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.

Older Veterans' Treatment Preferences: Psychotherapy and Self-Management Treatment Modalities.

OBJECTIVES: Self-management may help older Veterans with mental health challenges and can overcome barriers to traditional psychotherapy. However, the reasons underlying older Veterans' treatment preferences remain unknown. The current study investigated older Veterans' perspectives on psychotherapy and self-management. METHODS: Seventy-four Veterans ≥ 60 years old were included in this mixed methods study. Participants provided rationale(s) after ranking their preferences for psychotherapy and four self-management modalities. Logistic regressions examined whether depressive and anxiety symptom severity contributes to preferences. Qualitative analyses were conducted to investigate reasoning for preferences. RESULTS: Most participants preferred psychotherapy (64.9%) over self-management (35.1%). Logistic regressions showed that depressive and anxiety symptom severity was not significantly associated with preferences. Qualitative analyses revealed that past experience and access-related barriers were underlying the preferences. Themes unique to psychotherapy included the availability of emotional support and the process of information sharing. In contrast, ease of access was associated with self-management. CONCLUSIONS: Older Veterans preferred psychotherapy to receive support and to develop trust in meeting their goals. CLINICAL IMPLICATIONS: Older Veterans' needs point to the importance of providers' consideration of a person-centered approach and treatment collaboration. Notably, Veterans' preference for psychotherapy highlights the importance and need for human support in addition to self-management tools.

Guided self-management targeting anxiety and activity participation in older Veterans.

OBJECTIVES: This study examined the acceptance, feasibility, and preliminary effects of a guided self-management intervention using video delivery and a telephone coach on anxiety and activity engagement. METHOD: Ten Veterans aged 60 years or older with anxiety disorders determined by Structured Clinical Interview for Diagnostic and Statistical Manual 5th edition (SCID-5) at baseline visit participated in this non-randomized study examining a 4-week guided self-management intervention for anxiety. Feasibility was examined using participation engagement with the intervention. Measures of anxiety (Geriatric Anxiety Scale, PROMIS Anxiety Scale, Anxiety Control Questionnaire), depression (Patient Health Questionnaire 9-item), and activity participation (modified Activity Card Sort) administered at baseline and final (week 8) visit provided estimates of preliminary intervention effects. The Geriatric Anxiety Scale also was administered by phone at week 4. Participants completed a semi-structured qualitative interview at the final visit, which provided information about the acceptability, benefits of intervention, and barriers to engagement. RESULTS: All participants (N = 10) reported that the intervention somewhat or completely met their expectations, demonstrating intervention acceptability. Intervention completers (n = 9) experienced reduced anxiety over the first 4 weeks, alongside significant improvements in anxiety control and personalized activity goals across 8 weeks. However, anxiety symptoms tended to return to baseline at follow-up. Participants identified the relaxation videos and promotion of a daily relaxation routine as the most helpful intervention components. CONCLUSIONS: Findings indicate that the intervention may improve activity participation and reduce anxiety. Thus, guided self-management interventions show promise for reducing distress and maintaining engagement later in life.

Technology use and preferences for mental health self-management interventions among older veterans.

OBJECTIVES: The United States Department of Veterans Affairs offers numerous technology-delivered interventions to self-manage mental health problems. It is unknown, however, what barriers older military veterans face to using these technologies and how willing they would be to use technologies for mental health concerns. METHODS: Seventy-seven veterans (Mage = 69.16 years; SD = 7.10) completed interviews in a concurrent mixed methods study. Interviewers asked about technology ownership and described four modalities of delivering self-management interventions: printed materials, DVDs, Internet, and mobile apps. Interviewers obtained feedback about each modality's benefits, barriers, and facilitators. Participants ranked their self-management modalities preferences alone and compared with counseling. Multivariable adjusted logistic regression and qualitative analyses were conducted to investigate the reasons contributing to preferences. RESULTS: Most reported owning a computer (84.4%), having home Internet (80.5%), and a smartphone (70.1%). Participants preferred printed materials (35.1%) over mobile apps (28.6%), Internet (24.7%), and DVDs (13.0%). Lower computer proficiency was associated with preferring DVDs; higher proficiency was associated with Internet and mobile interventions. Residing in an urban area was associated with mobile apps. When counseling was an option, 66% identified this as their first preference. Qualitative findings showed veterans' desire for information, training, and provider support with technology. CONCLUSIONS: Older veterans reported high technology ownership rates but varied preferences for self-management interventions. Notably, two-thirds preferred some form of technology, which points to the importance of ensuring that providers offer existing technology-delivered interventions to older veterans. Veterans' strong preference for counseling emphasizes the need for human support alongside self-management.

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.

Relations of religion with depression and loneliness in older sexual and gender minority adults.

OBJECTIVES: High levels of religious involvement have been associated with positive mental health outcomes in older adults. This study investigated whether the effects of religion on healthy aging could generalize to older LGBTQ adults. METHODS: This study examined religious affiliation in childhood versus at present, as well as the relationships of outness to religious community and religious engagement with depression and loneliness in 102 lesbian, gay, and bisexual cisgender, transgender, and questioning adults (LGBTQ) over the age of 55. As part of a larger study, participants completed several questions and measures including: one outness to religious community item, 4 religious engagement questions, the Center for Epidemiological Studies Depression Scale, and the 8-item UCLA Loneliness Scale. RESULTS: Many older LGBTQ adults reported changes in religious affiliation from childhood to adulthood. Greater levels of outness to religious communities and lower religious engagement were related to lower levels of depression and loneliness. CONCLUSIONS: Findings suggest that outness to religious communities may be beneficial to the mental health of older LGBTQ adults. Higher levels of distress may lead to higher levels of religious engagement. CLINICAL IMPLICATIONS: Religion, especially those that are supportive of sexual minorities, may help to improve the well-being of older LGBTQ adults.

Effects of Mobile App-Based Intervention for Depression in Middle-Aged and Older Adults: Mixed Methods Feasibility Study.

BACKGROUND: Digital mental health interventions may help middle-aged and older adults with depression overcome barriers to accessing traditional care, but few studies have investigated their use in this population. OBJECTIVE: This pilot study examines the feasibility, acceptability, and potential efficacy of the Meru Health Program, an 8-week mobile app-delivered intervention. METHODS: A total of 20 community-dwelling middle-aged and older adults (age: mean 61.7 years, SD 11.3) with elevated depressive symptoms participated in a single-arm pilot study investigating the Meru Health Program, an app-delivered intervention supported by remote therapists. The program primarily uses mindfulness and cognitive behavioral skills to target depressive symptoms. A semistructured interview was completed at the baseline to establish current psychiatric diagnoses. Depressive symptoms were measured using the Patient Health Questionnaire and Patient-Reported Outcomes Measurement Information System (PROMIS) depression measures. Anxiety symptoms were measured using the Generalized Anxiety Disorder Scale and the PROMIS Anxiety measure. User experience and acceptability were examined through surveys and qualitative interviews. RESULTS: In total, 90% (18/20) of the participants completed the program, with 75% (15/20) completing at least 7 of the 8 introductory weekly lessons. On average, participants completed 60 minutes of practice and exchanged 5 messages with their therapists every week. The app was rated as helpful by 89% (17/19) participants. Significant decreases in depressive (P=.03) and anxiety symptom measures (P=.01) were found; 45% (9/20) of participants showed clinically significant improvement in either depressive symptoms or anxiety symptoms. CONCLUSIONS: The findings suggest that the commercially available Meru Health Program may be feasible, acceptable, and potentially beneficial to middle-aged and older adults. Although larger controlled trials are needed to demonstrate efficacy, these findings suggest that digital health interventions may benefit adults of all ages.

[Changes of physical and functional characteristics in soccer players]. / Evolución de las características físicas y funcionales en jugadores de futbol soccer.

UNLABELLED: The purpose of this study was to examine the trends in selected physical cardiovascular and metabolic variables in 248 first division professional soccer players within a period of 27 years (1973-2000). METHOD: In a cross sectional study (panel) 198 Mexican players and 50 mainly from Brazil and Argentina were evaluated for physical examination, body composition, blood samples, EKG and maximal oxygen uptake on a treadmill. Data were categorized by decade (70's n = 66, 80's n = 84 and 90's n = 98) and analyzed for significant differences by ANOVAS (p < 0.05). RESULTS: Value are presented in mean +/- standard deviation in chronological order. Age (years) 24 +/- 2, 26 +/- 2 and 27 +/- 3*. Weight (kg) 74 +/- 4, 73 +/- 4 and 74 +/- 5. Height (cm) 173 +/- 4, 175 +/- 4 and 176 +/- 5*. Body fat (%) 15 +/- 4, 12 +/- 4& and 10 +/- 4#*. Total cholesterol (mg/dL) 246 +/- 26, 220 +/- 24 and 198 +/- 20*. Triglycerides (mg/dL) 172 +/- 24, 190 +/- 26 and 147 +/- 24*#. Resting heart rate (bpm) 66 +/- 6, 60 +/- 4& and 54 +/- 5*#. VO2 max (mL.kg-1.min-1) 52 +/- 3, 54 +/- 2 and 57 +/- 2*. (& = p < 0.05 70's vs. 80's, * = p < 0.05 70's vs. 90's, # = p < 0.05 80's vs. 90's). CONCLUSION: Our findings indicated that soccer players performing in the 90's are older and taller, lower body fat, lower blood in lipids profile, and higher cardiovascular fitness than those performing in the decade 70's and 80's. In particular these findings might be related to the improvement at international setting of the South American and Mexican soccer level. Despite the favorable changes and the personal claim of great skill in these players more physiological gains must be aimed and acquired in order to compete in similar circumstances with national teams of superior international levels.