Artificial Emotional Intelligence in Socially Assistive Robots for Older Adults: A Pilot Study.

This paper presents our recent research on integrating artificial emotional intelligence in a social robot (Ryan) and studies the robot's effectiveness in engaging older adults. Ryan is a socially assistive robot designed to provide companionship for older adults with depression and dementia through conversation. We used two versions of Ryan for our study, empathic and non-empathic. The empathic Ryan utilizes a multimodal emotion recognition algorithm and a multimodal emotion expression system. Using different input modalities for emotion, i.e. facial expression and speech sentiment, the empathic Ryan detects users emotional state and utilizes an affective dialogue manager to generate a response. On the other hand, the non-empathic Ryan lacks facial expression and uses scripted dialogues that do not factor in the users emotional state. We studied these two versions of Ryan with 10 older adults living in a senior care facility. The statistically significant improvement in the users' reported face-scale mood measurement indicates an overall positive effect from the interaction with both the empathic and non-empathic versions of Ryan. However, the number of spoken words measurement and the exit survey analysis suggest that the users perceive the empathic Ryan as more engaging and likable.

Programmed Activity Attendance in Assisted Living: An Application of the Theory of Planned Behavior with Additional Health Factors.

Objectives: Programmed activities contribute to the quality of life of assisted living (AL) residents, but attendance rates are often quite low. Using the theory of planned behavior (TPB), this study explores relationships among social cognitive variables, multidimensional health factors, and programmed activity attendance in AL.Methods: In a cross-sectional survey, 185 AL residents (Mage = 83.64, SD = 9.64) self-reported physical and mental health; TPB constructs (i.e., attitudes, subjective norms, behavioral control, and behavioral intention); and the percentage of programmed activities attended in the previous week.Results: Structural modeling showed that TPB was a good fit for the data (χ2/DF = 1.67; CFI = .97; TLI = .96; RMSEA = .06), explaining 82% of variance in behavioral intention and 44% of variance in activity attendance. After adding health factors to the model, only mental health yielded a significant indirect effect on activity attendance.Conclusion: Results provide preliminary support for the viability of TPB as a framework to explain resident activity attendance in AL. Thus, the decision to attend programmed activities in AL may represent a social cognitive process, influenced by mental health.Clinical Implications: Interventions may consider targeting TPB constructs and mental health to increase activity behaviors amongst AL residents.

Validation of a Comprehensive Measure of the Family Caregiver Experience: The Caregiver Reaction Scale.

OBJECTIVES: The Caregiver Reaction Scale (CRS) is a multi-dimensional measure of the family caregiving experience that assesses role conflict, challenges, and positive aspects of caregiving. The CRS has been validated in a sample of older adult caregivers who sought counseling, but its validity and reliability in a broader population of caregivers had not been established. This study aimed to explore how well the CRS assesses the multiple dimensions of the caregiving experience in a sample of family caregivers who match the national profile of caregivers and to confirm the validity and structure of the subscales. METHODS: Family caregivers (N = 452), age 18-89 (M = 48.56, SD = 17.15) were recruited online and completed the CRS and questionnaires of burden and positive aspects of caregiving. A confirmatory factor analysis (CFA) was conducted to confirm the underlying factor structure of the CRS, and convergent and discriminant validity was examined. RESULTS: CFA supported the existing structure of the CRS; all subscales demonstrated very good internal consistency reliability (α ≤.88), convergent validity (r ≥.39), and discriminant validity (r ≤.12). CONCLUSIONS: The CRS offers a valid and reliable assessment of the caregiving experience as evidenced by the convergent and discriminant validity of CRS subscales with well-validated measures of burden and positive aspects of caregiving. CLINICAL IMPLICATIONS: The CRS assesses multiple dimensions of caregiving that can be used to better understand the caregiver's experience, guide clinical interventions and referrals, and identify caregiver strengths.

Programmed Activity Offerings and Attendance Patterns in Assisted Living.

The scope of programmed activity offerings and attendance rates for specific activities are not thoroughly captured in the assisted living (AL) literature. The purpose of this study is to report activity offerings and associated attendance rates, as well as relationships between individual factors and activity attendance patterns in a sample of 202 residents of 21 ALs. Sampled communities offered 50 different types of programmed activities. Each AL offered exercise and religious services, most offered BINGO (n = 19, 91%) and socials (n = 18, 86%). BINGO was the most frequently attended activity (n = 83; 47%), followed by religious services (n = 75; 38%), socials (n = 67; 40%), and musical performances (n = 62, 37%). Additional findings provide insight into the features of frequently attended activities, and the relationships between attendance and resident characteristics. The authors conclude with a discussion of implications for service delivery and future research.

Impact of COVID-19 on the Mental Health and Distress of Community-Dwelling Older Adults.

The purpose of this study was to examine the mental health of community-dwelling older adults as they adapted their everyday health behaviors during the COVID-19 pandemic. In response to a telephone survey, 126 older adults described perceived changes in physical and mental health, and adaptations in their everyday health behaviors. Descriptive statistics, bivariate correlations, and multiple regressions revealed that participants experienced changes in mental and physical health, reduced health service access, lower social engagement, and increased coping behaviors. Greater negative social impact of the pandemic was associated with higher levels of COVID-19 distress. Reduced mental health was significantly related to reductions in health service access, health changes, and fewer adaptive coping behaviors. Adaptive coping behaviors were helpful, just as reduced health access and social contact added risk for mental health problems. Suggestions were provided for alleviating mental health needs by increasing social contact and engaging in adaptive coping behaviors.

Older Cannabis Users Are Not All Alike: Lifespan Cannabis Use Patterns.

Although several studies have examined individual-level correlates of cannabis use in later life, there is scant evidence identifying heterogeneity among older users. Using data from Colorado, this study examines variability in lifespan patterns of cannabis use among individuals aged 60 years and older. Sample respondents reported cannabis use in the past year and frequency of use in four periods of adulthood. Analyses used a multi-way contingency table to identify mutually exclusive subgroups of cannabis users based on lifetime reports of use and linear probability models to identify predictors of group identity. Three subgroups of older cannabis users were identified: new users, stop-out or intermittent users, and consistent users. The three groups varied on current use frequency and method of ingestion, as well as social and health characteristics. Screening for past history of cannabis use may help health care providers identify older adults who need health information and monitoring related to cannabis use.

Sense of community and its relationship with psychological well-being in assisted living.

Objectives: Sense of community (SOC) is a comprehensive psychological assessment of the relationship between person and place and relates to positive psychological outcomes in community-living adults, but has not been tested in assisted living (AL). This study describes SOC, identifies associated factors, and explores the relationship between SOC and psychological well-being with a sample of AL residents.Method: Participants included 202 residents of 21 ALs. The Brief Sense of Community Scale, a multidimensional theory-based measure, assessed total SOC (Cronbach's α = .87; M = 25.89, SD = 6.08) and dimensions of SOC (i.e. need fulfillment, group membership, influence, and emotional connection).Results: A second-order confirmatory factor analysis supported the multidimensional theoretical framework of SOC with the current sample. While bivariate correlations and multiple regressions varied by dimension, social relationships, physical health, and decisional control in the move to AL consistently yielded positive relationships with SOC factors. In the final step of a hierarchical multiple regression, total SOC significantly related to psychological well-being (F(1, 192) = 7.92, p = .005); although, its contribution was small (3%) when accounting for relevant covariates.Conclusion: Key findings suggest that the most accepted framework of SOC with community-living adults can be applied to the AL setting, but requires additional theoretical and empirical work. Findings also provide preliminary support for the relationship between SOC and psychological well-being. The authors discuss implications for future research and clinical practice, including strategies to promote SOC for AL residents.

Measuring Attitudes Toward Medical and Recreational Cannabis Among Older Adults in Colorado.

BACKGROUND AND OBJECTIVES: Cannabis use among older adults is on the rise. Despite growing interest in the topic, there exists a paucity of standardized measures capturing cannabis-specific attitudes among older adults. Using data from a survey of older Coloradans, we create two scales that separately measure medical and recreational cannabis attitudes. We also examine how these two attitudes relate to individual-level characteristics. RESEARCH DESIGN AND METHODS: We assess reliability using Cronbach's alpha and item-rest correlations and perform confirmatory factor analyses to test the two attitude models. We conduct a seemingly unrelated regression estimation to assess how individual characteristics predict medical and recreational cannabis attitude scores. RESULTS: Twelve indicators combined into two valid and reliable scales. Both scales had a three-factor structure with affect, cognition and social perception as latent dimensions. For both scales, fit indices for the three-factor model were statistically superior when compared with other models. The three-factor structure for both scales was invariant across age groups. Age, physical health, and being a caregiver differentially predicted medical and recreational cannabis attitude scores. DISCUSSION AND IMPLICATIONS: Medical and recreational cannabis attitude scales can inform the development and evaluation of tailored interventions targeting older adult attitudes that aim to influence cannabis use behaviors. These scales also enable researchers to measure cannabis-specific attitudes among older adults more accurately and parsimoniously, which in turn can facilitate a better understanding of the complex interplay between cannabis policy, use, and attitudes.

Application of treatment fidelity in tailored caregiver interventions.

OBJECTIVES: Demonstrations of the effectiveness of interventions requires evidence that the model can be implemented with fidelity. Caregiving interventions that are tailored to the individual or family require flexibility, which adds some challenges to the assessment of fidelity. This paper outlines the components necessary for examining treatment fidelity and common barriers to implementing fidelity studies, offers considerations for designing fidelity studies with tailored caregiver interventions, and aims to provide a set of procedures that can be used to guide future fidelity studies. METHOD: Case study methods are used to illustrate the processes and findings, drawing on two research studies of fidelity in tailored caregiver interventions. RESULTS: Fidelity studies consist of core components (i.e. training on intervention delivery, adherence to the intervention, therapist competence, acceptability and outcomes) that should be maintained and monitored throughout the study to elucidate the relationship between the intervention and outcomes. These components are applicable to tailored caregiver interventions and can be implemented with the consideration of some key issues that are addressed prior to the evaluation. The two cases presented utilized similar methods to evaluate fidelity of two different tailored caregiver interventions. CONCLUSION: Treatment fidelity can be assessed for tailored caregiving interventions, which increases confidence about the potency of the active ingredients in the interventions. Standard fidelity guidelines can be implemented with minor additional considerations.

Patterns of Marijuana Use and Health Impact: A Survey Among Older Coloradans.

Access to recreational and medical marijuana is common in the United States, particularly in states with legalized use. Here, we describe patterns of recreational and medical marijuana use and self-reported health among older persons using a geographically sampled survey in Colorado. The in-person or online survey was offered to community-dwelling older persons aged above 60 years. We assessed past-year marijuana use including recreational, medical, or both; methods of use; marijuana source; reasons for use; sociodemographic and health factors; and self-reported health. Of 274 respondents (mean age = 72.5 years, 65% women), 45% reported past-year marijuana use. Of these, 54% reported using marijuana both medically and recreationally. Using more than one marijuana method or preparation was common. Reasons for use included arthritis, chronic back pain, anxiety, and depression. Past-year marijuana users reported improved overall health, quality of life, day-to-day functioning, and improvement in pain. Odds of past-year marijuana use decreased with each additional year of age. The odds were lower among women and those with higher self-reported health status; odds of use were higher with past-year opioid use. Older persons with access to recreational and medical marijuana described concurrent use of medical and recreational marijuana, use of multiple preparations, and overall positive health impacts.

Qualitative Analysis of Cannabis Use Among Older Adults in Colorado.

BACKGROUND: Although the rate of cannabis use by older adults is increasing more quickly than all other age groups, little is known about the reasons why older adults use cannabis and the outcomes they experience. OBJECTIVE: The objective of this study was to identify the most salient themes concerning the use of medical and recreational cannabis by older adults living in Colorado. Specifically, we sought to (1) characterize perceptions of cannabis use by users and non-users, (2) determine how older adults access cannabis, and (3) explicate both positive and negative outcomes associated with cannabis use. METHODS: Between June and November 2017, we conducted 17 focus groups in senior centers, health clinics, and cannabis dispensaries in 15 Colorado cities. Participants included 136 persons aged over 60 years who were both users and non-users of cannabis. We coded and analyzed session transcripts using thematic analysis with NVivo software. RESULTS: We identified 16 codes from which five main themes emerged. These themes included: a lack of education and research about cannabis, a lack of provider communication, access to medical cannabis, the outcomes of cannabis use, and a reluctance to discuss cannabis use. CONCLUSIONS: Older adults want more information about cannabis and desire to communicate with their healthcare providers. Older adults who used cannabis for medical purposes reported positive outcomes but highlighted difficulties in accessing medical cannabis. Older adults in Colorado also revealed how a stigma continues to be attached to using cannabis.

Preliminary Evidence for the Validity and Reliability of the Caregiver Reaction Scale.

OBJECTIVE: Reliable and valid measures of caregiver experience are critical components of researching the caregiver experience and providing effective care to family caregivers. Assessments should be comprehensive, including positive aspects of caregiving as well as multiple dimensions of stress and burden (Family Caregiver Alliance, 2006). One such measure is the Caregiver Reaction Scale (CRS), a clinical tool adapted from research protocols in 1990. METHODS: This study is a preliminary examination of the psychometric properties of the CRS using a sample of family caregivers (N = 502) seeking services at a community based mental health and aging family service agency. RESULTS: The eight subscales of the CRS exhibited very good internal reliability α ≥ .81. Test-retest reliability was r ≥ .62, and convergent validity evidence is positive. Means and standard deviations are reported. CONCLUSIONS: Initial psychometrics suggest the CRS offers a reliable and valid assessment of multiple dimensions of the caregiving experience and warrants further research.

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

A preliminary typology of caregivers and effects on service utilization of caregiver counseling.

OBJECTIVES: Caregivers (CGs) of older adults have unique and diverse needs for intervention. The present studies describe the characteristics of CGs and caregiving situations and how these relate to CG therapy utilization patterns in a community mental health setting. METHOD: Study 1: Through chart review, the researchers explored service utilization patterns and identified preliminary typologies of Caregiver Family Therapy (CFT) clients, N = 23. Study 2: By conducting a second chart review, the researchers sought to determine whether the categories that emerged in Study 1 applied to a second group of CFT clients, N = 36. RESULTS: Study 1: Four distinct categories of CGs emerged: High-Distress (high disorganization, high complexity), Resourceful but At-Risk (low disorganization, high complexity), Non-Committal (high disorganization, low complexity), and Model CGs (low disorganization, low complexity). Study 2: While the ability to classify CGs into category proved to have some inconsistencies, preliminary evidence suggests the ability to predict utilization once CGs were placed into category was good. In Study 2 a fifth category emerged: High Functioning but Static, which suggests CGs were on a continuum ranging from high to low on family organizational style and CG situation complexity. CONCLUSION: While caregiving situations vary widely among families and across time, this article provides a preliminary typology of CGs that may assist clinicians in tailoring CG interventions to meet the needs of their clients based on information garnered early in therapy, perhaps as early as the intake process.

Renovating Alzheimer's: "constructive" reflections on the new clinical and research diagnostic guidelines.

The development of disease concepts for conditions such as Alzheimer's disease (AD) is an ongoing social process that evolves over time. The biomedical paradigm about AD that has informed our culture's understanding of brain aging for the past several decades is currently undergoing a major and timely renovation in the early 21st century. This evolution is reflected in new guidelines issued by the National Institute on Aging and Alzheimer's Association (NIA/AA) for the diagnosis of AD and related conditions that aim at helping researchers identify and eventually treat AD in its presymptomatic stages. The purpose of this article is to offer the scientific, clinical, and ethics communities a critical analysis of the implications of proposed guidelines and prompt deeper reflection about the lessons learned from these new efforts both in terms of their actual content and the cultural context in which they were issued and will be used. From a social-constructivist perspective, we explore the gradual 100-year evolution of AD and summarize the proposed NIA/AA guidelines within this historical context, enumerating what we see as their main benefits and limitations. We then consider the potential implications of these guidelines in the clinical setting, and explore shifts in our cultural paradigm about brain aging that might be engendered by the logic of the guidelines.

The Palisades: an interdisciplinary wellness model in senior housing.

PURPOSE: The conceptual model and implementation strategies for a university-private housing collaboration in a multilevel housing campus for older adults are described. The faculty and private developers viewed senior housing as an opportunity for people to downsize their space in order to upsize their lives within a community rich with resources to support their developmental needs. METHODS: A wellness program that includes assessments developed and performed by a multidisciplinary team provides the basis for the development of resources and interventions aimed at upsizing residents' lives. Semi-annual assessments and feedback sessions provide the residents with opportunities to set and revise goals and to work with members of the team to identify resource needs. RESULTS: After the first year, the wellness assessment scheduling and protocol were streamlined and recruitment barriers were addressed. The addition of a system for providing feedback to residents about their assessment results enhanced the meaning and value of the process. IMPLICATIONS: The Palisades team hopes to assist in promoting similar projects designed to positively impact wellness in older adults.

Pikes Peak model for training in professional geropsychology.

The aging of the population will increase demand for psychological services for older adults, which challenges the profession of psychology to provide those services. In response to that challenge, professional geropsychology has been developing over the past few decades to meet current and prepare for anticipated future demand. The development of a range of training opportunities is important to enable psychologists to work effectively with older adults. This article describes the Pikes Peak model for training in professional geropsychology. The model is an aspirational, competencies-based approach to training professional geropsychologists that allows for entry points at multiple levels of professional development.