"A Soft Death": Perceptions and Attitudes Toward Palliative Care in Senegal.

Background and Objectives: Palliative care (PC) is a specialty medical service that aims to address the bio-psycho-social-spiritual needs of patients with serious illnesses and their care partners. Despite the value of PC, its expansion in Sub-Saharan Africa has been uneven and particularly underdeveloped in Senegal due to variability in access to training resources and funding. This study sought to understand the current landscape of PC services in Senegal and the barriers and opportunities in its growth. Research Design and Methods: Semistructured interviews were conducted with six PC clinicians, four caregivers of people with serious illnesses, one driver for a PC service, and one public health professor, all native to Senegal. Questions addressed their experience delivering or receiving PC, perceptions of barriers to implementation and access, and recommendations for additional resources and initiatives. Interviews were translated and transcribed from French into English. Transcripts were qualitatively coded for concepts during open and focused coding to identify themes. Results: Five themes were identified: (1) the current landscape of PC, (2) barriers to implementing PC, (3) strategies and philosophies in care, (4) unique features of Senegalese culture, and (5) the future of PC. Discussion and Implications: Our findings demonstrate that PC in Senegal remains an underresourced and underutilized specialty medical service, but work is being done by personally committed clinicians. Results can inform PC expansion by highlighting important cultural factors influencing care in Senegal, as well as the need to expand training opportunities for clinicians, increase education of other medical providers and the public about the nature of PC, integrate PC into the healthcare system, and expand research to evaluate the impact of these resources. PC has the potential to be an important force for improving the quality of life for Senegalese patients and their care partners.

Building the Geropsychology Workforce: A National Survey and Virtual Conference Define Critical Obstacles and Steps Forward.

The number of psychologists prepared to work with older adults falls far short of the demand. In the face of perceptions of a worsening geriatric workforce shortage, we describe the process of developing and implementing a national virtual conference aimed at generating solutions. A preconference survey (n = 174) found fewer applicants than desirable for aging-targeted graduate student, trainee, clinician, or academic positions (58.6%) and decreased student interest in aging (43.7%), with downstream consequences of filling age-targeted positions by those without aging backgrounds (32.3%), difficulty securing funding for aging-related positions (28.7%), and loss of aging-related positions (27.0%). Two fifths (40.7%) felt these problems have worsened as compared to 5 years ago. Qualitative responses provide detailed perspectives on these barriers and strategies generally and in particular as relates to racial and ethnic diversity and academic geropsychology. During a 2-day conference, attendees developed and prioritized strategies. Following a postconference survey to ascertain interest in volunteering, seven work groups were formed that have made progress on these issues. A virtual conference provides an inclusive, cost-effective, and fruitful opportunity to discuss workforce concerns in geropsychology and to generate numerous ideas to promote positive change.

Patient and caregiver questions and clinician responses during initial outpatient neuropalliative care appointments.

Objective: Open communication during appointments exemplifies person-centered care. The current study characterized questions asked by persons with neurologic illnesses and their caregivers-and clinicians' responses to those questions-during initial outpatient palliative care appointments. Methods: We coded type (direct or indirect) and topic of questions stated by patients and their caregivers in audio recordings from 38 initial outpatient palliative care appointments. We also coded the completeness and quality features of clinicians' responses. Results: Patients and caregivers stated 556 total questions; most were direct questions (79.7%) and primarily about symptoms, treatment, and lifestyle issues. Clinicians responded to more than 90% of all questions. Responses to both question types were similar in completeness and quality, but clinicians more frequently offered support in response to direct questions and gave recommendations in response to indirect questions. Conclusion: Persons with neurologic illnesses and their caregivers use different question types to obtain information about symptoms and treatment during initial palliative care appointments. Results may guide clinician training and patient education for optimizing information exchange in palliative care. Innovation: This study is the first to explore patient and caregiver use of indirect questions in neuropalliative care appointments and the quality of clinicians' responses to those questions.

Heterogeneity in Measures and Rates of Reported Dementia and Subjective Memory Complaints Across U.S. National Surveys.

OBJECTIVES: Several U.S. health surveillance surveys contain items related to self- and proxy reports of dementia and subjective memory complaints (SMC). Despite their similar content, these items differ in terminology, item specificity, and time frame. The goal of this study was to analyze whether item features might influence endorsement rates for dementia and SMC. METHODS: We calculated design-appropriate estimates for the endorsement of dementia and SMC across U.S.-based national surveys and employed pairwise comparisons to evaluate endorsement rates across surveys. We also examined item characteristics to explore possible effects on endorsement rates. RESULTS: Endorsement rates were wide-ranging for dementia (ranging from 2.7% to 9.9%) and SMC (5.6% to 46.6%). Pairwise comparisons revealed statistically significant differences on most dementia-related items (76%), and all SMC comparisons (100%). Items varied substantially in the terminology used to assess dementia and SMC (e.g., "dementia" vs "Alzheimer's disease") and used different time frames (e.g., "past month" vs "5 years"). DISCUSSION: National survey data on reported dementia and SMC can have important research, training, and policy implications, yet endorsement rates vary widely across surveys. That variability could emerge from subtle but influential item characteristics, and our findings highlight the need for item harmonization, in even their most basic characteristics. Standardizing items across national surveillance surveys facilitates comparison across surveys so that we can better understand the true burden of these conditions to inform public health initiatives.

Development and evaluation of a national careers in aging webinar series for psychology trainees.

Trainees may be interested in careers in aging but unfamiliar with career options, leading to a shortage in the geriatric workforce. In response to needs identified at a national geropsychology training conference, a multisite faculty group developed a six-session webinar series about careers in geropsychology, detailing career options in six unique settings. Each webinar session featured a moderated discussion with a panel of four professionals currently employed in the career of interest. The webinar was advertised to clinical and counseling psychology trainees with a potential interest in age-related careers, with evaluation of the series primarily including trainees from graduate programs, clinical internships, and postdoctoral fellowships. Participants rated their attitudes and beliefs about each career option at pre- and post-discussion. On average, each webinar session was attended by 48 individuals (SD = 12, range = 33-60). At baseline, attendees reported significantly more interest in careers in clinical practice compared to other careers, and interest in university settings increased from pre- to post-discussion. Across all six sessions, participants reported increased understanding of training experiences that would be helpful in pursuing that specific career. Findings point to the feasibility and utility of webinars for enhancing interest and confidence in pursuing careers in aging.

Effects of a Patient Question Prompt List on Question Asking and Self-Efficacy During Outpatient Palliative Care Appointments.

CONTEXT: Question prompt lists (QPLs) promote participation during medical appointments, including in the context of serious illness care. However, no studies have used parameters of a theoretical framework to examine the effects of QPL use in outpatient palliative care. OBJECTIVES: The current pilot randomized controlled trial evaluated use of a 25-question QPL during initial outpatient palliative care appointments. We applied tenets of Self-Efficacy Theory to investigate how use of a QPL affected appointment participation and perceived self-efficacy. METHODS: Participants were patients and care partners attending the patient's first palliative care appointment. Participants either received a QPL before the appointment (n = 29 appointments) or usual care (n = 30 appointments). Audio recordings of appointments were coded for total questions asked. Participants reported perceived self-efficacy in question asking pre- and postappointment. Analysis of variance was used to compare appointment participation between study conditions, and a linear mixed effects model was used to compare changes in ratings of perceived self-efficacy. RESULTS: Participants who received the QPL did not ask significantly more questions compared to participants in usual-care appointments. There was a main effect of time on self-efficacy in question asking, such that self-efficacy increased from pre- to postappointment, but there was no effect of the intervention. CONCLUSION: Despite their promise in previous studies, results of the current study suggest that QPLs may lack potency to shift patient and care partner question asking in palliative care appointments, and that other mechanisms outlined in Self-Efficacy Theory may characterize the relation between question asking and self-efficacy.

Situating the Pandemic in the Life-Course: Older Adults' Perspectives on the Challenges and Positives of the COVID-19 Pandemic.

Older adults experienced the highest rates of infections and deaths and significant social isolation during the COVID-19 pandemic. While these negative impacts are important to address, the positive outcomes among older adults during the pandemic are equally important. A survey was distributed to adults aged 65 or older living in St. Louis, Missouri from August 2020 through March 2021 to characterize the challenges and positives they found during the pandemic. A total of 103 older adults participated. Compared to previous times in their lives, a majority of participants felt the pandemic had been more disruptive (62%) and more confusing (78%) and a majority were more worried (58%) and more afraid of dying (53%) during the pandemic. The most common positives were increased emotional well-being (23% of responses) and stronger personal connections (20% of responses). This ability to identify positive outcomes of the pandemic demonstrates the resilience of older adults and counters the ageist narrative that dominated the dialogue early in the pandemic, which depicted older adults as weak, vulnerable, and dispensable. As the pandemic evolves, nurturing and leveraging these positives will be key to combatting the cycle of fear and restrictions that the pandemic could bring.

House Hunters, Gerontology Style: a problem-based learning classroom activity for undergraduate students.

Problem-based learning is an evidence-based, pedagogical approach that invites students to solve complex, real-life problems using knowledge learned in the classroom. Effective use of problem-based learning in undergraduate gerontology courses, specifically, is likely to deepen students' knowledge about course content related to aging and may also promote students' long-term interest in gerontology. House Hunters: Gerontology Style is a problem-based learning activity that can be used in small-group discussions to facilitate students' understanding of issues related to relocation and homebuying in older adulthood. In this activity - based on the popular television show - students act as real estate agents for a fictional older couple relocating closer to adult children. Assignment features can be tailored easily by the instructor to optimize specific learning objectives. In an evaluation of the activity, students who completed this activity reported that it was engaging, that it enabled them to apply material from the class, and that it facilitated their application of course material to a "real world" problem. Suggestions for modifications to future iterations of this assignment may include a more pointed focus on budgetary constraints on homebuying in older adulthood, approaching homebuying from a life course lens, and considering the role of disparities in the home buying process.

Older adults' perceptions and experiences of ageism during the COVID-19 pandemic.

The current study investigates older adults' perceptions of ageism in the United States during the COVID-19 pandemic. Using tenets of Stereotype Embodiment Theory and the Behaviors from Intergroup Affect and Stereotypes Map framework, we sought to (a) examine whether older adults experienced ageism as self-relevant during the pandemic and (b) understand whether older adults experienced certain media messages and interpersonal behaviors during the pandemic and interpreted them as being motivated by potentialpaternalistic age stereotypes. Older adults aged 65 and older recruited from the community (n = 73) participated in a semi-structured interview about their perspectives on ageism toward older adults during the pandemic. Participants also completed an online survey about their experiences with a range of messages and interpersonal behaviors throughout the pandemic. We thematically analyzed interview data and identified three primary themes: self-relevance of age stereotypes; awareness of negative, overgeneralized portrayals of older adults; and defenses against self-relevance of age stereotypes. Survey responses were analyzed using descriptive statistics and frequency counts and suggest that participants attributed messages and behaviors potentially imbued with paternalistic ageism as motivated primarily by care and concern for older adults. The findings add to the field's understanding of older adults' experiences and perceptions of ageism in the media and in interpersonal behaviors in the context of COVID-19.

The Association Between Patterns of Social Engagement and Conversion From Mild Cognitive Impairment to Dementia: Evidence From the Health and Retirement Study.

OBJECTIVES: This study examined the association between patterns of social engagement and conversion from cognitive impairment, no dementia (CIND) to dementia. It also tested whether social engagement is associated with conversion independently from physical and cognitive engagements. METHOD: Data from 2 waves (2010 and 2014) of the Health and Retirement Study (HRS) were used. The sample consisted of 1227 people who had CIND in 2010. To identify the heterogeneity of social engagement, latent class analysis was utilized. Multinomial logistic regression analysis was utilized to investigate the association between patterns of social engagement and probability of conversion to dementia and death or dropout. RESULTS: The result showed that patterns of social engagement that represent higher level and more variety of social engagement were associated with lower probabilities of conversion to dementia in 4 years but not with probabilities of death or dropout. The relationship held after controlling for physical and cognitive engagements. DISCUSSION: Findings implied that promoting social engagement may be protective against developing dementia even for the high-risk group of people with CIND. Future studies should investigate the mechanism behind the relationship between patterns of social engagement and lower probabilities of conversion to dementia.

Mental health and aging in the 2020s.

The COVID-19 pandemic has brought age bias and the unmet mental health needs of older adults into bold relief. Even before the pandemic, the psychological needs of older adults often went unaddressed, or were poorly addressed by a system that lacks an adequate number of providers and insufficiently integrates geropsychological services across care settings. In the decade ahead, the number of older adults in the United States will continue to grow, with the potential for expanded demand and contracted service options. Life changes that typically occur with aging will interact with societal upheavals (pandemic, civil unrest, economic inequality) to exacerbate the mental health needs in the current cohort of older adults and the "near old." At the same time, ageism, inequitable access, and financial and policy constraints may limit health care access. Following a review of current demographic and epidemiological data, we describe several trends that will affect the prevalence of mental health issues among older adults and how mental health care is delivered, and we discuss their implications for education, research, and practice. For both personal and professional reasons, all psychologists can benefit from understanding these trends in aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Advancing Your Confidence as an Educator (ACE): An Academic-VA Partnership to Enhance Educator Skills and Improve Attitudes About Careers in Aging.

Previous research suggests some psychologists may not consider academic careers because of doubts about their teaching competency, and this is especially true for psychologists interested in aging (i.e., geropsychologists). To enhance competencies in the practice of education, we developed a webinar series, Advancing Your Confidence as an Educator, to bolster skills and attitudes toward teaching and improve attitudes about careers in aging. Seven hour-long webinars addressed key skills in developing and executing courses and professional presentations, and 2 panel sessions addressed attitudes toward teaching by featuring early- and later-career professionals discussing their paths to and satisfaction with jobs as educators. Attendance across the highly interactive sessions was robust (M = 50). Evaluation data suggest the webinar was effective in meeting educational needs. To promote sustainable impact, the webinars are archived and freely available online. Challenges in marketing and evaluation arose, but overall, this effort is one way of cultivating a more vigorous interest and self-confidence in teaching.

Reliability and Validity of the Polish Version of the Alzheimer's Disease Knowledge Scale.

INTRODUCTION: In the context of increasing numbers of older adults and an increased prevalence of neurodegenerative diseases, the early diagnosis of dementia has become an important issue. Poland's population is aging, and the growing number of individuals with Alzheimer's disease (AD) may pose challenges for families and the health-care system. While creating effective psychoeducational interventions aiming at increasing caregivers' knowledge may be beneficial, Poland lacks a standardized measurement for assessing knowledge about AD or a related form of dementia. METHODS: The aim of our study was to translate and evaluate the Alzheimer's Disease Knowledge Scale (ADKS) among Polish individuals. RESULTS: The Polish ADKS was developed through a translation-back translation method. Psychometric evaluation was done with a sample of 942 individuals (caregivers, health-care professionals, and general population) who completed the questionnaire. DISCUSSION: The results indicate that the scale produces acceptable psychometric properties and can be used to evaluate the effectiveness of educational interventions among caregivers, health-care professionals, and the general population.

The Feasibility and Acceptability of an Intergenerational, Web-Based Intervention to Enhance Later-Life Family Care Planning.

BACKGROUND AND OBJECTIVES: Adult children collaborate with older parents on care needs, yet later-life families are often uncertain about how to approach these conversations. Using the McMaster Model of Family Functioning as a framework, we developed a web-based tool for later-life families to enhance communication, knowledge, and problem solving around parent preferences for care. RESEARCH DESIGN AND METHODS: Participants were older adult parents aged 65+ and at least one of their adult children. Families answered questions about the parent's care preferences via a web-based survey. Responses were aggregated in a tailored PDF that was distributed to each participant. Descriptive statistics were calculated to examine recruitment, retention, and satisfaction with the program. Repeated measures analyses of variance were calculated to determine preliminary efficacy of the intervention. RESULTS: This study included 142 participants across 49 families (n = 49 older adult parents, n = 93 adult children). Of them, 75.4% completed all three phases of the study while 18.3% completed two phases and 6.3% completed only one phase. Seventy-four percent of participants reported being satisfied or very satisfied with the intervention. At baseline, most families were modestly incongruent in their ratings of future care preferences. Participants reported increased conversations about care across the course of the study (F(1.71,179.32) = 42.18, p < .001). DISCUSSION AND IMPLICATIONS: This study demonstrated that a web-based intervention to enhance intergenerational communication is feasible, acceptable, and has preliminary efficacy to improve intergenerational communication. Despite recruitment challenges, similarly designed web-based resources may improve accessibility and scalability of intergenerational communication-enhancing interventions.

The Podiatric Medical Profession: A Gender Comparison.

The number of women in podiatric medicine and surgery has increased steadily over the past 4 decades; however, there appears to be a large and continued gender gap with respect to representation in academic medicine and other positions of power. National and state level organizational data were obtained from multiple podiatry professional societies to evaluate the rate at which women achieved leadership roles within the podiatric profession over time. A secondary questionnaire was also developed and electronically mailed to 8684 doctors of podiatric medicine to help capture additional leadership information and to provide further insight into the trends observed. The response rate was 26% (2276/8684). Female representation in academia, research/publications, most leadership positions, and board certifications has increased over time, but at a slower rate than the number of women entering the profession. We observed a decreasing trend of females completing fellowships, speaking at national meetings, becoming residency directors, and receiving American College of Foot and Ankle Surgeons- and American Podiatric Medical Association-sponsored grants/awards. Based on the survey results, female podiatric physicians were more likely to be single, have fewer children, spend more time in a clinical setting, be less satisfied with work, and experience higher work stress levels than their male colleagues. Of the female respondents, 73% described experiencing gender discrimination at some point in their career, and 42% reported experiencing sexual harassment, compared with only 6% and 5% of men, respectively. There continues to be a gender gap in leadership roles, which may be explained partially by work/life balance issues, gender discrimination, and other issues.

Identification of RIPK3 Type II Inhibitors Using High-Throughput Mechanistic Studies in Hit Triage.

Necroptosis has been implicated in a variety of disease states, and RIPK3 is one of the kinases identified to play a critical role in this signaling pathway. In an effort to identify RIPK3 kinase inhibitors with a novel profile, mechanistic studies were incorporated at the hit triage stage. Utilization of these assays enabled identification of a Type II DFG-out inhibitor for RIPK3, which was confirmed by protein crystallography. Structure-based drug design on the inhibitors targeting this previously unreported conformation enabled an enhancement in selectivity against key off-target kinases.

Purposeful engagement as a motivation for dementia caregiving: Comment on Lang and Fowers (2019).

Comments on an article by S. F. Lang and B. J. Fowers (see record 2018-24691-001). In Lang and Fowers' (2019) article, they provide multiple arguments for why dementia caregiving persists despite the seemingly great evolutionary risk. Adding to their list of considerations, the current commentary provides another potential explanation, namely, that individuals may enact dementia caregiving because it provides engagement toward purposeful aims. Having a sense of purpose predicts multiple evolutionary benefits, including greater longevity, and we discuss here 2 routes by which dementia caregiving may fulfill the role of purposeful engagement. First, it provides a mechanism for suiting some individuals' broader goals of helping others in need. Second, it may allow individuals an opportunity for reflection upon what constitutes personally meaningful pursuits. The commentary ends with a consideration of why adding purpose to the discussion of dementia caregiving can assist researchers and practice professionals interested in helping promote caregiver well-being. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Motion Preservation in Hallux Rigidus After Failure of Hydrogel Implantation: Treatment Considerations and a Report of 2 Cases.

Hallux rigidus is a common condition treated daily by surgeons worldwide. During the past decade, the standard treatment algorithm has been questioned by both patients and surgeons seeking alternatives to arthrodesis, which was previously considered the gold standard for advanced disease. Patients are living longer, and many have a more active lifestyle; thus, recreating and improving range of motion and achieving pain relief are increasingly desirable. The treatment spectrum and implant options for motion-preserving techniques in the metatarsophalangeal joint has been widened with the recent US Food and Drug Administration approval of a polyvinyl-alcohol hydrogel implant. In the controlled US Food and Drug Administration trial, the 2-year revision rate was 9.2% and all failures were revised to a first metatarsophalangeal arthrodesis. Outcomes comparison of these revisions to primary fusions showed less predictable pain relief and may warrant alternative treatment considerations, preferably those that allow for continuation of motion preservation. Revision of failed hydrogel implants to arthrodesis can be performed through various first metatarsophalangeal fusion techniques or, as introduced in this review, with a fourth-generation threaded hemiarthroplasty. Excellent 10-year results with primary hemiarthroplasty supported its use as revision procedure in 2 failed polyvinyl-alcohol implantations, preserving arthrodesis for future salvage if necessary. The purpose of this report was to outline a motion-preserving technique after failed hydrogel implants and describe preoperative, intraoperative, and postoperative considerations for optimized outcomes.