Adult Day Services for People With Intellectual and Developmental Disabilities: A Scoping Review.

BACKGROUND: Adult day services (ADS) are therapeutic, social, and health-related activities that keep people in their homes, rather than institutional settings. While there is a growing body of literature on ADS for older adults, there is far less information available about ADS for younger adults with intellectual and/or developmental disabilities (IDDs). METHOD: Researchers conducted a scoping review of 6 databases (892 total articles). RESULTS: After applying inclusion and exclusion criteria, 74 full articles were reviewed, with 10 articles meeting study requirements. The research team found the literature is limited to simple descriptive reports or interventions that use ADS as a platform. CONCLUSIONS: Simply put, we know very little about the services provided to younger adults with IDD in ADS. Implications for future research are discussed, including the need to catalog the services offered in ADS for younger adults with IDD and to evaluate their impact on participant well-being.

Healthy Aging and Older Adults with Autism: A Scoping Review.

BACKGROUND AND OBJECTIVES: Autism Spectrum Disorder (ASD) is a lifelong diagnosis. While several studies have examined the effects of autism throughout childhood, few have considered older adulthood and the difference between the allistic (i.e., persons who are not autistic) population and autistic older adults. In literature regarding healthy aging, there is sparse evidence regarding the intersections of older adulthood and autism. The purpose of this scoping review was to examine the state of literature regarding autistic older adults and the domains of healthy aging, utilizing the framework conceived by Arksey and O'Malley (2005). RESEARCH DESIGN AND METHODS: To identify the research question, we took the following steps: identify the relevant studies; select studies; chart the data; and collate, summarize, and report the results. The specific domains of healthy aging considered include physical health, mobility, mental health, cognition and memory, and social connectedness. RESULTS: A total of 35 articles were selected for final review. Fifty-seven percent of these studies considered only one domain of healthy aging, 23% studied two domains, while 14% measured three domains and 6% assessed four domains. No study considered all five domains. Of the five domains considered for this scoping review, mental health and cognition and memory were the most represented domains in the studies. DISCUSSION AND IMPLICATIONS: Overall, healthy aging among autistic older adults is largely understudied. More research is needed to better identify and tailor interventions and services for autistic older adults and their families to support healthy aging.

Validation of the Grief Support in Healthcare Scale among frontline nursing professionals working in COVID-19 inpatient wards in Korea.

Introduction: During the COVID-19 pandemic, healthcare workers (HCWs) have been exposed to higher levels of anxiety and psychological stress than the general population. Nurses who cared for COVID patients could not avoid repeated mourning as they witnessed the deaths of their patients. Therefore, tools are needed to evaluate whether there is adequate support for the grieving process of HCWs in both qualitative and quantitative manners. Methods: Data from 229 nurses who witnessed the deaths of COVID-19 inpatients were analyzed using an online survey of nurses working in three tertiary hospitals. Factor analysis was conducted to validate the 10-item Korean version of Grief Support in Healthcare Scale (GSHCS). Stress and Anxiety to Viral Epidemics-9 was used to measure stress and anxiety caused by coronavirus, Generalized Anxiety Disorder-7 was used to measure overall anxiety, and Patient Health Questionnaire-9 was used for depression. Convergent validity correlation analysis was also performed with GSHCS. Results: The two-factor model showed a good fit for the 10-item GSHCS (χ 2 = 35.233, df = 34, p = 0.410, CFI = 0.999, TLI = 0.990, RMSEA = 0.013, SRMR = 0.064). Cronbach's alpha is 0.918 and McDonald's omega is 0.913, suggesting that the 10-item version of the GSHCS is reliable for determining psychometric properties. Conclusion: According to this study, the 10-item Korean version of the GSHCS is a reliable and valid measure of psychological support for grief among frontline nursing professionals who have witnessed the deaths of patients they cared for while working in COVID-19 inpatient wards. A two-factor model of the GSHCS has a good model fit and good convergent validity with other rating scales that measure viral anxiety, depression, and general anxiety.

"Knowing when it's time to take a break": Nursing home social workers' coping during COVID-19.

Background: Nursing home (NH) social workers face many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs. Methods: This study employed a cross-sectional survey of NH social workers via social media and professional networks about their coping strategies during COVID-19. Open-ended responses were analyzed qualitatively using the rigorous and accelerated data reduction technique (RADaR). Results: The study included a sample of 63 (N = 63) NH social workers. Four themes defined ways the in which NH social workers coped with stress during COVID-19, including relying on friends and family, mindfulness and spirituality/religion, self-care strategies, and setting boundaries at work. Conclusion: These techniques appear to be effective; however there remains a need for institutional programs and policies to provide the time and space to holistically support coping in NH social workers and to prevent burnout and turnover, particularly during times of crisis.

Positive Aging and Death or Dying: A Scoping Review.

BACKGROUND AND OBJECTIVES: This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying. RESEARCH DESIGN AND METHODS: An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models. RESULTS: The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models. DISCUSSION AND IMPLICATIONS: The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.

COVID-19 and the Need for Adult Day Services.

COVID-19 has shone a harsh light on the inequities of health care in the United States, particularly in how we care for older people. We summarize some of the effects of lockdown orders on clients, family caregivers, and staff of adult day service programs throughout the United States, which may serve as a counterpoint to scientific evidence suggesting a lack of efficacy of these programs. Given the ramifications of state lockdown orders for users and staff of the long-term services and support system, we provide recommendations to better support community-based programs and those they serve. Specifically, (1) adult day programs should be classified as essential, (2) a focus on the value of adult day and similar programs is needed, and (3) an exploration of new ways to finance home and community-based services is warranted. Such advances in policy and science would help to integrate adult day services more effectively into the broader health care landscape.

Social Networks in an Assisted Living Community: Correlates of Acquaintance and Companionship Ties Among Residents.

OBJECTIVES: Social relationships are important for older adults' well-being, including those who live in assisted living (AL) communities. This study explores coresident networks within an AL community and identifies factors associated with residents' social ties. METHODS: Acquaintance and companionship networks within the community are described using cross-sectional survey data (N = 38). We use inferential network statistical methods to estimate parameters for factors associated with residents' acquaintance and companionship ties. RESULTS: Residents reported an average of 10 acquaintances and almost 4 companionships with other residents in the sample. The likelihood a resident had an acquaintance was associated with higher levels of cognitive functioning (p < .05), higher levels of physical limitations (p < .01), living in the AL community for a longer time (p < .01), and less frequent contact with outside family and friends (p < .05). Acquaintances were more likely between residents who moved in around the same time as each other (p < .01), lived on the same floor (p < .001), or had similar levels of physical limitations (p < .05). Companionships were more likely to be reported by male residents (p < .05) and residents with higher levels of cognitive functioning (p < .05) or depressive symptoms (p < .05). Longtime residents were more popular as companions (p < .01). Companionships were more likely between residents who lived on the same floor (p < .001) or were similar in age (p < .01). DISCUSSION: This research contributes to the literature of older adults' nonkin social relationships by providing detailed descriptions of the acquaintance and companionship networks within an AL community, quantifying correlates of residents' social ties, and distinguishing between acquaintances and companions.

Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19.

OBJECTIVES: Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes; however, it is unclear how social workers perceive their preparedness during this time. METHODS: This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction technique. RESULTS: Data are based on a sample of 63 (N = 63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. DISCUSSION: These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.

The use of community advisory boards in pragmatic clinical trials: The case of the adult day services plus project.

Community advisory boards (CABs) have become increasingly common and important in translational research in health care including studies focusing on home and community-based services. CABs are composed of stakeholders who share interest in research projects and typically include patients/clients, practitioners, community members, policymakers, and researchers. CABs advise researchers on issues ranging from research design and recruitment to implementation and dissemination. In this article, the researchers detail their experiences with the CAB for a pragmatic clinical trail of Adult Day Services (ADS) Plus, an education and support intervention for family caregivers of older adults with dementia using adult day services. Lessons learned, guidelines, and best practices are then presented for developing and working with a CAB in healthcare research.

Considerations for Developing Online Bereavement Support Groups.

The loss of a family member or friend can have profound psychological and physical implications, particularly for individuals without bereavement support services. Online support groups can be an effective means of extending services beyond the traditional modes of delivery. This is especially true for populations that include isolated individuals and those with limited support networks, limited transportation, challenging time commitments, or reside in communities with limited services available. The literature over the last 10 years was reviewed to discern the potential opportunities and challenges of providing online bereavement support group services. Discussed are challenges for recruitment of participants, availability of technology resources, addressing privacy and confidentiality issues, participants' knowledge of technical equipment, legal considerations, ethical considerations, accessibility, and other best practices. Diverse populations such as adolescents, older adults, and rural communities must be uniquely considered when using online support groups.

Developing a Set of Uniform Outcome Measures for Adult Day Services.

Adult day services (ADS) provide care to adults with physical, functional, and/or cognitive limitations in nonresidential, congregate, community-based settings. ADS programs have emerged as a growing and affordable approach within the home and community-based services sector. Although promising, the growth of ADS has been hampered by a lack of uniform outcome measures and data collection protocols. In this article, the authors detail a recent effort by leading researchers and practitioners in ADS to develop a set of uniform outcome measures. Based upon three recent efforts to develop outcome measures, selection criteria were established and an iterative process was conducted to debate the merits of outcome measures across three domains-participant well-being, caregiver well-being, and health care utilization. The authors conclude by proposing a uniform set of outcome measures to (a) standardize data collection, (b) aid in the development of programming, and (c) facilitate the leveraging of additional funding for ADS.

Embedding caregiver support in community-based services for older adults: A multi-site randomized trial to test the Adult Day Service Plus Program (ADS Plus).

There are over five million people in the United States living with dementia. Most live at home and are cared for by family. These family caregivers often assume care responsibilities without education about the disease, skills training, or support, and in turn become at risk for depression, burden, and adverse health outcomes when compared to non-dementia caregivers. Despite over 200 caregiver interventions with proven benefits, many caregivers lack access to these programs. One approach to enhance access is to embed evidence-based caregiver support programs in existing community-based services for people with dementia such as adult day services (ADS). Here we describe the protocol for an embedded pragmatic trial designed to augment standard ADS known as ADS Plus. ADS Plus provides family caregivers with support via education, referrals, and problem-solving techniques over 12 months, and is delivered on-site by existing ADS staff. Embedding a program in ADS requires an understanding of outcomes and implementation processes in that specific context. Thus, we deploy a hybrid design involving a cluster randomized two-group trial to evaluate treatment effects on caregiver wellbeing, ADS utilization, as well as nursing home placement. We describe implementation practices in 30 to 50 geographically and racially/ethnically diverse participating sites. Clinical trial registration #: NCT02927821.

Acute Hemolytic Transfusion Reaction Due to Anti-Kpa Antibody.

BACKGROUND: Kpa (KEL3, Penney) is a red blood cell antigen within the Kell system, first described in 1957, that occurs in less than 2 percent of the population. Although anti-Kpa antibodies were identified in 2-5 percent of those with alloantibodies among patients requiring chronic transfusion, only five previously published case reports of anti-Kpa reactions were identified. CASE REPORT: Reported here is a case of an elderly female who experienced an acute hemolytic transfusion reaction due to this antigen. Following initiation of blood transfusion, she experienced a sudden onset of rigorous chills, accompanied by elevated temperature, tachycardia, and hypertension. Laboratory studies showed uremia, elevated creatinine, positive direct Coomb's, and low haptoglobin. Serology revealed anti-Kpa antibody. CONCLUSION: This report is only the sixth, to our knowledge, of a significant reaction attributable to anti-Kpa and only the second of an acute hemolytic reaction associated with it. It serves as a reminder of the potential of low incidence antigens causing severe reactions; this potential should be considered when evaluating acute hemolytic reaction.

On fertile ground: An initial evaluation of green care farms in the United States.

Green care farms (GCF) provide unique opportunities to persons with disabilities to engage in meaningful and therapeutic activities in farm settings. In this pilot study, the researchers examined the feasibility and impact of the first GCF in the United States. Qualitative interviews (N = 19) and thematic analysis were conducted. GCF participants and family members were enthusiastic about participation and identified benefits such as respite and improved mood. Administrators and farmers indicated that GCF challenged the status quo of funding, programming, and farming. Administrators speculated that the future success of GCF relies upon administrative expertise, local relationships, and managing risk and liability.

Korean Survivors of the Japanese "Comfort Women" System: Understanding the Lifelong Consequences of Early Life Trauma.

Prior to and during World War II, thousands of girls and young women were abducted from Korea and forced into sexual slavery by the Japanese government. Termed comfort women, these girls and young women suffered extreme sexual, physical, and emotional abuse and trauma. Research on this group is not well-developed and people know little of the impact of this early life trauma on the lives of these women who are now in later life. Using snowball sampling, 16 older adult survivors of the comfort women system participated in semistructured qualitative interviews. Thematic analysis was conducted to gain an understanding of the trauma that these women suffered and how it impacted their lives. Results revealed the depths of the abuse these women suffered, including repeated rapes, physical beatings, humiliation, forced surgery and sterilization, and social exclusion. These early traumatic experiences appeared to reverberate throughout their lives in their family relations, their inability to marry and to conceive children, and their emotional and physical well-being throughout the life course and into later life. The experiences of these survivors illustrate the lasting impact of early-life trauma and can guide interventions with current survivors of sexual abuse or trafficking.

Decreasing the critical value of hemoglobin required for physician notification reduces the rate of blood transfusions.

Red blood cell transfusions have been cited as one of the most overused therapeutic interventions in the USA. Excessively aggressive transfusion practices may be driven by mandatory physician notification of critical hemoglobin values that do not generally require transfusion. We examined the effect of decreasing the critical value of hemoglobin from 8 to 7 g/dL at our institution. Along with this change, mandatory provider notification for readings between 7 and 8 g/dL was rescinded. Transfusion rates were compared retrospectively during paired 5-month periods for patients presenting in three key hemoglobin ranges (6.00-6.99, 7.00-7.99, and 8.00-8.99 g/dL). A change in transfusion practices was hypothesized in the 7-8 g/dL range, which was no longer labeled critical and for which mandated physician calls were rescinded. Transfusion rates showed a statistically significant 8% decrease (P≤0.0001) during the 5-month period post change in our transfusion practices. This decrease in the 7.00-7.99 g/dL range was significantly greater than the 2% decrease observed in either the 6-6.99 g/dL (P=0.0017) or 8-8.99 g/dL (P≤0.0001) range. Cost savings of up to $700,000/year were extrapolated from our results showing 491 fewer units of red blood cells transfused during the 5-month post change. These cost savings do not take into account the additional impact of complications associated with blood transfusions.

Beyond respite: the role of adult day services in supporting dementia caregivers.

Adult day services (ADS) are the leading provider of community-based care for persons with dementia and their caregivers. While the provision of caregiver respite is well-documented, little is known about the provision of other forms of dementia caregiver support. Logistic regression analyses of ADS providers (N = 297) in the MetLife Study indicated that the number of hours of social work support was a significant predictor of case management services, while nonprofit status was a significant predictor of caregiver education and support groups. These findings have implications for practice and policy related to this growing provider of dementia services.

Auto Therapy: Using Automobiles as Vehicles for Reminiscence With Older Adults.

Reminiscence can be beneficial for older adults and contribute to well-being and ego integrity. In this exploratory pilot study, researchers assessed the feasibility and tolerability of a novel reminiscence intervention using automobiles as the focal point. Nineteen older adults (N = 19) were asked to reminisce using photographs of automobiles from across their lifespan. The RE-AIM framework was used to assess the intervention in terms of reach, effectiveness, adoption, implementation, and maintenance. The intervention was well-received, quickly established rapport, and effectively fostered reminiscence. Social workers may find this intervention useful in helping older adults to explore their lives.