The Text4HealthyAging Program: An Evidence-Based Text Messaging Innovation to Support Healthy Urban Aging in Canada and Australia.

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities.

Comparing a clinician-assisted and app-supported behavioral activation intervention to promote brain health and well-being in frontline care.

BACKGROUND: Positive psychiatry offers an unique approach to promote brain health and well-being in aging populations. Minimal interventions through behavioral activation to promote wellness are increasingly available using self-guided apps, yet little is known about the effectiveness of app technology or the difference between clinician-supported behavioral activation versus self-guided app methodologies. OBJECTIVES: Investigate the difference in users and outcomes between two methods of the Fountain of Health (FoH) positive psychiatry intervention for behavioral activation to promote brain health and well-being: (1) clinician-assisted and (2) independent app use for behavioral self-management. DESIGN AND SETTING: As part of a larger knowledge translation intervention in positive psychiatry, two specific methods of a behavioral activation intervention were retrospectively compared. PARTICIPANTS: Two subsets of patients were compared; 254 clinician-assisted patients; 333 independent app users. INTERVENTION: A minimal positive psychiatry intervention in frontline care using the FoH health and behavior change clinical tools. MEASUREMENTS: Main outcomes were changes in psychological (health and resilience, well-being scores) and behavioral indices (goal attainment, items of goal SMART-ness). User profiles (age, sex and completion rates) were also compared. RESULTS: Clinician-assisted patients were more likely to be male, older, and have lower health and resilience scores at baseline. Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes (improved health and resilience, and well-being) were similar regardless of intervention method for those who completed the intervention. Behavioral outcomes revealed clinician-assisted patients set goals that better adhered to key goal-setting items. CONCLUSIONS: Clinician-patient relationships appear to be an important factor for intervention completion and behavioral outcomes, while further exploration of best practices for intervention completion using health apps in clinical practice is needed. A preliminary goal-setting methodology for effective behavioral activation, to promote brain health and wellness, is given.

Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults Title.

BACKGROUND: Benzodiazepine receptor agonist (BZRA) use disorder among older adults is a relatively common and challenging clinical condition. METHOD: The Canadian Coalition for Seniors' Mental Health, with financial support from Health Canada, has produced evidence-based guidelines on the prevention, identification, assessment, and management of this form of substance use disorder. RESULTS: Inappropriate use of BZRAs should be avoided by considering non-pharmacological approaches to the management of late life insomnia, anxiety, and other common indications for the use of BZRA. Older persons should only be prescribed BZRAs after they are fully informed of alternatives, benefits, and risks associated with their use. Clinicians should have a high index of suspicion for the presence of BZRA use disorders. The full version of these guidelines can be accessed at www.ccsmh.ca. CONCLUSIONS: A person-centred, stepped care approach utilizing gradual dose reductions should be used in the management of BZRA use disorder.

The Fountain of Health: effective health promotion knowledge transfer in individual primary care and group community-based formats.

ABSTRACTBackground:The Fountain of Health (FoH) initiative is a knowledge transfer (KT) project on the science of brain health and resilience promotion, in alignment with positive psychiatry. OBJECTIVES: Assess the effectiveness of FoH KT delivered in individual and group-based formats. DESIGN: Pre- and post-intervention quality assurance survey of FoH KT. SETTING: Interventions occurred in Nova Scotia, Canada. PARTICIPANTS: Adults over age 50 years without pre-existing dementia were targeted. A total of 92 participants received FoH KT in individualized (n = 41) and group-based (n = 51) formats. INTERVENTION: FoH KT (e.g. sharing evidence, lifestyle coaching, and goal setting) using a range of KT supports (e.g. FoH website, paper materials) was delivered to (1) individual patients by primary care clinicians and (2) community-based groups by lay leaders. MEASUREMENTS: The main outcome measure was participant pre- and post-quality assurance self-reports. RESULTS: Improvements were found in participant awareness of FoH, knowledge of evidence-based mental health promotion initiatives, and in application of this information in daily life in both individual and group-based settings. Improvements in participant knowledge about epigenetic factors that impact health and confidence with health behavior goal setting were reported in both contexts. Changes in self-perceptions of aging scores reached significance in the group intervention. CONCLUSIONS: FoH KT produced short-term positive self-reported changes in participants in both individual and group formats. Larger control studies with long-term follow up are needed to better assess effects of both individual and group formats of FoH KT and longer term impacts on health behaviors and outcomes.

Age-Friendly Communities Initiative: Public Health Approach to Promoting Successful Aging.

Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place. Prominent among these are the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States. In an AFC, older adults are actively involved, valued, and supported with necessary infrastructure and services. Specific criteria include affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and community leadership, and accessible health and wellness services. Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria, narrates case studies of AFCs in various stages of development, and suggests solutions to common challenges to becoming age-friendly. Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care.

The Fountain of Health: Bringing Seniors' Mental Health Promotion into Clinical Practice.

BACKGROUND: The Fountain of Health (FoH) initiative offers valuable evidence-based mental health knowledge and provides clinicians with evaluated tools for translating knowledge into practice, in order to reduce seniors' risks of mental disorders, including dementia. METHODS: A presentation on mental health promotion and educational materials were disseminated to mental health clinicians including physicians and other allied health professionals either in-person or via tele-education through a provincial seniors' mental health network. Measures included: 1) a tele-education quality evaluation form, 2) a knowledge transfer questionnaire, 3) a knowledge translation-to-practice evaluation tool, and 4) a quality assurance questionnaire. RESULTS: A total of 74 mental health clinicians received the FoH education session. There was a highly significant (p < .0001) difference in clinicians' knowledge transfer questionnaire scores pre- and post-educational session. At a two-month follow-up, 19 (25.7%) participants completed a quality assurance questionnaire, with all 19 (100%) of respondents stating they would positively recommend the FoH information to colleagues and patients. Eleven (20.4%) translation-to-practice forms were also collected at this interval, tracking clinician use of the educational materials. CONCLUSIONS: The use of a formalized network for knowledge transfer allows for education and evaluation of health-care practitioners in both acquisition of practical knowledge and subsequent clinical behavior change.

A knowledge transfer study of the utility of the nova scotia seniors' mental health network in implementing seniors' mental health national guidelines.

BACKGROUND: The Canadian Coalition for Seniors' Mental Health (CCSMH) developed national best-practice guidelines in seniors' mental health. Promoting adoption of new guidelines is challenging, as paper dissemination alone has limited impact on practice change. PURPOSE: We hypothesized that the existing knowledge transfer (KT) mechanisms of the Nova Scotia Seniors' Mental Health Network would prove useful in transferring the CCSMH best-practice guidelines. METHODS: In this observational KT study, CCSMH best-practice guidelines were delivered through two interactive, case-based teaching modules on Depression & Suicide, and Delirium via a provincial tele-education program and local face-to-face sessions. Usefulness of KT was measured using self-report evaluations of material quality and learning. Evaluation results from the two session topics and from tele-education versus face-to-face sessions were compared. RESULTS: Sessions were well attended (N = 347), with a high evaluation return rate (287, 83%). Most participants reported enhanced knowledge in seniors' mental health and intended to apply knowledge to practice. Ratings did not differ significantly between KT session topics or modes of delivery. CONCLUSIONS: The KT mechanisms of a provincial seniors' mental health network facilitated knowledge acquisition and the intention of using national guidelines on seniors' mental health among Nova Scotian clinicians. Key elements of accelerating KT used in this initiative are discussed.

"Ow!": spontaneous verbal pain expression among young children during immunization.

OBJECTIVES: Although self-reports are a commonly used means of assessing pain in clinical settings, little is understood about the nature of children's spontaneous verbal expressions of pain. The purpose of this study was to describe verbalizations of pain among children receiving a preschool immunization and to examine how pain verbalizations correspond to children's facial expressions and self-reports of pain intensity. METHODS: Fifty-eight children between the ages of 4 years 8 months and 6 years 3 months (67% female) were videotaped while receiving their routine preschool immunization. Global ratings of facial expression and detailed transcription and coding of pain verbalizations were undertaken. Children provided self-reports of pain using a 7-point faces pain scale. RESULTS: Fifty-three percent of children used verbalizations spontaneously to express their pain. The modal verbalization was the interjection "Ow!," which expressed negative affect and was specific to the experience of pain. Older children were less likely to use verbalizations to express their pain. Children who used verbalizations to express pain displayed greater facial reactions to pain and rated their pain experience as being more intense than children who did not use words to express their pain. DISCUSSION: Results indicate that many young children do not spontaneously use verbalizations to express pain from immunization. When 5-year-olds use verbalizations to express pain, the verbalizations are most often brief statements that express negative affect and directly pertain to pain. Knowledge of how children verbalize pain may lead to an improved ability to assess and manage pediatric pain.

The adult learner rediscovered: psychiatry residents' push for cognitive-behavioral therapy training and a learner-driven model of educational change.

OBJECTIVE: This study surveyed residents' experiences learning an emerging area of demand in psychiatry at a time when there is a lag in training resources. Unexpectedly, the data generated useful evidence in support of adult learning theory. The result is a post hoc examination of learner attitudes and activities during the spread of a new medical content domain. Implications of the results for adult learning theory are considered. METHODS: A survey evaluating interest, motivation, perceptions, and barriers toward learning cognitive-behavioral therapy (CBT) was given to 85 psychiatry residents at a single institution, with a 95% return rate and even distribution across years of training. RESULTS: The vast majority of residents were highly interested and motivated to learn CBT. One hundred percent considered CBT clinically useful, and 99% anticipated using it in future practice. Consistent with the model of adult learning theory, reasons for seeking CBT training tended to focus on personal interest (86%), motivation (81%), and opinion of its clinical usefulness (68%). Only a minority considered training requirements a motivation for seeking training (44%). The most commonly reported difficulty in gaining exposure to CBT was supervisor availability (65%). CONCLUSIONS: Residents exhibited qualities of adult learners for whom personal interests were more important than training requirements with regard to seeking training in new modes of treatment. In the wake of recent theoretical scrutiny of adult learning and its applicability to undergraduate medicine, these results suggest that postgraduate medicine might be uniquely suited to the study of adult learning theory.

Watch needle, watch TV: Audiovisual distraction in preschool immunization.

OBJECTIVE: To evaluate the effectiveness of audiovisual distraction compared with a blank TV screen in the reduction of pain associated with intramuscular immunization. DESIGN: Subjects were randomly assigned to watch television (TV) (N = 29) or a blank TV screen (control) (N = 33) during immunization, and were videotaped. Immediately after the injection, the children rated their pain. Videotapes were coded for pain behaviors and for distraction. t tests determined between-group mean differences and chi-square tests compared proportions for clinically significant self-reported pain. SETTING: Two urban pediatric practices in Halifax, Nova Scotia, Canada. SUBJECTS: Five-year-old children (N = 62), undergoing diphtheria, polio, tetanus, and pertussis immunization, and their parents. INTERVENTIONS: An age-appropriate musical cartoon or a blank TV screen. OUTCOME MEASURES: Pain measurements were the children's self-reports on Faces Pain Scale, facial actions on Child Facial Coding System, and Children's Hospital of Eastern Ontario Pain Scale. Distraction was measured by mean time spent watching the TV screen. Parents rated their own and their child's anxiety on a visual analogue scale. RESULTS: There were no significant group differences for any pain or distraction measures. The relative risk estimate for clinically significant pain among the distraction group was 0.64 (range: 0.23-1.80). Higher levels of distraction (i.e., greater time looking at the TV screen) related to lower levels of pain on all three pain measures. Only correlations with objective pain measures were statistically significant. CONCLUSIONS: Watching cartoons did not distract children during needle injection nor reduce their pain. Looking at the TV screen was related to lower behavioral pain scores in the total sample.