Factors Associated with Implementing the Integrated Behavioral Health Care Model and Iraqi Refugees in the USA.

The aim was to identify which factors facilitate providing integrated behavioral health care for Iraqi refugees in nationally recognized community health center in Northern USA. The social-ecological model (SEM) framework guided this qualitative case study exploring the experience of 11 professional staff. Data were collected from June through August 2021 through individual interviews. Eight themes emerged based on the SEM levels: Intrapersonal-gender-driven engagement; interpersonal-the need for discretion and trusting relationship; community-collaboration with community resources and integrator from the community; organizational-holistic care, and long-term care; and policy-insufficient educational preparation. The results highlight components for clinical practice and policymakers regarding a population that is a big consumer of mental health care. Future research should explore other vulnerable populations, the effect of social groups, and the incorporation of community resources as part of the integrated care team.

Late Life Depression Education: Impact on Acute Care Nurses' Knowledge, Attitude, and Screening Practices.

Late life depression (LLD) in hospitalized older adults is associated with poor outcomes. Unfortunately, LLD is often unrecognized by health care providers because of inadequate knowledge and unfavorable attitudes. The purpose of the current study was to measure the effectiveness of LLD education on acute care nurses' knowledge, attitudes, and screening and referral practices. A one-group pre-/post-test design was used. Data were collected using the Late Life Depression Quiz, Revised Depression Attitude Questionnaire, and closed and open-ended practice questions. Forty nurses attended a 15-minute presentation on LLD and the 5-item Geriatric Depression Scale. Nurses were educated to screen adults aged ≥65 years for depression and refer those who screened positive to a social worker. There was a significant increase between pre- and posttest knowledge and attitude scores (p < 0.001). Screening increased significantly (p = 0.006) post-intervention, but no difference was noted in referrals to social workers. Findings support that a brief educational intervention increased nurses' knowledge and attitudes toward depression and depression screening in hospitalized older adults. [Journal of Gerontological Nursing, 48(12), 43-51.].

Bhutanese Older Adult Refugees Recently Resettled in the United States: A Better Life With Little Sorrows.

PURPOSE: This study explores the experiences and adjustment process among older Bhutanese refugees resettled in the United States and identifies their unmet health and social service needs. DESIGN: This phenomenological study design included the conduction of nine in-depth semistructured interviews in the respondents' native language. The researchers adhered to the steps outlined by Moustakas for data analysis. RESULTS: The five identified themes included the following: a better life but with little sorrows, cultural tensions related to adaptation, language as a barrier to success in the United States, isolation and loneliness, and worries about citizenship and its impact on the future. Discussion/Implications for Practice: Psychological adjustment to life in the United States can have profound impact on the health of Bhutanese older adults. Nurses and health care providers should integrate culturally congruent health care, raise awareness of the unique needs, and advocate for policy changes that will benefit this group of older adult refugees whose lives have frequently been upended.

Colorectal Cancer Screening: An Educational Intervention for Nurse Practitioners to Increase Screening Awareness and Participation
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Colorectal cancer screening aims to detect colorectal cancer at an early stage, when treatment is more likely to be curative. Lack of participation in such screening is a major issue in primary care practices, where nurse practitioners (NPs) often provide care. This study aimed to determine whether an educational intervention for NPs would increase their awareness of, and increase patients' participation in, colorectal cancer screening. 
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A Medicare Current Beneficiary Survey-Based Investigation of Alternative Primary Care Models in Nursing Homes: Cost and Utilization Differences.

The current study used the Medicare Current Beneficiary Survey-Based (MCBS) Cost and Use files for 2006-2008 to investigate whether health care costs and service utilization of nursing home residents varied with nurse practitioner (NP) and physician assistant (PA) involvement, compared to the use of medical doctors (MDs) only. The sample included Medicare beneficiaries 65 and older residing in a nursing home for the entire study year (433 annual observations). A generalized estimating equations procedure was used to assess whether health care cost and utilization measures varied by cohort. Point estimates indicated that the annual per-person cost of non-institutional services (total medical cost less the cost of the nursing home itself) was $3,847 and $3,170 more for individuals in the MD-only and MD-dominant cohorts, respectively, compared to those in the NP/PA-dominant cohort. [Res Gerontol Nurs. 2016; 9(3):115-122.].

A Medicare current beneficiary survey-based investigation of alternative primary care models in nursing homes: functional ability and health status outcomes.

This study assessed how the health status and functioning of Medicare beneficiaries residing in nursing homes varies systematically with nurse practitioners (NPs) and physician assistants (PAs) providing primary care services. A secondary analysis was conducted using data from the 2006, 2007, and 2008 Medicare Current Beneficiary Surveys. The study sample included 433 participant-year observations within one of three cohorts: (a) medical doctor (MD)-only, those who received primary care services exclusively from a physician; (b) MD-dominant, those who received some primary care services from an NP or PA, but those visits accounted for less than one half of total primary care visits; and (c) NP/PA-dominant, those who received more than one half of their primary care visits from an NP or PA. Participants in the MD-only cohort had significantly less orientation and independence in activities of daily living compared to participants in the NP/PA-dominant cohort. Other study variables did not vary significantly by practice model. Although the study provides some evidence that NP/PA involvement is associated with improved functioning, it is premature to draw strong inferences.

Long-term care in the United States and Finland: policy lessons to be learned.

Gerontological nurses are crucial members of long-term care (LTC) policy development teams as they work toward the provision of quality, equitable, seamless, and affordable LTC for all. When developing LTC policies in the United States, it is useful to explore such services in other countries. This policy brief provides an overview of LTC services in Finland to examine possible policy lessons for U.S. LTC service and delivery. Finland provides LTC to its older adult population under a universal program whereby services are provided as part of their universal health care and social services coverage. The U.S. system provides LTC primarily under Medicaid along with some coverage financed under Medicare. The challenges in the U.S. system include fragmented LTC delivery and financing, increasing LTC costs, and maintaining quality of care. Although difficult to compare the LTC costs in these two countries, available data suggest that Finland spends less on LTC the older adult population.

Custodial grandparents raising grandchildren: lack of legal relationship is a barrier for services.

In the United States, the majority of custodial grandparents are raising their grandchildren without a legal relationship. The lack of a legal relationship (i.e., foster care, custody, adoption) is a barrier for obtaining services and has resulted in limited access to information and public services, inadequate financial assistance, and difficulty providing medical and educational consent. This situation arises not only as a consequence of eligibility criteria, but also because children being raised by custodial grandparents remain outside the child welfare system. Federal and state policies were not designed for this population; subsequently, the majority of grandparent caregivers remain without access to services and support. In this article, perceptions of custodial grandparents concerning family obligations and the child welfare system as a barrier to pursuing a legal relationship are reviewed. Challenges with existing financial and health services, educational needs of grandparents and providers, and suggestions for policy changes are presented.

Social interactions and depressive symptoms among community dwelling older adults in Nepal: a synergic effect model.

In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.

Correlates of life satisfaction among older Nepalese adults living with a son.

The objective of this study was to identify the correlates of life satisfaction in elderly Nepalese adults living with a son. A convenience sample of 489 urban elderly was recruited from Kathmandu, Nepal. Socio-demographic, economic, health, and social support variables were used as correlates of life satisfaction. Life satisfaction was measured using 9 of the 11 items of the Life Satisfaction Index by Liang. Results showed that the strongest correlate of life satisfaction was perceived financial satisfaction (p < 0.0001). High life satisfaction was also more likely reported by elderly who were educated (p < 0.05), had fewer functional limitations (p < 0.005), and better perceived health (p < 0.0001). Other correlates with high life satisfaction were instrumental support (p < 0.05) but not emotional support from the son. Further research on correlates of life satisfaction in developing countries will assist health care practitioners and policy makers involved in the well-being of aged populations.

Leisure and religious activity participation and mental health: gender analysis of older adults in Nepal.

BACKGROUND: Involvement in activities has been found to be beneficial for improving quality of life and successful aging for older adults. Little is known, however, about the involvement in activities and depression of older adults in Asian developing countries. This study explores whether participation in leisure social and religious activities are related to depression and satisfaction with life in older adults of Nepal. Gender differences are also explored. METHODS: The study sample was derived from a survey which aimed to determine the intergenerational relationships between older adults and their married sons. A cross-sectional quantitative study of older adults sixty years and over in Nepal was conducted with face-to-face interviews using structured instruments. A convenience sample of 489 community dwelling older adults, 247 men and 242 women, were included in the study. The dependent variables, depression and satisfaction with life, were measured by the Geriatric Depression Scale (GDS) and Satisfaction With Life Scale (SWLS) respectively. Age, gender, marital status, education, perceived health, financial satisfaction, social support received and provided by older adults, and social activity were independent variables in the study. RESULTS: Saying prayers (B = -2.75; p < 0.005), watching television and listening to the radio (B = -1.88; p < 0.05), and participating in physical activity (B = -1.05; p < 0.05) correlated to lower depression for older men, but only watching television and listening to the radio (B = -2.68; p < 0.005) related to lower rates of depression for women. Socializing with others (B = 1.22; p < 0.05) was related to higher satisfaction with life for men, but for women visiting friends (B = 1.29; p < 0.05), socializing with others (B = 1.45; p < 0.005), and watching television and listening to the radio (B = 0.92; p < 0.05) related to improved satisfaction with life. Activity engagement significantly improved mental health in older adults. CONCLUSION: Specific activity participation was a significant correlate of lower levels of depression and higher levels of satisfaction with life among older adults in Nepal. The findings explore the need for further research on activity participation in developing countries so that it can be useful for health care practioners and those involved with the activities of aged populations in developing countries.

Long-term care insurance in Japan: implications for U.S. long-term care policy.

The purpose of this article is to review the long-term care insurance program in Japan and the present system of payment of long-term care services in the United States. The long-term care insurance system in Japan was implemented in 2001 for the purpose of promoting independence in older adults with functional disability. It reimburses for both home and institutional care. Several concerns expressed about the Japanese system include increasing applications for nursing home placement, lower use of home care services than anticipated, limited coverage for disabilities for those under 65, regional variations in service, educational preparation for case managers, and access to care for older adults. Revisions to the Japanese system and implications for U.S. long-term care policy are discussed.