Telehealth use and COVID-19: Assessing older veterans' perspectives.

Video telehealth (VT) technology has increased mental health treatment access for veterans. Although veterans report high levels of satisfaction with VT, age disparities remain. Older adults in the general population face several barriers to using new technology, reflecting a "digital divide" between age cohorts. This trend continued during the COVID-19 pandemic, as older veterans were less likely to use VT-and more likely to use the telephone-for mental health visits than younger veterans. Although VT use has grown considerably during the pandemic, few studies have investigated older veterans' VT use relative to telephone services. Older veterans (aged 65 +) who completed at least one telephone or VT visit in an outpatient geriatric mental health clinic during the first 6 months of COVID-19 received a telehealth satisfaction questionnaire via U.S. mail. While respondents (N = 66) reported moderate levels of satisfaction with VT and telephone appointments, there was less interest in using telehealth exclusively postpandemic. Fewer telephone users reported having access to email and internet and greater barriers to using VT. Veteran rurality was not associated with access to internet or email and did not affect telehealth ratings. Analyses of treatment engagement showed that the rate of missed appointments did not change during COVID-19. Post hoc qualitative analysis of open-ended comments revealed themes of barriers and needs, as well as positive and negative telehealth experiences that were consistent with quantitative findings. Despite experiencing barriers to using VT, older veterans identified potential benefits and solutions to enhance participation across the older adult population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

SAVE-CLC: An Intervention to Reduce Suicide Risk in Older Veterans following Discharge from VA Nursing Facilities.

Objective: We describe the development and implementation of a telephonic intervention (SAVE-CLC) piloted at three VA sites for Veterans returning to the community from VA nursing facilities (Community Living Centers or "CLCs"). Care transitions present a known period of medical risk for older adults and may pose increased risk for suicide. Veterans discharging from CLCs are at elevated risk compared to age and gender matched controls.Methods: Using a quality improvement approach, input was gathered from key stakeholders to aid in the development of the intervention. Veterans were screened for depressive symptoms and need for additional support by phone.Results: Of the Veterans who received the SAVE-CLC intervention, 87.9% had at least one prior mental health diagnosis, though only 19.7% had an outpatient mental health appointment arranged at CLC discharge. Results suggest that the intervention is feasible across multiple outpatient settings and is generally well-received by Veterans and caregivers, with 97% of those contacted reporting that the telephone calls were helpful.Conclusion: This flexible, telephone-based intervention addresses the unmet need of integrating mental health care into discharge planning during care transitions.Clinical Implications: SAVE-CLC offers a feasible and acceptable solution to suicide risk in older Veterans exiting a CLC.

Group-based Acceptance and Commitment Therapy (ACT) for Older Veterans: Findings from a Quality Improvement Project.

OBJECTIVES: The purpose of this project was to develop, implement, and evaluate a 12-session Acceptance and Commitment Therapy (ACT) for Older Veterans group protocol. METHODS: The Plan-Do-Study-Act (PDSA) quality improvement model was the foundational process for this project. Veterans age 55 years and older participated in an ACT for Older Veterans group in an outpatient geropsychology clinic at a Veterans Affairs Medical Center. Study methods included analysis of participant feedback gathered in a focus group, process measures (i.e., number of sessions attended and number of early terminations), and outcome measures (i.e., depressive symptoms, anxiety symptoms, and psychological flexibility). RESULTS: Seventeen participants completed an average of ten sessions. Less than 25% of participants terminated early. Depressive symptoms improved, though there were no statistically significant changes in anxiety symptoms and psychological flexibility. The focus group yielded several recommendations that were implemented in subsequent groups. CONCLUSIONS: The PDSA model helped in the development of a group therapy intervention that is both relevant and beneficial to older Veterans presenting with a variety of biopsychosocial issues. Results provide support for further research investigation of ACT for Older Veterans Group. CLINICAL IMPLICATIONS: ACT used in a group format is a feasible and acceptable psychotherapy for older Veterans.