Examination of the Problem Gambling Severity Index for Use with Older Adults: A Rasch Model Approach.

Research and prevalence studies commonly use the nine-item Problem Gambling Severity Index (PGSI; Ferris and Wynne in The Canadian Problem Gambling Index, 2001) to measure problem gambling severity in older adults. However, the appropriateness of the PGSI for use with older adults must be evaluated to ensure accurate interpretation of scores. This study evaluated the PGSI with older adults that gamble using a Rasch model approach, which has not yet been examined in the literature. Data from the Quinte Longitudinal Study (Wiiliams et al. in The Quinte Longitudinal Study of Gambling and Problem Gambling 2006-2011, Bay of Quinte region, Ontario [Canada] (V28), 2014) were utilized, accessed through the Gambling Research Exchange of Ontario (GREO). Using WINSTEPS.V5, a Rasch rating scale model was applied to an older adult sample from Ontario, Canada (n = 571, Mage = 66, range = 60-80 +) to assess: (1) the dimensionality and fit between individual PGSI items and the underlying latent construct of problem gambling; (2) utility of items and response options; and (3) potential differential item functioning (DIF) between genders. Using a larger sample (N = 3206, Mage = 45, range = 18-80 +), DIF was examined across three age subgroups. Results supported unidimensionality of the PGSI and item polarity (rpm range = 0.42-0.85). Infit and outfit statistics showed mixed model misfit for three items. The use of three response options were deemed productive for measurement, but almost always was not frequently endorsed. Model-person separation (1.00) and reliability (0.50) were poor, and model-item separation (6.12) and reliability (0.97) were excellent. There was no significant DIF between older adults by gender. Three items showed significant DIF between older and younger adults. Possible modifications to improve the PGSI for use with older adults are discussed.

Exploring life-course patterns of substance abuse: a qualitative study.

OBJECTIVES: This research sought to examine how older adults with substance abuse issues understand the pattern of their use. Qualitative interviews explored: (1) Whether self-reported age of onset of substance abuse in fact aligned with the age when use became problematic; (2) Patterns of substance use over the life-course; (3) Precipitants of substance use throughout the lifespan; (4) Factors that prevented identification of problem use; (5) How participants came to recognize that their substance use was problematic. METHOD: Participants were 11 men and 9 women aged 62-78 years (M = 69.80, SD = 3.86) who were clients of an older adult substance abuse treatment program. Semi-structured interviews were conducted and transcribed for thematic analysis. RESULTS: Interview data revealed discrepancies between self-identified age of substance abuse onset and reported problematic use throughout the lifetime. Thematic analysis revealed factors that contributed to participants not recognizing problem use earlier in life, such as normalizing and minimizing the impact of use and lack of severe consequences earlier in life. Additionally, factors that led to increased use (i.e. retirement, grief), and to recognition of problem use and treatment-seeking were identified (i.e. social, financial, legal, and health problems). CONCLUSION: In general, self-reported age of substance abuse onset and patterns of substance abuse were highly variable across participants. These results have implications for assessment of substance use among older adults, as well as preventative efforts to decrease risk of substance abuse.

Body satisfaction and self-esteem among middle-aged and older women: the mediating roles of social and temporal comparisons and self-objectification.

Objectives: The relationship between body satisfaction and self-esteem among older women is understudied, in particular the potential mechanisms underlying the relationship. The purpose of this study was to investigate social and temporal comparisons and self-objectification, their relationship to body satisfaction and self-esteem, and the extent to which they mediated the relationship between body satisfaction and self-esteem.Method: Women (N = 180) between the ages of 55 and 91 (mean age = 66 years) completed questionnaires assessing body satisfaction, self-esteem, social and temporal comparisons, and self-objectification.Results: Most correlations between body satisfaction, social and temporal comparisons, self-objectification, and self-esteem were highly significant in the expected directions. Upward temporal comparison was used most frequently followed by downward social comparison. Upward temporal comparisons most often targeted the 30 s and 40 s, while social comparisons most often targeted same age peers. Women were more likely to endorse competence-based over appearance-based self-objectification items. Upward and downward social comparison mediated the relationship between body satisfaction and self-esteem, with the strongest indirect effects among younger women.Conclusion: This study highlights the importance of temporal and social comparison in maintaining body satisfaction among middle-aged and older women and their tendency to emphasize competence versus appearance in evaluating their bodies. Results are discussed in the context of developmental and cohort effects that influence body satisfaction among older women.

Social support and cognitive function in middle- and older-aged adults: descriptive analysis of CLSA tracking data.

BACKGROUND: Cognitive function is important for healthy aging. Social support availability (SSA) may modify cognitive function. We descriptively examined the association between SSA and cognitive function in a population-level sample of middle- and older-aged adults. METHODS: We analyzed the tracking dataset of the Canadian Longitudinal Study on Aging. Participants aged between 45 and 85 years answered questions about SSA and performed three cognitive tests (Rey Auditory Verbal Learning Test, Animal Fluency Test and Mental Alternation Test) via telephone. We divided global SSA and global cognitive function scores into tertiles and generated contingency tables for comparisons across strata defined by sex, age group, region of residence, urban vs. rural residence and education. RESULTS: The proportion of participants with low global cognitive function was often greater among persons who reported low global SSA. The proportion of persons with high cognitive function was greater in participants with high SSA. The findings were most pronounced for females, 45- to 54-year olds, all regions (especially Québec) except Atlantic Canada, urban dwellers and persons with less than high school education. CONCLUSIONS: Our results can help public health officials focus on providing social supports to subgroups of the population who would benefit the most from policy interventions.

Mental health knowledge and training needs among direct care workers: a mixed methods study.

OBJECTIVES: Direct care providers (DCWs) spend the most time with clients in the home, and as such, play an integral role in identifying mental health problems. However, DCWs receive little preparation in mental health and there is little research regarding their role in the mental health care of clients. The purpose of this study was to explore DCWs' knowledge, attitudes, and experiences of caring for clients with mental health problems from the perspectives of DCWs and key administrators (KAs). METHOD: Mixed method design. Structured interviews were conducted with DCWs. Focus groups were conducted with KAs. RESULTS: Twenty-nine DCWs and 12 KAs took part in the study. Loneliness and memory problems in clients were the most prevalent challenges identified by DCWs. DCWs' self-reported mental health knowledge was mid to high across all domains, although they had many misconceptions about mental health and aging. Helpful strategies in working with clients included communication skills, rapport-building, behavioral, cognitive, emotion-regulation, and making use of external resources. KAs noted individual differences in DCWs' mental health knowledge and indicated that mental health issues were often viewed by DCWs as dispositional problems or a normal part of aging. KAs viewed DCWs' greatest challenges as personalizing difficult client behaviors, lack of knowledge about how to manage specific behaviors, and difficulties managing their own emotions towards clients. CONCLUSION: Data from this study suggest important areas for DCW development. However, system issues that affect DCWs such as workload, resources, mental health stigma, and diverse client populations should be addressed concurrently.

Cultural Differences in Young Adults' Perceptions of the Probability of Future Family Life Events.

Most young adults are exposed to family caregiving; however, little is known about their perceptions of their future caregiving activities such as the probability of becoming a caregiver for their parents or providing assistance in relocating to a nursing home. This study examined the perceived probability of these events among 182 young adults and the following predictors of their probability ratings: gender, ethnicity, work or volunteer experience, experiences with caregiving and nursing homes, expectations about these transitions, and filial piety. Results indicated that Asian or South Asian participants rated the probability of being a caregiver as significantly higher than Caucasian participants, and the probability of placing a parent in a nursing home as significantly lower. Filial piety was the strongest predictor of the probability of these life events, and it mediated the relationship between ethnicity and probability ratings. These findings indicate the significant role of filial piety in shaping perceptions of future life events.

Conflict between Family Caregivers and Staff in Nursing Homes: Feasibility of the Daily Diary Method.

OBJECTIVE: The purpose of this study was to investigate the daily diary method (DDM) for assessing family-staff conflicts in nursing homes, to provide descriptive information on conflict, and to examine the relationship between conflict and mood among family caregivers. METHODS: Participants were nine caregivers that experienced conflict with staff on an ongoing basis. They were contacted daily by telephone for 14 days and were asked (1) whether a conflict had occurred, (2) to describe the severity and type of conflict, and (3) to rate their positive and negative affect. RESULTS: Compliance was excellent with no attrition, and there were only 2 missing data points over 126 potential observations. Conflicts occurred on 22% of the days, were rated as moderately severe, and were related to poor resident care, lack of information, and staff attitudes. Participants reported significantly lower positive affect (p < .05) and higher negative affect (p < .001) on conflict versus no-conflict days. Exit interviews indicated positive attitudes towards the DDM. CONCLUSIONS: These results support the feasibility of the DDM for providing an in-depth understanding of family-staff conflict and its relationship to caregivers' mood. CLINICAL IMPLICATIONS: The DDM would ideally be used as an outcome measure in studies that assess interventions that target high-conflict family-staff relationships.

Global Host Partner Perspectives: Utilizing a Conceptual Model to Strengthen Collaboration with Host Partners for International Nursing Student Placements.

OBJECTIVES: Collaboration in international nursing student placements requires equitable partnerships between global partners to address areas of shared importance, such as equity and justice in health promotion. This qualitative study was the first to use the Leffers and Mitchell Conceptual Model for Partnership and Sustainability in Global Health to elicit global host partners' perspectives regarding effective collaboration for Canadian community health nursing placements in the Dominican Republic. DESIGN AND SAMPLE: Focus group and semi-structured interview methodology was conducted with Dominican Republic (Dominican and Haitian) host partners (n = 23) about the engagement processes and host partner factors for effective partnership. RESULTS: Dominican (83%) and Haitian (17%) participants, comprised similar numbers of male and female adults aged 18-60 years (mean age = 36 years), represented the full range of the Dominican Republic host partners (e.g., teachers, health professionals). Interpretive analysis revealed themes that included (1) the unique role of the cultural broker; (2) relational collaboration in a collective society; (3) reciprocal approaches that honor local expertise; and (4) contextual socioeconomic and cultural factors that influence partnerships. CONCLUSIONS: Future research and implications at the individual, community, and policy levels are discussed.

Age differences in PTSD among Canadian veterans: age and health as predictors of PTSD severity.

ABSTRACT Background: To date, few studies have investigated age differences in posttraumatic stress disorder (PTSD) symptoms and none has examined age differences across symptom clusters: avoidance, re-experiencing, and hyperarousal. The first objective of this study was to investigate age differences in PTSD and its three symptom clusters. The second objective was to examine age and indices of health as predictors of PTSD symptom severity. Methods: Participants were 104 male veterans, aged 22 to 87 years, receiving specialized mental health outpatient services. Assessments included measures of health-related quality of life, pain severity, number of chronic health conditions, and symptoms of PTSD, both in total and on the symptom clusters. Results: There were significant age differences across age groups, with older veterans consistently reporting lower PTSD symptom severity, both in total and on each of the symptom clusters. Hierarchical regression analyses indicated that the inclusion of health indices accounted for significantly more variance in PTSD symptoms over and above that accounted for by age alone. Pain severity was a significant predictor of PTSD total and the three symptom clusters. Conclusions: This is the first study to report lower levels of PTSD severity among older veterans across symptom clusters. These findings are discussed in relation to age differences in the experiencing and processing of emotion, autobiographical memory, and combat experiences. This study also emphasizes the importance of assessing pain in those with symptoms of PTSD, particularly older veterans who are less likely to receive specialized mental healthcare.

PTSD symptoms and pain in Canadian military veterans: the mediating roles of anxiety, depression, and alcohol use.

Symptoms of posttraumatic stress disorder (PTSD) and pain are often comorbid among veterans. The purpose of this study was to investigate to what extent symptoms of anxiety, depression, and alcohol use mediated the relationship between PTSD symptoms and pain among 113 treated male Canadian veterans. Measures of PTSD, pain, anxiety symptoms, depression symptoms, and alcohol use were collected as part of the initial assessment. The bootstrapped resampling analyses were consistent with the hypothesis of mediation for anxiety and depression, but not alcohol use. The confidence intervals did not include zero and the indirect effect of PTSD on pain through anxiety was .04, CI [.03, .07]. The indirect effect of PTSD on pain through depression was .04, CI [.02, .07]. These findings suggest that PTSD and pain symptoms among veterans may be related through the underlying symptoms of anxiety and depression, thus emphasizing the importance of targeting anxiety and depression symptoms when treating comorbid PTSD and pain patients.

Mental health help-seeking attitudes, utilization, and intentions among older Chinese immigrants in Canada.

OBJECTIVES: This study had three objectives. First, to determine the extent to which demographic factors, perceived social support, and Chinese cultural beliefs predict attitudes toward mental health help seeking; second, to assess mental health utilization; and third, to assess intentions to utilize mental health services among older Chinese immigrants in Canada aged 55 and above. METHOD: A total of 149 older Chinese adults (M = 73.92 years, SD = 9.99, range = 55-95 years) completed a semi-structured interview protocol in Cantonese or Mandarin. Demographic and health information were collected, and questionnaires assessing perceived social support, mental health help-seeking attitudes, and belief in Chinese culture and values were administered. RESULTS: Demographic and health information, perceived social support, Chinese cultural beliefs and values accounted for 21.8% of the variance in help-seeking attitudes. Descriptive data related to mental health utilization and intentions are provided. CONCLUSION: Older Chinese participants exhibited less positive attitudes that were significantly associated with Chinese cultural beliefs and values. Implications for practice with older Chinese adults are also discussed.

Sense of community in long-term care: the views of family caregivers of elderly military veterans.

BACKGROUND: Family involvement in long-term care (LTC) is important but it can prove challenging and result in conflict with staff if families do not feel connected to the LTC facility or if they believe that their contributions are undervalued. According to McMillan & Chavis (1986), sense of community (SOC) refers to a feeling of belonging, having influence, having needs met, and having an emotional connection to individuals in a community, and may be particularly essential for family caregivers of military veterans in LTC. This is the first study that evaluates SOC among family caregivers in LTC. METHODS: Semi-structured interviews and self-report questionnaires assessing caregiver demographics, caregiving variables, and SOC were administered to 46 family caregivers. RESULTS: Caregivers endorsed a SOC that was positively related to key caregiving variables, such as family adjustment and satisfaction with care, and was negatively related to conflict with staff. Notably, caregivers' connections to the military community were positively related to SOC in LTC. Multiple regression analyses indicated that satisfaction with care accounted for the most variance in SOC (32.7%). CONCLUSIONS: This is the first study that examines SOC among family caregivers of military veterans in LTC, a subgroup of family caregivers with unique histories and needs. Although there are measures designed to assess family members' level of satisfaction with different facets of LTC, SOC provides unique information about whether family members feel part of the LTC community as valued partners in care. SOC is an important yet understudied construct that could contribute substantially to our understanding of family-focused care.

Does Caregiving Influence Planning for Future Aging?: A Mixed Methods Study Among Caregivers in Canada.

A mixed method design was used to examine how caregiving and transitioning a family member into long-term care (LTC) influence planning. Participants, aged 50+ from the community, completed self-report questionnaires. Quantitative data evaluated differences between three groups (non-caregivers, caregivers, caregivers with experience in assisting with a LTC transition); and predictive effects of caregiving, care expectations and social support to planning. Interviews among a subsample of caregivers examined how experiences of caregiving, including assisting in a transition to LTC, and social support influenced planning. Results indicated that: (1) caregivers with LTC transition experience planned significantly more than non-caregivers, (2) caregiving, care expectations, and social support significantly predicted of planning, and (3) future care expectation was an important mechanism in the relationship between caregiving and planning. These findings underscore the impact of caregiving experiences on expectations of future care needs and preparation for future care needs, and the importance of social support.

Social Isolation and Psychological Distress Among Older Adults Related to COVID-19: A Narrative Review of Remotely-Delivered Interventions and Recommendations.

The COVID-19 pandemic is associated with several short- and long-term negative impacts on the well-being of older adults. Physical distancing recommendations to reduce transmission of the SARS-CoV2-19 virus increase the risk of social isolation and loneliness, which are associated with negative outcomes including anxiety, depression, cognitive decline, and mortality. Taken together, social isolation and additional psychological impacts of the pandemic (e.g., worry, grief) underscore the importance of intervention efforts to older adults. This narrative review draws upon a wide range of evidence to provide a comprehensive overview of appropriate remotely-delivered interventions for older adults that target loneliness and psychological symptoms. These include interventions delivered by a range of individuals (i.e., community members to mental health professionals), and interventions that vary by implementation (e.g., self-guided therapy, remotely-delivered interventions via telephone or video call). Recommendations to overcome barriers to implementation and delivery are provided, with consideration given to the different living situations.

Depression literacy among older Chinese immigrants in Canada: a comparison with a population-based survey.

BACKGROUND: Investigations of mental health literacy are important because the recognition of a mental health problem is the first step in seeking appropriate mental health care. Lack of recognition is a significant barrier to accessing mental health resources. Older Chinese immigrants are at increased risk for depression; however, there is no research investigating their depression literacy, including their beliefs about treatment, etiology, and prognosis. METHODS: This study investigated depression literacy among 53 older Chinese immigrants in Canada (aged 55-87 years) and compared their literacy to Canadian-born participants of the same age who were part of a larger population-based survey. Depression literacy was assessed through interviews using a case vignette and included the following indices: rates of correct identification of depression; perceived efficacy of various people, professions and treatments; and perceptions of etiology and prognosis. RESULTS: In the Chinese sample, 11.3% correctly identified depression in the case vignette. In contrast, 74.0% of participants in the population-based survey correctly identified depression. Differences in the perceptions of helpful people and interventions, etiology, and prognosis were also noted between the samples. Both samples strongly endorsed physical activity as helpful in the treatment of depression. CONCLUSIONS: In light of these results, it is clear that older Chinese immigrants would benefit from information regarding the symptoms, etiology, and treatment of depression, and that this information may begin to address the serious underutilization of mental health services among this group. Our discussion highlights practice implications and promising interventions.

Geropsychology content in clinical training programs: a comparison of Australian, Canadian and U.S. data.

BACKGROUND: There is a worldwide shortage of mental health professionals trained in the provision of mental health services to older adults. This shortage in many countries is most acutely felt in the discipline of psychology. Examining training programs in clinical psychology with respect to training content may shed light on ways to increase interest among students and improve practical experiences in working with older adults. METHODS: A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology. RESULTS: Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings. CONCLUSIONS: In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.

Screening for mental disorders in residential aged care facilities.

INTRODUCTION: The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities seeks to improve care of persons in residential aged care facilities (RACFs). As part of that effort the current authors have contributed an overview and discussion of the uses of brief screening instruments in RACFs. METHODS: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted. RESULTS: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated. CONCLUSIONS: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.

Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review.

INTRODUCTION: Maintenance of cognitive function into old age is important for ageing populations. Researchers seek to identify modifiable risk and protective factors for cognitive function. One such modifiable factor is functional social support, that is, one's perception of whether their social network can provide resources such as material help, companionship, information and emotional contact, if needed. While the literature generally reports positive associations between functional social support and cognitive function, results vary according to study methods such as the tool used to measure functional social support or the specific cognitive domain under investigation. Our review will summarise the association between functional social support and cognitive function in middle-aged and older-aged adults who reside in any setting (eg, community dwelling, long-term care facilities). We will also identify sources of discrepant findings between studies. METHODS AND ANALYSIS: This protocol was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. PubMed, PsycINFO, Sociological Abstracts, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus will be searched from inception to the present using a search strategy developed with a medical librarian's help. We will supplement the database searches with a grey literature search. English-language or French-language studies with a comparison group will be subject to inclusion, regardless of the measures used to assess functional social support or cognitive function. We will assess risk of bias with the Cochrane Risk of Bias Tool-Version 2 or the Newcastle-Ottawa Scale, narratively synthesise the extracted data and conduct a meta-analysis of studies with similar characteristics (eg, sample age and sex, cognitive function outcomes). Two independent raters will screen articles and assess risk of bias. ETHICS AND DISSEMINATION: This review is timely given the push toward early diagnosis and treatment of dementia/major neurocognitive disorder and other types of cognitive impairment. This protocol does not require a formal ethics review. We will publish our findings in a peer-reviewed journal.

Social support availability is positively associated with memory in persons aged 45-85 years: A cross-sectional analysis of the Canadian Longitudinal Study on Aging.

OBJECTIVES: This study examines the association between a modifiable psychosocial factor, social support availability (SSA), and the memory domain of cognitive function in persons aged 45-85 years. METHODS: We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) (n = 21,241) to conduct multiple linear regression analyses of the association between SSA (overall and four subscales) and memory. The CLSA assessed immediate and delayed recall memory using the Rey Auditory Verbal Learning Test (RAVLT). RESULTS: Higher levels of each type of SSA were positively associated with better performance on both immediate and delayed recall memory. The largest associations (ß coefficients [95% confidence intervals]) for z-score differences on the RAVLT were observed for overall SSA (immediate: 0.07 [0.04-0.10]; delayed recall: 0.06 [0.02-0.09]) and the emotional/informational subscale (immediate: 0.06 [0.03-0.09]; delayed recall: 0.05 [0.02-0.08]). CONCLUSION: SSA is modifiable and positively associated with memory. Public health initiatives to provide support resources such as material aid, emotional support, or companionship may entail positive benefits for memory. Promotion of SSA is also important for policies encouraging early diagnosis and intervention in dementia.

The prevention of depression in nursing home residents: a randomized clinical trial of cognitive-behavioral therapy.

The prevention of depression in individuals who are at risk is important for affected individuals, their family members, and for society at large. This study presents the results of a randomized clinical trial aimed at the prevention of depression in nursing home residents. Residents were screened with the Geriatric Depression Scale (GDS) and a diagnostic interview. Those with elevated GDS scores who did not meet diagnostic criteria for depression were randomly assigned to a treatment or control (treatment as usual, TAU) condition. The treatment was an adaptation of the Coping with Stress program developed by Clarke et al. (1995; Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312-321), and focused on various components typical of cognitive-behavioral treatment (CBT) programs (e.g. increasing pleasant events, reducing negative cognitions). Both groups were assessed on measures of depression before treatment, after treatment, and at 3- and 6-month follow-up points. Compared with the TAU group, residents receiving the intervention showed considerable improvement over the 6-month follow-up on the GDS. Average scores on the GDS, for example, went from 14.0 to 9.4 in the CBT group over the course of treatment and follow-up, vs. scores from 13.4 to 12.3 for the TAU group over the same time. However, results on the Center for Epidemiological Studies Depression Scale at 3 months were nonsignificant. Overall, the results of this study suggest that a brief, group-based CBT program can have significant benefit in nursing home residents at risk for depression.