Substance Use Screening in Geriatric Primary Care: Cultural Issues and Alcohol Consumption in the Deep South.

OBJECTIVES: To investigate indicators of potentially hazardous alcohol use among older adults living in a region with high substance use stigma. METHODS: Patients at a university-affiliated geriatrics clinic in the Deep South of theUS completed behavioral health screenings including self-reported alcohol use, symptoms of depression or anxiety, and cognitive functioning between 2018 and 2022. RESULTS: Participants (N = 278) averaged 76.04 years of age (SD = 9.25), were predominantly female (70.9%), and non-Hispanic white (84.5%), with an averageof 6.08 comorbid diagnoses (SD = 2.86). Race/ethnicity, age, and symptoms of anxiety were associated with alcohol use and hazardous alcohol use, with non-Hispanic whites, younger individuals, and those with more anxiety symptoms reporting more alcohol use. Notably, alcohol use and hazardous alcohol use were associated with cognitive functioning in the dementia range. CONCLUSION: Self-reported alcohol use is low in geriatric primary care in the Deep South, US, differs by race/ethnicity, and is predictive of cognitive impairment when alcohol use is hazardous. Issues of trust and stigma may play a role in self-report ofstigmatized behaviors. CLINICAL IMPLICATIONS: Self-reported alcohol intake must be considered within the cultural context of regional stigma. Recommendations to address this are provided.

When worlds collide: Socio-political conflict in patient care.

The country as a whole has been on high alert since early 2020. That year began with the SARS-CoV-2 pandemic, then moved through the largest single day drop of the Dow Jones industrial average, the murders of Breonna Taylor and George Floyd and subsequent Black Lives Matter protests, murder hornets, the election of Joe Biden, alleged voter fraud, and then culminated on January 6, 2021, with the assault on the United States Capital Building. Societal issues including racism, discrimination, and distrust of leaders have been themes in the news and social media. It should come as no surprise that we may be called upon to provide treatment to patients with whom we have significantly different belief systems, which could result in conflict. The emotional rawness that pervades much of society lays emotions bare for many. Our ethical responsibilities as healthcare providers compel us to think about these complex relationships intentionally, and with compassion. In an interactive workshop conducted at the 42nd Forum for Behavioral Science in Family Medicine, participants were led through scenarios in which conflict could enter the exam room, discussion of the potential consequences, and consideration of ways to respond ethically in those situations. The discussions were couched in the codes of ethics of the American Psychological Association, the National Association of Social Workers, and the American Medical Association. The interactive session was designed to encourage participants to (1) consider potentialities of patient-provider conflict, (2) consider ethical, compassionate responses, and (3) be mindful of social media.

Affirmative Palliative Care for Transgender and Gender Nonconforming Individuals.

ABSTRACT: Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice. An interdisciplinary national team of experts collaborated to identify ways nurses could better uphold their professional responsibilities to TGNC individuals with serious illness. The purposes of this article are to: 1) describe elements of TGNC-inclusive palliative nursing care; and 2) present eight concrete recommendations to achieve affirmative clinical practice for TGNC patients living with life-limiting illness and their family of origin and/or family of choice. These recommendations address professional development, communication, medication reconciliation, mental health, dignity and meaning, social support and caregivers, spiritual beliefs and religion, and bereavement care.