Examining the Efficacy of a Brief Cognitive-Behavioral Therapy for Chronic Pain (Brief CBT-CP) Group Delivered via VA Video Connect (VVC) Among Older Adult Veterans.

OBJECTIVES: To evaluate the effectiveness of a Brief CBT-CP Group delivered via VA Video Connect (VVC) among different age groups of Veterans with chronic noncancer pain being seen in primary care. A secondary aim was to evaluate participant characteristics of patients who completed vs. did not complete the group. METHODS: Single-arm treatment study in which outcomes were evaluated by comparing self-reported symptom levels pre- and post-treatment. Dependent variables included generalized anxiety, quality of life, disability, physical health, and pain outcomes. RESULTS: Following a 2 × 3 mixed-model ANCOVA, a main effect of time was found for all outcome variables, demonstrating significant improvements in disability rating, physical health, quality of life, generalized anxiety, and pain outcomes from pre- to post-treatment. There were no significant main effects for age group for any outcome variable, suggesting that patients of all ages reported improvements. CONCLUSIONS: Accommodations and adaptations to telehealth treatment for older adults are proposed and discussed. CLINICAL IMPLICATIONS: The Brief CBT-CP Group via VVC is an effective and accessible treatment for older adults with chronic noncancer pain who are being managed in the primary care setting. Certain Veterans are less likely to complete the Brief CBT-CP Group via VVC.

Impacts of the Coronavirus Pandemic on the Emotional and Physical Health of Older Adults Compared with Younger Cohorts.

OBJECTIVES: This study compared emotional and physical health and overall well-being related to social restrictions during the pandemic among older, middle-aged, and younger adults in the United States (n = 276). METHODS: Online surveys collected information on mental and physical health, as well as positive and negative impacts of the pandemic. One-way MANOVAs and hierarchical regressions were used to analyze data. RESULTS: Depressive symptoms and coronavirus anxiety differed significantly by age, with older adults reporting less depressive and anxious symptoms than younger cohorts. Negative COVID experiences significantly predicted higher levels of stress, anxiety, and insomnia symptoms in younger adults as compared to older cohorts. CONCLUSIONS: Findings indicate that social restrictions had a more substantial negative impact amongst younger adults compared to older adults, particularly in terms of mental health and well-being. CLINICAL IMPLICATIONS: Older adults may be more resilient to the impacts of the pandemic than younger cohorts and thus may serve as a critical resource for how to navigate crisis situations of this nature. Future studies should continue to monitor health outcomes as the pandemic subsides in conjunction with the vaccine rollout, as the long-term effects of social distancing and stay-at-home measures are yet to be determined.

Urgent laparoscopic repair of acutely symptomatic PEH is safe and effective.

BACKGROUND: Acute incarceration of paraesophageal hernias (PEHs) requiring urgent or emergent surgery is rare. Patients are often elderly with significant comorbidities and have historically been treated with open abdominal or thoracic incisions. Our study was designed to evaluate the feasibility, safety, and efficacy of laparoscopic paraesophageal hernia repair (LPEHR) in patients with PEH and acute gastric volvulus. METHODS: We reviewed our prospectively maintained database and identified 269 patients who underwent an initial LPEHR between January 2003 and January 2012. Patients were divided into group A (acute), group B (age- and comorbidity-matched 1:3), and group C (all elective repairs). Group A included those admitted with acute symptoms related to PEH and underwent urgent repair. Patient age, Charlson score, operative time, length of stay (LOS), morbidity, mortality, and recurrence rates were compared. RESULTS: Patients who underwent urgent LPEHR had a higher perioperative morbidity rate than the elective and matched groups. The overall mortality rate was low and no statistical difference was found between groups A, B, and C. LOS in group A was longer than groups B and C. The need for ICU admission was also higher in group A. There was no statistical difference in recurrence rates. CONCLUSIONS: Historically, patients presenting with acute symptoms related to PEH have required open repair, which is associated with significant morbidity and mortality. The acute group was older and sicker than our elective LPEHR patients and had more adverse events resulting in a longer LOS, even when compared with comorbidity-matched elective patients. However, the LOS remained shorter than that reported for open repair and there was no mortality. The recurrence rates in all groups were low and comparable to elective repairs.