examine whether participants' (N = 2,205; Mage = 65 ± 11) persistent high optimism predicts better cognitive functions over time, compared to high optimism at only one time-point or not at all while controlling for covariates; we also examined whether individuals' perceived generativity mediates the above association. The findings revealed that persistent high optimism was significantly associated with better episodic memory and executive function. Further, perceived generativity positively mediated the association between persistent high optimism and episodic memory. Future research should examine mechanisms for potential aspects of high optimism and perceived generativity on late-life cognitive performances.

Creating age-friendly nursing homes: The time is now.

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis.

OBJECTIVES: Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. DESIGN: Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. SETTING AND PARTICIPANTS: NH residents with dementia. MEASUREMENTS: Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. RESULTS: Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). CONCLUSIONS: Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.

Self-rated health and mental health among older incarcerated males.

OBJECTIVES: Older incarcerated persons are a rapidly growing population with considerable mental health needs. We evaluated perceived worth and meaningfulness in life as mediators in the relationship between self-rated health (SRH) and depression and anxiety. METHOD: Mediation analyses were conducted among 222 older incarcerated males from eight correctional facilities in Connecticut.PHQ-9 and GAD-7 assessed depression and anxiety, respectively. Subscales of the Geriatric Suicidal Ideation Scale (GSIS) measured perceived worth and meaningfulness in life. RESULTS: Greater SRH was associated with lower depression and anxiety. More perceived worth and meaningfulness in life were associated with better SRH and lower depression and anxiety. There is evidence of perceived worth and meaningfulness in life mediating the SRH-depression (ß = -0.86; 95% CI = -1.32 to -0.48; ß= -0.46, 95% CI = -0.82 to -0.17, respectively) and SRH-anxiety (ß = -0.71; 95% CI = -1.08 to -0.39; ß = -0.34, 95% CI = -0.65 to -0.10) relationships. CONCLUSION: SRH has both direct and indirect effects on depression and anxiety, by working through perceived worth and meaningfulness in life, in older incarcerated males. Assessing SRH, and focusing on ways to maintain self-worth and meaning, may be instrumental in promoting and sustaining their good mental health.

Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies.

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety problems among residents in LTC facilities, describe the efficacy of the current instruments that are used to detect anxiety in these settings, and provide clinical guidance for the thorough assessment of anxiety. Regarding measurement tools, the GAI, GAI-SF, GAS-LTC, and the BADS are the only self-report measures designed for older adults that have been successfully validated for use with older adults living in LTC settings. Clinicians should focus on ways to educate LTC directors and staff to emphasize the importance of screening and assessing for anxiety, using validated measures, to improve the assessment and treatment of anxiety in their residents.

Psychologists in Long-Term Care (PLTC) Guidelines for Psychological and Behavioral Health Services in Long-Term Care Settings.

To address concerns about limited training of psychologists working in long-term care (LTC) facilities, the Psychologists in Long-Term Care (PLTC) organization published Standards for Psychological Services in Long-Term Care Facilities (Lichtenberg et al., 1998). The expanding evidence base for knowledge and skills, the increasing diversity of LTC residents, and the complexity of presenting problems have compounded the guidance psychologists need when providing services in this setting. In this article, the PLTC Guidelines Revision Task Force presents PLTC guidelines based on the original prescriptive PLTC Standards. The content of the PLTC Standards was updated and the format changed from prescriptive standards to aspirational guidelines. We begin with general guidelines regarding knowledge and skills in LTC (education and training. understanding of LTC systems. end-of-life care), followed by specific guidelines covering the basic psychological service activities in LTC (referral, assessment, treatment, ethical issues, and advocacy). The PLTC Guidelines are designed to provide direction for psychologists who work, or plan to work, in LTC and to guide continuing education pursuits.

Cognitive deficits in Parkinson's disease with excessive daytime sleepiness: a systematic review.

Objectives: This systematic review synthesizes the most recent literature on neuropsychological deficits in adults with Parkinson's disease who experience excessive daytime sleepiness (EDS). Confounds and methodological limitations are explored. A framework entitled the Cascade Model of Excessive Daytime Sleepiness (CMEDS) is proposed to explain the role of EDS in contributing to cognitive impairment for patients with Parkinson's disease.Method: Systematic search through PubMed, PsychInfo and citation records. In total, 175 articles were screened for possible inclusion. Eight studies were included, encompassing 1373 patients with Parkinson's disease - 442 of whom had Parkinson's disease with EDS.Results: For Parkinson's disease patients with EDS, global deficits, executive dysfunction and deficits in processing speed were found beyond the typical cognitive phenotype of patients without EDS. Language skills, memory and visuospatial skills appeared to be similar between those with and without EDS. In untreated, de novo, patients, there were no cognitive differences between the EDS groups.Conclusion: This review suggests that Parkinson's disease patients suffering from EDS may have additional cognitive deficits globally, in executive control, and in processing speed. As suggested by the CMEDS framework, the impact of EDS on cognition may be related to Parkinson's disease pathology, comorbidities and medication use.

Effectiveness of online dementia caregivers training programs: A systematic review.

Over the next thirty years, Alzheimer's disease rates will increase alongside global aging. With the anticipated increase in demand, knowledgeable and skilled dementia caregivers will be in need across the long-term care spectrum. This study is a systematic review of online dementia-based training programs for formal and informal caregivers conducted to analyze evidence for using online training programs. We used the Preferred Reporting Items for Systematic Reviews (PRISMA) method. Methodological quality was assessed by the Cochrane Collaboration Back Review Group criteria. No previously published systematic review has analyzed online dementia training programs among both formal and informal caregivers. A systematic search of Web of Science, PsychInfo, and PubMed resulted in a final sample of (N = 19) studies. Results suggest that online interventions improve the condition and preparedness of caregivers, but future evaluations should consider study designs with multiple time points, control groups, and content that is personalized and interactive.

Who gets certified by the American Board of Professional Psychology and why: A diversity survey.

OBJECTIVE: To measure the profile of diversity among specialists certified by the American Board of Professional Psychology (ABPP). METHOD: A survey of ABPP specialists consisting of 18 demographic questions, and two questions regarding board certification and experience with diversity. RESULTS: Although ABPP specialists appear to be more diverse in certain aspects, especially regarding sex/gender (female, 43% vs 34% in prior survey), the majority remain non-Hispanic, White in race/ethnicity (87%), followed by only 3% Black, and 3% Hispanic/Latinx representation. Recognition as a specialist, job requirement, and professional expectations were the top three reasons for board certification. The top three themes regarding specialists' experiences with diversity were (a) Need for active outreach and mentoring, (b) ABPP does a good job regarding diversity, and (c) Make it more affordable. CONCLUSION: With the need for a competent and diverse workforce, ABPP will continue to conduct this survey to determine the progress that has been made in increasing the diversity of certified specialists.

Age-dependent determinants of antipsychotic use among newly admitted residents of skilled nursing facilities: A population-based study.

OBJECTIVES: To assess factors related to antipsychotic (AP) use in skilled nursing facilities for newly admitted residents aged 18 to 49, 50 to 64, 65 to 84, and 85 years or older. METHODS: Retrospective, population-level, Minimum Data Set (MDS) 2.0 data from the United States during the year of 2009 were used. Over 1 million residents were included. Fourteen clinically relevant variables were identified through a literature search. Antipsychotic use was defined as APs dispensed daily for the prior 7 days. Logistic regression was used to identify clinically relevant variables, which were then ranked based on magnitude of their association with APs. RESULTS: Bipolar disorder and schizophrenia were consistently related to AP use across age groups. For older age groups, off-label indications such as cognitive impairment, dementia, behavioral symptoms, and physical restraint use were more closely related to AP use, while delusions and hallucinations decreased in strength. Higher proportions of APs were found in all diseases and symptoms in nonelderly adults, with the exception of physical restraint use. Concurrent physical restraint and AP use was highest for older adults aged 65 to 84 at 36%. CONCLUSIONS: Correlates of AP use varied by age, with stronger associations between on-label conditions and AP use among younger adults and off-label conditions among older adults. Several less conventional determinants, namely, Parkinson disease, traumatic brain injury, and the use of physical restraints were identified to increase the likelihood of AP use. This study highlights the importance of monitoring for adverse effects for residents of all ages.

Certified nursing assistants' perspectives of the CARES® activities of daily living dementia care program.

BACKGROUND: There has been a proliferation of online training programs for nursing home direct care staff related to dementia care, yet little is known about the effectiveness of the training. Some evidence exists that online training is effective in addressing problem behaviors of nursing home residents with dementia by enhancing self-efficacy, improving attitudes, and increasing knowledge of nursing home staff. STUDY AIM: The current study aim was to evaluate the implementation of an online training program consisting of ten, one-hour modules which applies the CARES® concepts and learning framework to activities of daily living (ADL) care for persons with dementia. METHODS: Responses from Likert-type items, and open-ended questions were analyzed in a sample of 48 certified nursing assistants (CNAs) from 10 nursing homes in six states (ME, MT, ND, WI, MN, MO) that were part of a National Institute of Aging funded intervention study (Grant #AG026210). RESULTS: The mixed-method study findings indicated that CNAs gained a better understanding, more knowledge, and more confidence in caring for persons with dementia. Recommendations were made regarding training length and technical issues, and some questioned the practicality of providing person-centered care when resident assignment was very high. CNAs expressed satisfaction with the online training, found it easy to use, and many said they would recommend the training. CARES® ADL Dementia Care online training appears to be a viable way of helping CNAs address the personal care needs of long-term care residents. Future CARES® ADL Dementia Care program research should include more racially diverse CNAs.

Come, join, lead: Attracting students to careers in aging and promoting involvement in gerontological societies.

Geriatric educators face the challenge of attracting more clinicians, scientists, and educators into geriatrics and gerontology, and promoting involvement in gerontological societies. A survey of psychologists (N = 100) examined factors that attract students in clinical/counseling psychology to practice with older adults, as well as experiences in organizational service. For 58%, interest in aging began at the undergraduate level, but for others interest developed later. About one half cited academic exposure such as mentorship (51%), research (47%), or coursework (45%) as sparking interest, along with family (68%) or work experience (61%). Involvement in professional organizations lags (58%), in part owing to misperceptions about what those activities require. A continued targeted effort at the undergraduate and graduate level is essential to attract students to careers in aging. To preserve vital professional organizations, enhanced outreach may be useful to dispel myths about service and encourage engagement.

Personality and its Relationship to Depression and Cognition in Older Adults: Implications for Practice.

OBJECTIVES: Personality is an important contributor to an individual's mental health and is consistently linked to the two most prevalent mental health conditions among older adults: dementia and depression. This review summarizes the current findings on personality and its association with cognitive decline and depression, as well as treatment outcomes and possible intervention strategies. METHODS: Literature searches were conducted in Web of Science, PubMed, and PsycINFO. Search terms included 'personality traits,' 'depression,' 'treatment,' and 'older adults.' RESULTS: Cognitive decline and depressive disorders are both associated with a common personality profile: high neuroticism, and low conscientiousness, extraversion, openness, and agreeableness. Across studies, the most consistent predictor of late-life depression, its course, and treatment outcomes is higher neuroticism. CONCLUSIONS: Personality traits are associated with cognitive decline, as well as the diagnosis and course of late-life depression in older adults. However, formal personality assessment is not typically incorporated in clients' treatment plans, even though personality traits may influence treatment efficacy and outcomes. CLINICAL IMPLICATIONS: Formal assessment of personality traits may be beneficial in terms of treatment adherence and outcomes for older adults. Tailored interventions that specifically target the client's strengths are likely to be well received by both clients and clinicians.

An evaluation of the CARES® Dementia Basics Program among caregivers.

BACKGROUND: In 2014, the state of Oregon established Oregon Care Partners to provide high quality, free training to all dementia caregivers. This study evaluated participants' changes in knowledge, sense of competency in dementia caregiving, and ability to identify person-centered caregiving techniques after completing CARES® Dementia Basics online program, one of the educational resources available through this initiative. METHODS: A convenience sample of informal and formal caregivers (N = 51) provided data at three points in time; pre-test, post-test, and a follow-up test after an additional 30-day period to determine sustained changes in knowledge, sense of competency, and person-centered care. RESULTS: From pre-test to post-test, modest improvements were detected in sense of competence in performing dementia care (ps < 0.01) and dementia-based knowledge, F(2, 150) = 7.71, p < 0.001, a multivariate effect size of w 2 = 0.09. Even though improvements in sense of competency were not universal, three out of five individual items demonstrated positive growth from pre-test to post-test as well as four out of the five items from pre-test to follow-up test. Importantly, gains observed in dementia-based knowledge from pre-test to post-test were largely maintained at the 30-day follow-up. No significant changes were found in the correct identification of person-centered techniques after the training F(5, 150) = 1.63, p = 0.19. CONCLUSIONS: Future research should investigate how best to maintain educational interventions within the caregiving environment and to assess subsequent skill change.

Impact of serious mental illness online training for certified nursing assistants in long term care.

Certified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-® Serious Mental Illness™ training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre-post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned.