Implementation of STAR-VA for behavioral symptoms of dementia in acute care: Lessons learned.

As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.

Identifying Specific Gaps in Knowledge of Aging and Examining Its Relation to Biases Toward Older Adults.

Accurate aging knowledge is key to reducing ageist attitudes that impact older adult well-being. We first investigated how aging knowledge and negative and positive age-bias indirectly expressed via aging knowledge responses were related to an explicitly negative ageism measure. We then identified specific gaps in the aging knowledge of emerging adults and middle-aged adults. More negative ageism correlated with less aging knowledge overall and in psychological and social, but not biological, domains. Negative ageism correlated with negative age-bias, but not positive age-bias, expressed via aging knowledge responses. Knowledge of aging was poorest regarding social and psychological aspects of aging and best regarding biological aging. Middle-aged adults had slightly, but significantly, more accurate aging knowledge and less negative age-bias than emerging adults; positive age-bias did not differ by age-group. These results suggest that effectiveness of anti-ageism educational interventions may be enhanced if focused on improving knowledge of social and psychological aging.

Effects of Alzheimer's Diagnosis and Gender on Ageist Attitudes, Aging Anxiety, and Emotional Reactions to Older Adults.

BACKGROUND AND OBJECTIVES: We investigated whether ageist attitudes, aging anxiety, and emotional reactions to older adults differ based on Alzheimer's disease (AD) diagnosis, older adult gender, and participant gender, as well as their interactions. RESEARCH DESIGN AND METHODS: Using an experimental design, 291 participants (176 men, 115 women; 19-55 years) were randomly assigned to read 1 of 4 descriptions of an older adult that varied cognitive health and gender. Measures of ageist attitudes, aging anxiety, and emotional reactions to the older adult were completed online. RESULTS: Relative to a cognitively intact older adult, an older adult with AD evoked less ageist attitudes, less aging anxiety, more compassion, and less emotional distance. A significant interaction between older adult gender and participant gender indicated women felt greater emotional distance from an older adult man than an older adult woman, while men showed no significant difference. DISCUSSION AND IMPLICATIONS: The more positive emotions and less ageist responses to an older adult with AD could present as paternalistic and diminish older adults' agency. Women may prioritize shared gender identity over age, which has implications for caregivers and health professionals working with older adults.

Maximizing Veterans Health Affairs Community Hospice Collaborations: Review of Perceived Resource Needs to Support Veterans at End of Life.

Within the United States, approximately 330 000 military veterans die annually, but only 5% of deaths occur in Veterans Health Administration (VHA) facilities. To help provide end-of-life care for veterans, the VHA built community partnerships with community hospice and palliative care (HPC) organizations. Veterans experience unique psychosocial factors making it vital to ensure HPC organizations have access to veteran-specific knowledge and resources to reduce suffering. To better understand the strengths and limitations of these partnerships, community HPC staff (N = 483) responded to quantitative and qualitative survey questions developed using an access to care theory for veterans. Survey responses demonstrated variable perceptions of access to VHA care and resources. Respondents reported excellent experiences (44%) and relationships with their local facility (50%) and had a reliable contact who provided needed assistance (92%). Thematic analysis identified a need for VHA care and barriers to access, which were associated with technical characteristics, and geographical and cultural issues. These findings can help inform future research and policy regarding access to VHA resources for end-of-life care for veterans in the community and guide resource development for community HPC providers.

Older Adult Health Condition as a Moderator of How Middle-Aged Adults' Ageist Attitudes and Aging Anxiety Relate to Their Compassion for and Emotional Distance from Older Adults.

OBJECTIVES: Using Terror Management Theory and Social Identity Theory as frameworks, we examined whether the relationship of aging anxiety to compassion for and emotional distance from older adults was mediated by ageist attitudes and whether an older adult's health condition moderated these relationships. METHOD: Using an experimental design, 292 middle-aged adults (40-55 years) were assigned to read a description of an older adult with Alzheimer's Disease (AD), prostate cancer, or who was healthy. RESULTS: The relationship of aging anxiety to compassion was mediated by ageist attitudes in both the AD and prostate cancer conditions. More ageist attitudes related to less compassion more strongly for unhealthy older adult conditions than for the healthy older adult condition as well as for the AD condition compared to the cancer condition. Ageist attitudes related to more emotional distance from the older adult with AD than the older adult with cancer. DISCUSSION: Older adults with AD may evoke a stronger relationship of ageist attitudes with emotions toward older adults. These findings extend previous research by examining middle-aged participants, a population often serving as caregivers to their aging relatives.

Advancing Trauma-Informed Care Education for Hospice and Palliative Staff: Development and Evaluation of Educational Videos.

Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit. Through problem identification and needs assessment, we identified 6 goals and 28 specific content objectives presented through cinematic action with flashbacks or voice-over narration with graphics. Videos were evaluated through a survey (N = 155) and analysis of "chat" responses (N = 186) to targeted questions during a webinar presentation to clinicians (N = 345). Approximately 75% rated videos as "very much" relevant to needs, having helped learn something new, and realistic. Analysis of chat responses showed videos conveyed most content objectives (92%). In addition, participants stated videos were helpful in demonstrating nursing skills of listening, responding, and displaying empathy, as well as showing case presentations involving cognitive impairment and the patient experience. Participants expressed a desire for longer videos/more information including a wider range of PTSD presentations and comorbidities.

Experiences with and attitudes toward interprofessional health care teams among American clinical, counseling, and school psychology doctoral students: a mixed methods study.

Attitudes toward interprofessional collaboration influence interprofessional health care team (IPHCT) functioning and quality of patient care. Yet, research has not examined the attitudes and experiences of psychology doctoral students on IPHCTs. Utilizing a volunteer sample of 214 clinical, counseling, and school psychology doctoral students from at least 47 doctoral programs in the United States, this study aimed to clarify psychology doctoral students' experiences on IPHCTs and explore predictors of their attitudes toward IPHCTs. Discovery-oriented analysis and hierarchical multiple regression were used to identify themes of students' self-reported interprofessional experiences and significant predictors of positive attitudes obtained via online survey questionnaires. Students who had worked on IPHCTs commonly reported taking roles of mental health therapeutic service provision and consultation and reported difficulty with team dynamics and navigating hierarchical structures. Students perceived the psychologist role primarily as clinical expert and team leader. Students reported making positive contributions, increased competency in interprofessional practice, and improvement in patient care as the most common benefits of IPHCTs. Each additional year spent on an IPHCT was related to more positive perceptions of the quality of care delivered by IPHCTs as well as greater endorsement of positive interprofessional socialization practices.

Hospice and palliative care clinicians' perceptions of posttraumatic stress disorder at end-of-life in military veterans.

At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms.