Geri-Mobile Health: Feasibility of a VA Mental Health Mobile Apps Coaching Program for Older Veterans.

OBJECTIVES: This program evaluation examined the feasibility, acceptability, and preliminary effects of an individualized coaching program to help older Veterans use VA mental health mobile apps to address mental health and well-being goals. METHODS: The program delivers individual technical and clinical support to facilitate the use of mobile devices and VA apps. Participants completed assessments of mobile device proficiency, app use frequency, app comfort, quality of life, and mental health symptoms (completed by a subset, n = 11) pre- and post-participation. RESULTS: Of 24 enrollees, 17 completed the program and received an average of 7.58 (SD = 2.87) sessions including the initial assessment. Mobile device proficiency (t (16) = -3.80, p = .002) and number of days/week apps were used (t (16) = -2.34, p = .032) increased significantly from pre- to post-participation. Depressive and anxiety scores decreased significantly (t (10) = 3.16, p = .010; t (10) = 3.29, p = .008) among the subset completing those measures. Overall satisfaction was high; 100% reported they would recommend the program. CONCLUSIONS: Findings suggest the program is feasible, highly acceptable, and increases mobile device proficiency and use of apps. CLINICAL IMPLICATIONS: Coaching programs can equip older adults with the skills to use mental health apps.

Converting a Geriatrics Clinic to Virtual Visits during COVID-19: A Case Study.

BACKGROUND: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. DESIGN: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. SETTING: Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. INTERVENTION: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. MEASUREMENTS: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. RESULTS: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. CONCLUSION: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.

Development and Refinement of Educational Materials to Help Older Veterans Use VA Mental Health Mobile Apps.

The U.S. Department of Veterans Affairs (VA) in collaboration with the Department of Defense has created mobile applications (apps) that target military Veteran-specific mental health challenges. With over half of Veterans being older than 65, it is essential to support these individuals' access to and use of these apps. One critical barrier to older adults using apps is that they may not be aware of mental health apps and often need assistance learning to use their devices. To address these gaps in knowledge, we designed and evaluated patient education materials teaching how to download apps and the basics of mobile device use. The materials also included step-by-step guides for three VA mobile apps: Mindfulness Coach, Mood Coach, and PTSD Coach. Guided by user-centered design and feedback from providers and older Veterans, the materials were developed and refined. Six local technology and geriatric content experts provided initial feedback. Next, six older Veterans (M = 78.5 years; 50% owned smartphones) formally evaluated the materials with a majority (83.3%) electing to 'recommend the materials to others.' Lastly, 12 providers provided feedback on the materials and 79% rated the materials as helpful. Providers viewed the materials as especially useful for patients who are unable to return to clinic. Overall, providers and Veterans found the materials easy to understand and valuable for novice users. Findings suggest the use of user-centered design principles and iterative evaluations to create patient technology education materials are vital to increase the use of mental health mobile apps among older Veterans.

Come, join, lead: Attracting students to careers in aging and promoting involvement in gerontological societies.

Geriatric educators face the challenge of attracting more clinicians, scientists, and educators into geriatrics and gerontology, and promoting involvement in gerontological societies. A survey of psychologists (N = 100) examined factors that attract students in clinical/counseling psychology to practice with older adults, as well as experiences in organizational service. For 58%, interest in aging began at the undergraduate level, but for others interest developed later. About one half cited academic exposure such as mentorship (51%), research (47%), or coursework (45%) as sparking interest, along with family (68%) or work experience (61%). Involvement in professional organizations lags (58%), in part owing to misperceptions about what those activities require. A continued targeted effort at the undergraduate and graduate level is essential to attract students to careers in aging. To preserve vital professional organizations, enhanced outreach may be useful to dispel myths about service and encourage engagement.

The Big Shortage: Geropsychologists Discuss Facilitators and Barriers to Working in the Field of Aging.

Geropsychology is a vibrant field of scientific study, pedagogy, and clinical practice, and the need for more geropsychologists will only expand as the population ages. This study involved in-depth, semi-structured telephone interviews with 30 clinical geropsychologists about their training and current work. Qualitative coding of interviews was undertaken using an inductive coding approach. Results revealed four major themes: factors influencing entry into the field of geropsychology, the rewards of being a geropsychologist, competing demands on time and money, and barriers to involvement in leadership. These results suggest some possible points of intervention to attract people to the field of aging and promote their professional development and success.

Training for Geropsychology Supervision and Practice: Perspectives of Geropsychology Program Graduates.

Addressing the geropsychology workforce shortage requires ongoing training of psychologists to develop geropsychology competencies, as well as expanding the number of geropsychology supervisors to train them. This study surveyed graduates of geropsychology doctoral and postdoctoral training programs regarding their current geropsychology practice and supervision activities and perceptions of their own training preparation for these activities. One hundred psychologists (87 who had completed all formal training and 13 current postdoctoral fellows) responded to an online survey. Of those who had completed geropsychology training, 82% reported currently engaging in clinical care, and 55% reported providing supervision; more than half of clinical and supervision activities focused on older adults. Participants reported generally strong quality of training to prepare them for providing geropsychology services; areas of more uneven preparation included family and group interventions and select consultation activities. Participants reported quite variable preparation for general supervision practice, and desire for more training and practice in supervisory roles. Geropsychology training programs may use feedback from graduates for ongoing program development, and professional geropsychology may wish to consider forums for enhancing geropsychology supervision skills.

Training for Research and Teaching in Geropsychology: Preparing the Next Generation of Scholars and Educators.

For geropsychology to flourish in the years ahead, we need scientists to advance knowledge and teachers to draw new professionals into the field. In this project the authors surveyed 100 geropsychologists who completed a doctoral degree in clinical or counseling psychology about their experience with training for research and teaching. The majority were currently conducting some degree of research (38%) and some form of teaching (45%). The majority of ratings for components of research training were in the "very good to excellent" range, whereas elements of teacher training were rated in the "poor to good" range, though there was variability among persons and components. Qualitative comments revealed enthusiasm for research and teaching roles and a need to enhance our training of geropsychologists as educators. The authors provide several suggestions that could enhance research and teacher training for current and future students of professional geropsychology.

"What's wrong with grandma?": depictions of Alzheimer's disease in children's storybooks.

Alzheimer's disease (AD) affects the entire family system, including young children. Yet there are few resources to help children understand AD. Storybooks are used to educate children about other diseases and may be useful in AD as well. In this study, we examined the depiction of AD in 33 English-language children's storybooks written specifically about AD. As a group, storybooks present AD as a brain disease, but provide little information about the diagnostic process or treatments. Clinical presentations are diverse among characters with AD, and no single book presents a comprehensive depiction of the cognitive, behavioral, affective, and functional symptoms of the disease. In fact, the prevalence of some symptoms in this "population" of storybook characters diverges substantially from epidemiological reports. Books designed to familiarize children about AD should be comprehensive and accurate. Current resources, while useful, could be improved to ensure health literacy about AD in young children.

Linguistic features of power dynamics in triadic dementia diagnostic conversations.

OBJECTIVE: The purpose of this study was to examine linguistic expressions of power during dementia diagnosis disclosure. METHODS: Videotapes of dementia diagnosis disclosure sessions were reviewed to examine linguistic features of 86 physician-patient-companion triads. Verbal dominance and pronoun use were measured as indications of power. RESULTS: Physicians dominated the conversation, speaking 83% of the total time. Patients spoke more than companions (10% versus 6%). Dementia status was only related to the amount of time companions spent talking. Physicians used fewer first person singular and more first person plural pronouns than patients and companions. Power indices did not predict anxiety, depression, or satisfaction with the medical visit. CONCLUSION: During the disclosure of a dementia diagnosis, physicians tend to dominate the conversation, exerting their social status through a variety of linguistic features. Patients and companions are not more distressed or dissatisfied as a result and exert their own subtle attempts to assert their role in the conversation. PRACTICE IMPLICATIONS: Recognition of a hierarchical structure within healthcare interactions may be the first step toward maximizing patient outcomes. Evaluating patient expectations and preferences regarding physician communication style may be the most effective way of promoting patient-centered healthcare communication.