Missing link: a qualitative analysis of community-based organisations' contributions to partnered collaborative care to treat late-life depression.

OBJECTIVE: Extending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing patients' social needs; however, little is known about how CBOs contribute to such partnered depression care. We explored how six primary care clinic and CBO partnerships came together to provide late-life depression care through the Care Partners funded in 2014. DESIGN: 43 key informant interviews and 15 focus groups were conducted with care managers, administrators and primary care providers partnering to provide late-life depression care. Data were coded and analysed iteratively using qualitative thematic analysis. SETTING: Six primary care clinic-CBO sites across California. PARTICIPANTS: Care managers, administrators and primary care providers participated in this study. RESULTS: Three unique contributions of CBOs to depression care in these clinic-CBO partnerships were identified: (1) CBOs added new services that focus on social needs and enhanced depression care; (2) CBOs strengthened core aspects of collaborative care for depression; (3) CBOs provided new avenues for building connections and trust with underserved patients. CONCLUSIONS: CBOs, when partnered with clinics, enhanced both medical and social aspects of depression treatment for older adults. CBOs are well positioned to assist primary care clinics in treating the complex health needs of older adults by providing new and strengthening existing aspects of partnered depression care while building patient trust among culturally diverse populations.

Experiences of low-income college students in selection of health insurance, access, and quality of care.

OBJECTIVE: To understand the experiences and perspectives of low-income University of California undergraduates related to their health insurance options, access to and quality of care. PARTICIPANTS: 14 undergraduate students across five UC campuses who identified as socioeconomically disadvantaged or low-income. METHODS: We conducted 4 focus groups organized by type of insurance coverage in April 2022. RESULTS: (1) the insurance selection process for low-income students is complicated by multiple, sometimes competing factors; (2) the lack of clear information confuses students' selection of insurance and health care options; and (3) students experiences challenges in access and quality of care, irrespective of insurance type. CONCLUSIONS: Ensuring access to high quality care, information and coverage is critical to the university mission to support a diverse, equitable and inclusive environment, for a student body that reflects the needs of the population of California.

Assessment of a COVID-19 vaccination protocol for unhoused patients in the emergency department.

BACKGROUND: We aimed to evaluate the feasibility of implementing an emergency department (ED)-based Coronavirus Disease of 2019 (COVID-19) vaccination protocol in a population of unhoused patients. METHODS: On June 10, 2021, a best practice alert (BPA) was implemented that fired when an ED provider opened the charts of unhoused patients and prompted the provider to order COVID-19 vaccination for eligible patients. We downloaded electronic medical record data of patients who received a COVID-19 vaccine in the ED between June 10, 2021 and August 26, 2021. The outcomes of interest were the number of unhoused, and the total number of patients vaccinated for COVID-19 during the study period. Data were described with simple descriptive statistics. RESULTS: There were 25,871 patient encounters in 19,992 unique patients (mean 1.3 visits/patient) in the emergency department during the study period. There were 1,474 (6% of total ED population) visits in 1,085 unique patients who were unhoused (mean 1.4 visits/patient). The BPA fired in 1,046 unhoused patient encounters (71% of PEH encounters) and was accepted in 79 (8%). Forty-three unhoused patients were vaccinated as a result of the BPA (4% of BPA fires) and 18 unhoused patients were vaccinated without BPA prompting. An additional 76 domiciled patients were vaccinated in the ED. CONCLUSIONS: Implementing an ED-based COVID-19 vaccination program is feasible, however, only a small number of patients underwent COVID-19 vaccination. Further studies are needed to explore the utility of using the ED as a setting for COVID-19 vaccination.

Rural residence across the life course and late-life cognitive decline in KHANDLE: A causal inference study.

Background: Modifiable risks for dementia are more prevalent in rural populations, yet there is a dearth of research examining life course rural residence on late-life cognitive decline. Methods: The association of rural residence and socioeconomic status (SES) in childhood and adulthood with late-life cognitive domains (verbal episodic memory, executive function, and semantic memory) and cognitive decline in the Kaiser Healthy Aging and Diverse Life Experiences cohort was estimated using marginal structural models with stabilized inverse probability weights. Results: After adjusting for time-varying SES, the estimated marginal effect of rural residence in childhood was harmful for both executive function (ß = -0.19, 95% confidence interval [CI] = -0.32, -0.06) and verbal episodic memory (ß = -0.22, 95% CI = -0.35, -0.08). Effects of adult rural residence were imprecisely estimated with beneficial point estimates for both executive function (ß = 0.19; 95% CI = -0.07, 0.44) and verbal episodic memory (ß = 0.24, 95% CI = -0.07, 0.55). Conclusions: Childhood rurality is associated with poorer late-life cognition independent of SES.

Moving beyond referrals to strengthen late-life depression care: a qualitative examination of primary care clinic and community-based organization partnerships.

BACKGROUND: National guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. METHODS: We conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants' experiences with the partnered initiative. RESULTS: We found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. CONCLUSIONS: These findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.

Beware of Stereotypes: Are Classmates' Stereotypes Associated With Students' Reading Outcomes?

This study examined the associations between classmates' reading-related gender stereotypes and students' reading self-efficacy, self-concept, motivation, and achievement. Our sample consisted of 1,508 fifth-grade students (49% girls; age: 10.89 years); data were collected at two time points. Multilevel analyses yielded two main results: First, there was a relation between students' individual reading-related gender stereotypes and their reading self-concept, self-efficacy, and motivation with boys experiencing negative and girls experiencing positive effects. Second, a contextual effect was found: after controlling for students' individual reading-related gender stereotypes, classmates' gender stereotypes were negatively related to all of the boys' reading outcomes. The results provide evidence for the assumption that classmates are important communicators of gender stereotypes and that they reinforce conforming behaviors.

Complexity in partnerships: A qualitative examination of collaborative depression care in primary care clinics and community-based organisations in California, United States.

Partnering across health clinics and community organisations, while worthwhile for improving health and well-being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross-organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community-based organisations in the United States that were part of an initiative to address late-life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017. Additionally, more than 80 project-related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi-level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships.

Self-esteem across the second half of life: The role of socioeconomic status, physical health, social relationships, and personality factors.

Self-esteem development across adulthood has been in the center of interest for some time now. However, not much is known about factors that shape self-esteem and its development in the second half of life and whether the factors differ with age and gender. To examine these questions, this study uses 2-wave data from the population-based NorLAG study in Norway (N = 5,555; Mage = 58 years; 51% women) and combines self-report data on self-esteem and personality with registry-based information on socioeconomic status (education, income, unemployment), health problems (sick leave, lifetime history of disability), and social relationships (cohabiting partner, lifetime history of divorce and widowhood). Results from latent change score models revealed that self-esteem peaked at around age 50 and declined thereafter. More importantly, lower socioeconomic status, not having a cohabiting partner, unemployment, and disability were each uniquely associated with lower levels of self-esteem and/or steeper declines in self-esteem over the 5-year study period. Over and above registry-based information, personality characteristics were relevant, with a more mature personality being associated with higher self-esteem level. Emotionally stable participants also showed less pronounced declines in self-esteem. Moreover, associations of disability and of emotional stability with self-esteem level were weaker with advancing age. Among women, self-esteem level was more strongly associated with emotional stability and less strongly with openness, compared to men. Our findings demonstrate the utility of registry-based information and suggest that physical health, social relationships, and personality factors are in manifold ways uniquely associated with self-esteem and its development later in life. (PsycINFO Database Record

More stable estimation of the STARTS model: A Bayesian approach using Markov chain Monte Carlo techniques.

The STARTS (Stable Trait, AutoRegressive Trait, and State) model decomposes individual differences in psychological measurement across time into 3 sources of variation: a time-invariant stable component, a time-varying autoregressive component, and an occasion-specific state component. Previous simulation research and applications of the STARTS model have shown that serious estimation problems such as nonconvergence or inadmissible estimates (e.g., negative variances) frequently occur for STARTS model parameters. This article introduces a general approach to estimating the parameters of the STARTS model by employing Bayesian methods that use Markov Chain Monte Carlo (MCMC) techniques. With the specification of appropriate prior distributions, the Bayesian approach offers the advantage that the model estimates will be within the admissible range, and it should be possible to avoid estimation problems. Furthermore, we show how Bayesian methods can be used to stabilize STARTS model estimates by specifying weakly informative prior distributions for the model parameters. In a simulation study, the statistical properties (bias, root mean square error, coverage rate) of the parameter estimates obtained from the Bayesian approach are compared with those of the maximum-likelihood approach. A data example is presented to illustrate how the Bayesian approach can be used to estimate the STARTS model. Finally, further extensions of the STARTS model are discussed, and suggestions for applied research are made. (PsycINFO Database Record

Perceived control across the second half of life: The role of physical health and social integration.

Perceived control is a key component of successful aging and may serve as a protective factor against age-related declines in central domains of functioning. However, it is a largely open question whether and how perceived control changes from midadulthood to very old age and how such change is shaped by health and social contexts. To examine these questions, we apply growth models to up to 15-year 4-wave longitudinal data from the German Ageing Survey (DEAS; N = 10,081; aged 40-85 years at baseline; 49% women). Results revealed that perceived control is relatively stable in midlife, but starts to decline after midlife. Starting at 70, perceived control declines an average of a quarter of a SD per 10 years. Suffering from comorbidity and functional limitations were each associated with considerably lower perceived control. Volunteering and less loneliness were each uniquely associated with higher perceived control, over and above the other social factors as well as sociodemographic and health variables. Surprisingly, less social support was associated with stronger perceived control. We also found significant interaction effects suggesting that the combination of functional limitations with older age and loneliness with lower education were each associated with particularly compromised perceived control. Overall we found little evidence for correlates of change in perceived control, with only the loneliness-control association becoming slightly weaker over time. We take our findings to suggest that various different facets of social integration later in life are uniquely relevant for perceived control and suggest routes for further inquiry. (PsycINFO Database Record

Self-esteem is relatively stable late in life: the role of resources in the health, self-regulation, and social domains.

A large body of research has documented changes in self-esteem across adulthood and individual-difference correlates thereof. However, little is known about whether people maintain their self-esteem until the end of life and what role key risk factors in the health, cognitive, self-regulatory, and social domains play. To examine these questions, we apply growth modeling to 13-year longitudinal data obtained from by now deceased participants of the Berlin Aging Study (N = 462; age 70-103, M = 86.3 years, SD = 8.3; 51% male). Results revealed that self-esteem, on average, does decline in very old age and close to death, but the amount of typical decline is minor. Health-related constraints and disabilities as well as lower control beliefs and higher loneliness were each associated with lower self-esteem late in life. We obtained initial evidence that some of these associations were stronger among the oldest-old participants. Our results corroborate and extend initial reports that self-esteem is, on average, fairly stable into the last years of life. We discuss possible pathways by which common and often severe late-life challenges may undermine an otherwise relatively robust self-esteem system.

Effects of personality on the transition into caregiving.

Recent research has emphasized the critical role of personality in the caregiving situation, but not much is known about how individual differences shape the transitions into and out of caregiving. Based on longitudinal data from the German Socio-Economic Panel (SOEP, N= 14,495), we explored how personality is associated with adopting and maintaining the caregiving role. The results revealed that individuals with less emotional stability were more likely to take over the responsibility to provide care. Moreover, care-related personality change was affected by sex and age. In detail, female care entrants were more burdened than their male counterparts, and younger caregivers seemed to adapt better to the caregiving role than older ones. The findings point to the interplay of personality and sociostructural conditions in the caregiving role over time.