Effects of Adverse Childhood Experiences in Black Older Adults.

Adverse childhood experiences (ACEs) are socially complex events that affect children early in their lives. Research indicates that experiencing multiple ACEs increases an individual's risk for chronic physical and mental illness and premature death. Multigenerational traumas, including slavery, segregation, and institutional racism, have created an environment that perpetuates social and economic inequalities, ultimately leading to an increased risk of ACEs in Black individuals. ACEs' effects can manifest in Black older adults as physical health problems and mental health and social issues. Addressing the disparities in ACEs among Black older adults requires a multifaceted approach. Culturally sensitive and trauma-informed approaches are vital in supporting the mental and physical health of Black older adults who experienced ACEs. Clinicians, researchers, and policymakers need to advocate for supportive policies and interventions that address systemic racism, promote economic opportunities, and ensure equitable access to resources. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 9-12.].

Biopsychosocial Model of Traumatic Stress Symptoms in Women Experiencing Homelessness: A Qualitative Descriptive Study.

Trauma is nearly ubiquitous among women experiencing homelessness (WEH). WEH develop post-traumatic stress disorder (PTSD) at rates far exceeding the general population. The consequences of untreated PTSD can cascade, exacerbating existing physical, mental, and social health inequities, placing this population at risk for disproportionate biopsychosocial health adversity. Despite the outsized impact of PTSD, WEH are less likely to access or receive appropriate trauma-focused services. Understanding the unique and intersecting factors that contribute to the disproportionate PTSD toll on WEH may elucidate risk and protective factors, as well as possible intervention pathways to address the disparate trauma burden. This study employed a qualitative descriptive approach to develop understanding of the determinants of trauma risk, exposure, and outcomes among WEH. Semi-structured interviews were completed with 10 WEH, six shelter staff, four mental health professionals. Six deductively biopsychosocial model-derived themes were identified, alongside supporting categories. Themes/categories highlighted the role of biological, psychological, and socio-environmental determinants in shaping risk for and actualization of traumatic events and adverse outcomes. Trauma played an outsized role in shaping the health of WEH participants in this study, and the need for and interest in tailored trauma screening, treatment, psychoeducation options was highlighted. Recursive relationships between biopsychosocial determinants and trauma impact were identified. Participants emphasized population tailored trauma-focused interventions, specifically brief co-designed and community partner implemented interventions that address substance use behaviors, while leveraging the strengths of WEH. Addressing the marked trauma burden in WEH shows promise in promoting measurable biopsychosocial health improvements in this resilient yet overlooked population.

Older Adults and Late-Life Depression.

As the U.S. population ages, the prevalence of late-life depression (LLD) increases. The general assumption that depression is part of normal aging and lack of diagnostic criteria specific to older adults resulted in this condition being underdiagnosed and untreated, leading to serious public health concerns, including high rates of suicide. Because of its complex etiologies, LLD requires careful assessment, especially in older adults from diverse ethnic/racial backgrounds. Suicide risk should be thoroughly assessed, including regular follow ups. Modifiable risks, such as cardiovascular conditions, should be addressed in middle-age populations to prevent LLD. Evidence-based treatment modalities include pharmacological (less effective) and more effective nonpharmacological (i.e., neuromodulation, psychotherapy) approaches. LLD has policy and research implications. Evidence exists of a new impetus to invest federal, state, and local funding for public health programs dedicated to improving the overall health of older adults. Research is needed to measure outcomes of these programs. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 8-11.].

Substance Use Disorders in Older Adults.

Although substance misuse (primarily alcohol and prescribed benzodiazepines and opioids) among Americans aged ≥60 years is becoming an escalating health concern, substance use disorder (SUD) is often underestimated and/or undiagnosed, preventing older adults from receiving needed treatment. Chronic medical conditions, mental health issues, and psychosocial stressors increase older adults' risks for developing SUD. Racial/ethnic minority groups (e.g., American Indian, Alaska Native) experiencing health care inequities and limited resources are more vulnerable to developing SUD. It is recommended that SUD screening be included in annual check-ups using tools adapted to older adults. Clinicians should consider older adults' comorbidities to differentiate symptoms of substance use from neurocognitive disorders, depression, anxiety, and metabolic disorders. To ensure successful outcomes, interventions must be tailored to the specific needs of older adults. Building on the current federal government administration's support, SUD practice guidelines should be updated with older adults in mind. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 15-19.].

Mental Health of Older Adults at the End of Life.

With advanced age, older adults (aged ≥65 years) become increasingly aware of the finality of their lives and many accept death as an unavoidable universal event. Over the past few decades, end-of-life treatment preferences shifted in the United States toward hospice and palliative care over curative treatment, with the ultimate goal of facilitating a good death. In addition to physical comfort, emotional well-being is essential in older adults at the end of life. Despite high prevalence of depression, patients on hospice are rarely screened for depressive symptoms. Left untreated, depression increases the risk for complicated grief and suicide. Provider education and training are needed to facilitate early detection of symptoms and timely treatment for depression and grief at the end of life. Family caregivers should also be included in mental health support, as they care for their loved ones and beyond, including post-death bereavement support. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 12-15.].

Combating Social Isolation in Older Adults: An Intergenerational Nursing Communication Project.

The importance of social connection to health and well-being has long been recognized. Social isolation is prevalent and impactful in the lives of older adults across care settings. A semester-long communication-focused clinical project was developed and piloted with sophomore Bachelor of Nursing Science students during Fall 2020 and replicated in Fall 2021 and 2022. Students were paired with older adult volunteers/mentors from a senior living organization and contacted mentors every 2 weeks over the 15-week semester. Older adult volunteers served as mentors, sharing their wisdom and life experiences. Students practiced their communication skills and learned about their mentor's life. Pre- and post-activity surveys of student attitudes toward older adults/aging suggested a dramatic and positive shift in perspective, and mentors rated the experience highly favorably. Intergenerational communication and relationship building has the potential to combat social isolation, promote healing and growth, and enable mutually beneficial engagement. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 7-11.].

'Walk a mile in my shoes:' African American caregiver perceptions of caregiving and self-care.

African American Alzheimer's disease and related dementia (ADRD) family caregivers are understudied in intervention research with discrepant evidence existing on their mental and physical health outcomes. The stress toll of ADRD caregiving, coupled with the well-documented health disparities for African Americans, place these caregivers at higher risk for morbidity and mortality.Objectives: The purpose of this study was to explore African American ADRD family caregivers' perceptions of caregiving and self-care.Design: Qualitative descriptive study based on individual, one-time, semi-structured interviews from a purposeful sample of current/former African American ADRD community-dwelling family caregivers. Participants agreed to either face-to-face or telephonic interviews between 60 and 90 minutes in length.Results: Twenty-one caregiver interviews were conducted with primarily adult children (mean age = 62.61 (SD = 12.88); 81% completed college; 57% women). Content analysis yielded three major themes: Stressors, Resources, and Coping. The results demonstrate a complex interaction of sociocultural and environmental stressors and perceptions of resources that influence the coping strategies adopted by caregivers to navigate their caregiving experience.Conclusions: These findings suggest a broadened perspective to further inform the development and testing of interventions to address the health outcomes and caregiving needs of African American ADRD caregivers.

Pandemic Lessons: Resilience and Hope.

In the United States, the coronavirus disease 2019 pandemic took a heavy toll on older adults, particularly those residing in long-term care facilities who were reduced to extended periods of isolation from families, friends, and health care providers. The concepts of resilience and hope became extremely relevant in the context of pandemic-related restrictions that exacerbated loneliness across all age groups. A review of evidence indicates that resilience is defined as an on-going, conscious process of adaptation in the face of adversity, whereas hope is defined as a resilience moderator through its process of making sense of a difficult situation. Cognitive-behavioral therapy and life review interventions were found to effectively enhance hope, thus contributing to increased resilience in older adults diagnosed with depression, bereavement, and/or medical conditions. Mental health providers at any level of practice should assess older adults for levels of loneliness, isolation, resilience, and hope and consider interventions to boost resilience and hope. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 10-12.].

Mental Health of LGBTQ Older Adults.

More than 54 million people in the United States are aged ≥65 years, including an estimated 2.4 million people who identify as lesbian, gay, bi-sexual, transgender, or queer (LGBTQ). As a group, LGBTQ older adults experienced criminalization, discrimination, and social stigma the majority of their lives, with rates of victimization and stigma increasing with age. LGBTQ older adults continue to experience social and health disparities compared to heterosexual individuals. To meet the needs of LGBTQ older adults, it is necessary to understand the impact of politics, culture, and social norms as they came of age. Unique mental health needs, such as social isolation, loneliness, disenfranchised grief, and long-term social support, are discussed through the lens of the minority stress model. Implications and recommendations for health care, research, and policy, such as creating a safe and welcoming environment and providing culturally competent care for LGBTQ older adults, are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 60(4), 7-10.].

Loss and Grief in the Context of Dementia Caregiving.

As a universal human reaction to perceived and/or actual loss, grief is becoming increasingly pervasive at all levels of society. Among the broad spectrum of loss experiences, those associated with dementia are perhaps of the most complex. The shift toward considering loss and grief within the context of dementia caregiving is promising. However, pre-loss grief is understudied, and interventions are lacking. Only few studies have evaluated the effectiveness of pre-loss psychosocial grief interventions for dementia caregivers. Preliminary findings from an ongoing clinical trial testing the effects of an 8-week, group-based online video intervention with dementia caregivers indicate that compared to precoronavirus disease 2019 pandemic, the experience of loss and separation was exacerbated by loss of control and severe physical contact restrictions in long-term care facilities. Finding effective grief interventions that can be translated into clinical and community-based environments is necessary to alleviate dementia caregivers' emotional distress and improve their quality of life. [Journal of Psychosocial Nursing and Mental Health Services, 60(10), 7-10.].

Lessons From the Field: Strategies for Success in Obtaining Grant Funding.

OBJECTIVE: To summarize a preconference workshop that focused on how to be successful in obtaining funding by making one's scholarship innovative and significant. METHOD: In 2021, at the annual American Psychiatric Nurses Association (APNA) Conference, a panel of nurse scholars reflected on and discussed how to make grant proposals innovative and significant. Two moderators posed questions to five panelists at different stages in their research trajectories about four key research concepts: idea conception, framing for the funding agency, significance, and innovation. RESULTS: Conceptualizing an innovative, scholarly idea starts with a passion for the topic, a team of experts and scholarly community, and time to think and delve into the literature. For funding opportunities, start small, read the funding announcements thoroughly and carefully, and make sure it is the right fit. Strategies to illustrate significance include avoiding generalizations, maintaining objectivity, being clear about impact, and using strength-based language. Contemplate the many facets of innovation as well as balance innovation and feasibility. CONCLUSIONS: Inclusion of challenges in composing significance and innovation sections of grant proposals offers knowledge for psychiatric nurse researchers to add to their toolkits as they seek funding and conduct research and scholarship.

Research Priorities in Psychiatric Mental Health Nursing: Funding Availability, Recently Published Work, and Future Directions for Advancing Our Science.

BACKGROUND: Identifying and sharing psychiatric mental health (PMH) research priorities can help identify gaps in the literature, determine training needs for nurses, and assist investigators in locating funding. AIMS: The aims for this project included: (1) identify PMH nursing specialty research priorities from large, public funding entities; (2) compare the identified research priorities and scholarly articles published in 2020; and (3) outline future directions for advancing the science of PMH nursing. METHODS: Strategic plans of funding entities for PMH research were reviewed for research priorities. Summarized priorities were then compared with publications from peer-reviewed PMH nursing journals. Work conducted in the United States was extracted and categorized as original research, evidence-based practice (EBP), or quality improvement (QI), then design and population. RESULTS: Priorities from 13 funding entities comprised three domains (education, research, and practice), with nine areas, 30 topics, and subtopics. Eight journals produced 432 articles with 99 (23%) conducted in the United States. Among these journals, publications fitting research priorities ranged from 1 to 33 articles. Of the 99 articles, 85% were original research and 15% were either EBP or QI. Descriptive articles comprised 64% and 23% tested interventions. Populations studied included workforce; adults; infants, children, and adolescents; and parents. CONCLUSIONS: All published articles by the U.S. PMH nurses matched the funding priorities, but not all funding priorities were addressed by 2020 publications. The majority of work was conducted outside of the United States and most published from the United States was descriptive, contrary to many United States funders' priorities for interventional research.

Chronic Grief Management: A Live-Streaming Video, Group-Based Intervention for Family Caregivers of Individuals With Dementia in Long-Term Care.

Family caregivers of individuals with Alzheimer's disease and related dementias (ADRD) experience long-term mental health effects. Although caregivers who place relatives in long-term care (LTC) experience increased depression, anxiety, and chronic grief post-placement, interventions to improve caregivers' mental health have focused mainly on in-home care. Current researchers previously tested a group-based Chronic Grief Management Intervention (CGMI) with ADRD caregivers of individuals in LTC, with significant effects on caregiver mental health outcomes. In the current study, researchers adapted the CGMI for synchronous online video using Adobe® ConnectTM and iPads® (Chronic Grief Management-A Live-Streaming, Online Intervention [CGMI-V]). Specific aims were to test feasibility of digital delivery of the CGMI-V and explore caregivers' online group experience. Researchers assessed participants at baseline for sociodemographic information and at the end of the program with a four-item satisfaction survey and focus group. Digital delivery of the CGMI-V was feasible and caregiver satisfaction was high. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 17-24.].

Effects of a Staff Training Intervention on Seclusion Rates on an Adult Inpatient Psychiatric Unit.

The current article presents the effects of a 90-minute staff training intervention aimed at reducing inpatient psychiatric seclusion rates through strengthened staff commitment to seclusion alternatives and improved de-escalation skills. The intervention occurred at an 18-bed adult inpatient psychiatric unit whose seclusion rates in 2015 were seven times the national average. Although the project's primary outcome compared patient seclusion rates before and after the intervention, anonymous staff surveys measured several secondary outcomes. Seclusion rates were reduced from a 6-month pre-intervention average of 2.95 seclusion hours per 1,000 patient hours to a 6-month post-intervention average of 0.29 seclusion hours per 1,000 patient hours, a 90.2% reduction. Completed staff surveys showed significant staff knowledge gains, non-significant changes in staff attitudes about seclusion, non-significant changes in staff de-escalation skill confidence, and use of the new resource sheet by only 17% of staff. The key study implication is that time-limited, focused staff training interventions can have a measurable impact on reducing inpatient seclusion rates. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 23-30.].

Longitudinal Effects of Activities, Social Environment, and Psychotropic Medication Use on Behavioral Symptoms of Individuals With Alzheimer's Disease in Nursing Homes.

A secondary data analysis of 25,560 minutes of structured clinical observations from a longitudinal study examined the impact of time-varying background factors, social environment, and psychotropic medication use on behavioral symptoms of nursing home residents with Alzheimer's disease (AD). Data were collected at baseline (N = 177), 12 months (N = 138), and 24 months (N = 111). Mixed-effects regression modeling showed that at 24 months: (a) higher cognitive and physical function and having a private bedroom/bathroom had the most positive influence on resident positive behaviors; (b) use of antipsychotic medications and solitary activities had the most negative influence on resident positive behaviors; (c) higher cognitive function significantly decreased negative behaviors; and (d) care-related activities and total number of psychotropic medications significantly increased negative behaviors. The current study describes risk factors for behavioral disturbances and the impact of activities, social environment, and psychotropic medications on behavioral outcomes in nursing home residents with AD. [Journal of Psychosocial Nursing and Mental Health Services, 56(11), 18-26.].

Comparing the Effect of a Moderate Physical Activity Intervention on the Mental Health Outcomes of African American and Caucasian Dementia Family Caregivers: A Secondary Data Analysis.

Increased attention to the effects of the stressful demands of caregiving on the mental health of dementia caregivers has resulted in the development of numerous interventions. The current study is a secondary analysis of a randomized controlled trial that tested a 12-month moderate physical activity intervention with dementia caregivers. Our secondary data analysis examined racial differences in caregiver mental health outcomes including subjective burden, depressive symptoms, and positive affect, as well as differences in physical activity. A total of 211 community-dwelling dementia family caregivers were randomly assigned to a 12-month Enhanced Physical Activity (treatment) Intervention (EPAI) or a Caregiver Skill Building (control) Intervention (CSBI). Of these, 34 African American and 80 Caucasian caregivers completed the study. At baseline, race was associated with subjective burden and positive affect, but not with depressive symptoms. Post intervention (12 months), there were no racial differences in subjective burden or depressive symptoms. However, race was significantly associated with decreased positive affect (p = 0.003) and decreased total minutes of physical activity (p = 0.012). Findings suggest that the mental health needs of African American caregivers warrant additional exploration, where physical activity may be of benefit. These findings provide a cultural perspective to consider during intervention development for future nurse-driven research.

A Case Study Approach to Nursing Home Placement: Smooth and Difficult Cases and Implications for Nursing.

Nursing home placement is one of the most challenging aspects of the caregiving journey. A case study approach was used to understand the experiences of caregivers during the first few months following nursing home placement. Two caregivers were selected from a larger qualitative descriptive study because their experiences exemplified smooth and difficult transitions for both themselves and their older family member. The caregivers were interviewed shortly after placement and 3 months post-placement. Four major contextual issues were identified that indicated the similarities and differences between the two cases, including (a) the caregiver's relationship with the older adult during the home caregiving time and post nursing home placement, (b) the circumstances surrounding placement, (c) support systems, and (d) continued involvement in care post-placement. Nursing home staff who understand these issues and address concerns through family-centered care can ease the transition and promote successful collaborations between staff and families.

Family Caregivers Define and Manage the Nursing Home Placement Process.

The nursing home placement process is complex and difficult for family caregivers. This qualitative descriptive study examines the experiences of caregivers involved in the management of care and placement of an older family member using the Family Management Style Framework. Ten caregivers were recruited from four nursing homes in the Midwest. The caregivers were interviewed shortly after placement and again 3 months post-placement. Results provide a unique understanding of care management and the nursing home placement process from the perspective of the primary family caregiver. Overall, there were similarities across the same types of caregiving dyads, for example, spousal and adult-children caregivers. Caregivers expressed the need to maintain the identity of their older family member, a familial responsibility for caregiving, and change in their family relationship over time. Appreciating caregivers' challenges and needs gives health care professionals a better understanding for how to provide assistance for a smoother nursing home transition.

The Impact of Rapidly Progressing Neurodegenerative Disorders on Caregivers: An Integrative Literature Review.

Neurodegenerative disorders affect over 6 million people in the United States. A subset of these patients experiences symptoms that progress rapidly, along with a 5- to 10-year life expectancy (amyotrophic lateral sclerosis). This subgroup often becomes dependent on family caregivers. Managing care demands at the end of life that are brought on by rapid disease progression has a negative impact on caregiver quality of life. The purpose of this integrative review is to highlight the gaps in the existing body of research on the effect of neuropalliative care on quality of life of this caregiver population. A total of 13 articles met inclusion criteria and were selected for review. The most frequently occurring themes and findings in the literature shed light on neuropalliative care and provided some insight into both caregivers and patients' perspective at the end of life. What sets this population apart from caregivers and patients of other terminal diseases is the nature of disease progression and the rapid life adjustments that come along with it. Integration of neuropalliative has shown to provide additional support for caregivers and patients; however, it remains underused. To promote equitable access to these services, it is necessary to address several structural barriers.