Effect of older adult health and age on psychology doctoral trainees' expectations of clinical work with older adult clients.

This experimental, repeated-measures study investigated the effects of client health and client age on doctoral psychology students' clinical expectations for their work with older adult clients. Doctoral clinical and counseling psychology trainees (N = 223) completed measures assessing clinical expectations for three older adult clients of varying health status (healthy, recent Alzheimer's Disease (AD) diagnosis, heart disease) who all presented with depressive symptoms. Trainees were randomly assigned to the 71-year-old or 81-year-old condition. Trainees perceived a depressed client with a recent AD diagnosis as a less appropriate candidate for therapy, less motivated and less responsible for therapy, and less able to develop a therapeutic relationship. Additional health-based differences in prognosis, comfort, and competence were moderated by client age. Although age did have a small effect, the health of the older adult client had a stronger influence on trainees' clinical expectations for work with older adults. Cognitive health concerns were perceived as a greater barrier to clinical work with older adults than were physical health concerns. Health biases for clinical work with older adults could impact the quality of mental healthcare provided.

Older Adult Health Condition as a Moderator of How Middle-Aged Adults' Ageist Attitudes and Aging Anxiety Relate to Their Compassion for and Emotional Distance from Older Adults.

OBJECTIVES: Using Terror Management Theory and Social Identity Theory as frameworks, we examined whether the relationship of aging anxiety to compassion for and emotional distance from older adults was mediated by ageist attitudes and whether an older adult's health condition moderated these relationships. METHOD: Using an experimental design, 292 middle-aged adults (40-55 years) were assigned to read a description of an older adult with Alzheimer's Disease (AD), prostate cancer, or who was healthy. RESULTS: The relationship of aging anxiety to compassion was mediated by ageist attitudes in both the AD and prostate cancer conditions. More ageist attitudes related to less compassion more strongly for unhealthy older adult conditions than for the healthy older adult condition as well as for the AD condition compared to the cancer condition. Ageist attitudes related to more emotional distance from the older adult with AD than the older adult with cancer. DISCUSSION: Older adults with AD may evoke a stronger relationship of ageist attitudes with emotions toward older adults. These findings extend previous research by examining middle-aged participants, a population often serving as caregivers to their aging relatives.

Clinical and counseling psychology doctoral trainees' attitudes toward and interest in working with older adult clients.

The small percentage of psychologists specializing in geropsychology will be increasingly insufficient to meet projected mental health needs of the growing older adult population in the United States. The current study examined contact with older adults, empathy, and multicultural competence as predictors of counseling and clinical psychology doctoral trainees' attitudes toward and interest in working with older adults. A sample of 311 doctoral trainees in clinical (n = 234) and counseling (n = 78) psychology were surveyed online. A structural equation model testing hypothesized interrelationships between study variables showed good fit. Greater contact with older adults was significantly related to less ageist attitudes, greater interest in work with older adults, and more empathy. Less ageist attitudes were significantly related to greater interest in clinical work with older adults. Greater empathy was significantly related to less ageist attitudes and greater multicultural competence, but to less interest in working with older adults. Empathy mediated the relation of contact to attitudes. Increasing positive contact with older adults as part of doctoral training in counseling and clinical psychology may enhance trainees' empathy, attitudes toward older adults, and interest in work with older adults.

Health Bias in Clinical Work with Older Adult Clients: The Relation with Ageism and Aging Anxiety.

OBJECTIVES: This experimental study examined health bias in mental health trainees' ratings of work with an older adult client and whether differences based on health were moderated by aging anxiety and ageist attitudes. METHODS: Graduate-level mental health trainees (N = 488) were randomly assigned to read a vignette of an older adult client in good health or poor health, after which they rated aspects of clinical work with this client and completed measures of aging anxiety and ageist attitudes. RESULTS: Trainees rated clinical work with the unhealthy older adult client more negatively than with the healthy older adult client. Health-based differences were larger at average and higher levels of ageist attitudes when considering the appropriateness of the client for therapy and at average and higher levels of aging anxiety for perceived competence to treat and comfort in treating the presenting complaint. CONCLUSIONS: Trainees' health bias toward older adults may be magnified by higher aging anxiety and ageist attitudes. Training programs' intervention on these variables may improve geropsychological competencies of future mental health professionals. CLINICAL IMPLICATIONS: Quality of mental health care for older adult clients may be compromised when biases about older adults, particularly those in poor health, are not addressed.

Experiences with and attitudes toward interprofessional health care teams among American clinical, counseling, and school psychology doctoral students: a mixed methods study.

Attitudes toward interprofessional collaboration influence interprofessional health care team (IPHCT) functioning and quality of patient care. Yet, research has not examined the attitudes and experiences of psychology doctoral students on IPHCTs. Utilizing a volunteer sample of 214 clinical, counseling, and school psychology doctoral students from at least 47 doctoral programs in the United States, this study aimed to clarify psychology doctoral students' experiences on IPHCTs and explore predictors of their attitudes toward IPHCTs. Discovery-oriented analysis and hierarchical multiple regression were used to identify themes of students' self-reported interprofessional experiences and significant predictors of positive attitudes obtained via online survey questionnaires. Students who had worked on IPHCTs commonly reported taking roles of mental health therapeutic service provision and consultation and reported difficulty with team dynamics and navigating hierarchical structures. Students perceived the psychologist role primarily as clinical expert and team leader. Students reported making positive contributions, increased competency in interprofessional practice, and improvement in patient care as the most common benefits of IPHCTs. Each additional year spent on an IPHCT was related to more positive perceptions of the quality of care delivered by IPHCTs as well as greater endorsement of positive interprofessional socialization practices.

Gender as Potential Moderator of Associations Among Trauma Exposure, Posttraumatic Stress Disorder Symptoms, and Alcohol Use Disorder Symptoms in Young Adults.

Traumatic events (TEs), posttraumatic stress disorder (PTSD) symptoms, and alcohol use disorder (AUD) symptoms can significantly impair functioning, yet little is known about whether associations among these variables differ between men and women within young adult samples. The current study conducted a path analysis of archival, longitudinal data from the Drug Use Trajectories: Ethnic/Racial Comparisons 1998-2002 (DUT) study (Turner, 2011) to examine gender differences as a possible moderator of the relations between TEs, PTSD symptoms, and AUD symptoms among 1,076 young adults (aged 18-23 years) residing in South Florida. The sample included 580 male (53.9%) and 496 female (46.1%) participants, whose ethnicity was self-reported as African American (n = 280, 26.0%), non-Hispanic White (n = 268, 24.9%), other Hispanic (n = 267, 24.8%), and Cuban (n = 261, 24.3%). Significant positive associations were found between TEs and PTSD symptoms, ßs = .08-.30; PTSD and AUD symptoms, ßs = .09 - .10; PTSD symptoms over time, ß = .52; and AUD symptoms over time, ß = .46. In addition, for male but not female participants, a higher frequency of PTSD symptoms at Wave I was related to more AUD symptoms at Wave II, ß = .09. Findings build upon existing research to further elucidate the role of gender as a potential moderator of the associations among TEs, PTSD symptoms, and AUD symptoms for young adults and provide important implications for future research and clinical practice, including informing mental health prevention and treatment efforts.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) El género como posible moderador de las relaciones entre Trauma, síntomas del Trastorno de Estrés Postraumático, y síntomas del trastorno por consumo de alcohol en adultos jóvenes. GÉNERO, EXPOSICIÓN AL TRAUMA. TEPT Y CONSUMO DE ALCOHOL. Los eventos traumáticos (ETs), los síntomas del trastorno de estrés postraumático (TEPT) y los síntomas del trastorno por consumo de alcohol (TCA) pueden afectar significativamente el funcionamiento, pero se sabe poco acerca de si las asociaciones entre estas variables difieren entre hombres y mujeres en una muestra de adultos jóvenes. El presente estudio llevó a cabo un análisis de ruta de los datos longitudinales archivados de las trayectorias de consumo de drogas: Estudio de Comparaciones Étnica/Racial 1998-2002 (DUT en sus siglas en inglés) (Turner, 2011) para examinar las diferencias de género como posible moderador de las relaciones entre los ETs, los síntomas de TEPT y los síntomas de TCA entre 1,076 adultos jóvenes (de 18 a 23 años) que residen en el sur de Florida. La muestra incluyó 580 participantes, hombres (53.9%) y 496 mujeres (46.1%), cuya etnia fue autorreportada como afroamericanos (n = 280, 26.0%), blancos no hispanos (n = 268, 24.9%), otros hispanos (n = 267, 24.8%), y cubanos (n = 261, 24.3%). Se encontraron asociaciones positivas significativas entre ETs y los síntomas de TEPT, ßs = .08-.30; los síntomas de TEPT y los síntomas de TCA, ßs = .09-.10; los síntomas de TEPT con el tiempo, ß = .52; y los síntomas de TCA con el tiempo, ß = .46. Además, para los participantes masculinos pero no femeninos, se encontró una frecuencia más alta de síntomas de TEPT en la medición I la cual se relacionó con más síntomas de TCA en la medición II, ß = .09. Los hallazgos se basan en investigaciones existentes para dilucidar aún más el papel del género como posible moderador de las asociaciones entre los ETs, los síntomas del TEPT y los síntomas de la TCA en adultos jóvenes, y proporcionan importantes implicancias para la investigación futura y la práctica clínica, incluida la información sobre la prevención y el tratamiento de la salud mental.

Identifying Specific Gaps in Knowledge of Aging and Examining Its Relation to Biases Toward Older Adults.

Accurate aging knowledge is key to reducing ageist attitudes that impact older adult well-being. We first investigated how aging knowledge and negative and positive age-bias indirectly expressed via aging knowledge responses were related to an explicitly negative ageism measure. We then identified specific gaps in the aging knowledge of emerging adults and middle-aged adults. More negative ageism correlated with less aging knowledge overall and in psychological and social, but not biological, domains. Negative ageism correlated with negative age-bias, but not positive age-bias, expressed via aging knowledge responses. Knowledge of aging was poorest regarding social and psychological aspects of aging and best regarding biological aging. Middle-aged adults had slightly, but significantly, more accurate aging knowledge and less negative age-bias than emerging adults; positive age-bias did not differ by age-group. These results suggest that effectiveness of anti-ageism educational interventions may be enhanced if focused on improving knowledge of social and psychological aging.

Effects of Alzheimer's Diagnosis and Gender on Ageist Attitudes, Aging Anxiety, and Emotional Reactions to Older Adults.

BACKGROUND AND OBJECTIVES: We investigated whether ageist attitudes, aging anxiety, and emotional reactions to older adults differ based on Alzheimer's disease (AD) diagnosis, older adult gender, and participant gender, as well as their interactions. RESEARCH DESIGN AND METHODS: Using an experimental design, 291 participants (176 men, 115 women; 19-55 years) were randomly assigned to read 1 of 4 descriptions of an older adult that varied cognitive health and gender. Measures of ageist attitudes, aging anxiety, and emotional reactions to the older adult were completed online. RESULTS: Relative to a cognitively intact older adult, an older adult with AD evoked less ageist attitudes, less aging anxiety, more compassion, and less emotional distance. A significant interaction between older adult gender and participant gender indicated women felt greater emotional distance from an older adult man than an older adult woman, while men showed no significant difference. DISCUSSION AND IMPLICATIONS: The more positive emotions and less ageist responses to an older adult with AD could present as paternalistic and diminish older adults' agency. Women may prioritize shared gender identity over age, which has implications for caregivers and health professionals working with older adults.

Awareness of age-related change and its relationship with cognitive functioning and ageism.

 .Given ageism's negative impacts on older adults, the theoretical model for awareness of age-related change (AARC) hypothesized that experiencing ageism may mediate the relationship of cognitive functioning to AARC. We tested this hypothesis and alternatively proposed that cognitive functioning mediated the relationship of ageism to AARC. Analyses were conducted using measures of memory and inductive reasoning for 215 older adults (66-90 years) recruited online. Significant direct effects of ageism, memory, and inductive reasoning and significant mediated effects were found in both models, with more support for cognition mediating the relationship between ageism and AARC than for ageism mediating the relationship between cognitive functioning and AARC. This study added to the literature by empirically investigating theoretically proposed antecedents of AARC. Policymakers should address ageism to support healthy aging. Findings may assist therapists working to help older adults gain insights regarding how ageism impacts cognitive functioning and awareness of age-related changes.

The Associations between eMental Health Literacy, Barriers to Mental Health Services, and Psychological Distress in Older Adults.

Building on eHealth literacy and mental health literacy, this cross-sectional survey study examined associations between eMental health literacy (the degree to which individuals obtain, process, and understand basic mental health information online to inform mental health-related decisions), perceived barriers to mental healthcare, and psychological distress. Data were collected online for 247 older adults in the United States. Higher eMental health literacy was associated with fewer perceived barriers to mental healthcare, in models conceptualizing psychological distress as an outcome of eMental health literacy and barriers to care (intrinsic, ß = -0.36, p < .001; extrinsic, ß = -0.24, p = .002) and as a covariate of eMental health literacy (intrinsic, ß = -0.33, p = .001; extrinsic, ß = -0.24, p = .003). Continued research and replication of findings are needed to better understand the potential role of eMental health literacy in reducing barriers to mental health services in later life.

It's Complicated: Minority Stress, Social Support, In-Group Social Contact, and Sexual Minority Older Adults' Well-Being.

BACKGROUND AND OBJECTIVES: We applied the Minority Stress Model to sexual minority older adults to examine how distal minority stressors of ageism and heterosexism related to psychological well-being (life satisfaction, quality of life, psychological distress, and loneliness). We investigated social support and in-group social contact as stress-ameliorating factors and tested for a potential intersection of stress due to minority identities. RESEARCH DESIGN AND METHODS: A sample of 189 sexual minority older adults (50-86 years; M = 60.41) completed survey measures online. Hierarchical regression analyses with interaction terms were utilized to test study hypotheses. RESULTS: Findings offered partial support for the Minority Stress Model. Large effect sizes were obtained, explaining 32%-56% of the variance in psychological well-being with models including ageism, heterosexism, stress-ameliorating factors, and demographics. Ageism and heterosexism related to greater psychological distress; however, heterosexism became nonsignificant after controlling for stress-ameliorating factors. Ageism and heterosexism's relations to loneliness and quality of life followed similar patterns. Social support was a strong predictor of better psychological well-being for all measures. In-group social contact buffered against distress resulting from ageism, but heightened distress resulting from heterosexism. The interaction of ageism and heterosexism was not significant. DISCUSSION AND IMPLICATIONS: Ageism was a distinct source of distress for sexual minority older adults. Although social support emerged as crucial to well-being, the mixed findings related to in-group contact as a stress-ameliorating factor may indicate a need for tailored social engagement to optimize community connection as protective for sexual minority older adults.

Emerging Adult Caregivers: Quality of Contact, Ageism, and Future Caregiving.

BACKGROUND AND OBJECTIVES: More emerging adults (18-25 years) are performing caregiving tasks for older adults, yet minimal research has examined how the quality of this experience may inform their willingness to provide care again in the future. Based on an intergroup contact theory framework, this study examined whether quality of contact moderated the relationship between ageist attitudes and willingness to be a caregiver at age 50. RESEARCH DESIGN AND METHODS: A sample of 248 emerging adults (mean age = 23.29) providing informal care to an older adult (aged 65+) completed survey measures online. Regression analysis with interaction terms was utilized to test study hypotheses. RESULTS: Quality of contact moderated the relationship between ageism and willingness to provide instrumental and nursing care in the future. As quality of contact decreased, overt ageist attitudes became more strongly related to less willingness to provide care, and ambivalent ageist attitudes became more strongly related to greater willingness to provide care. DISCUSSION AND IMPLICATIONS: Caregiving during emerging adulthood may weaken the relationship between overt ageist attitudes on future caregiving intentions, especially when quality of contact is high, which is consistent with intergroup contact theory. Emerging adult caregivers may have a greater willingness to provide care in the future if supports focused on increasing quality of contact and emphasizing the strengths of the older adult population.

Factor structure and invariance of the Quality of Life in Alzheimer's Disease (QoL-AD) Scale.

The factor structure and factorial invariance of the Quality of Life in Alzheimer's Disease (QoL-AD) Scale was investigated in a sample of 653 nondemented, community-dwelling older adults, ages 57 to 95 years (M = 71.62, SD = 8.86), from the Seattle Longitudinal Study. The total sample was split into two random halves to explore and confirm the structure of the QoL-AD. Confirmatory factor analyses indicated better fit for a three-factor solution than one- or two-factor solutions. Weak factorial invariance was found for the three-factor solution (Physical, Social, and Psychological Well-being) across age group and gender. These findings may help to establish a baseline quality of life before the onset of any noticeable AD symptoms.

The relationship between social support and psychological distress among Hispanic elders in Miami, Florida.

This study compared 5 psychological models of the relationship between social support (SS) and behavioral health. These theoretical models, which have garnered some level of prior empirical support, were as follows: (a) main effects, (b) buffering effects, (c) social exchange, (d) equity, and (e) protective health outcomes of providing SS. A population-based sample of 273 community-dwelling Hispanic elders drawn from East Little Havana, Florida (ages 70-100 years old; 86% Cuban) completed self-report measures of SS, financial strain, and psychological distress (PD). Hierarchical multiple regression analyses were used to test the competing SS models. Results indicated that satisfaction with received SS was, as specified in the main-effects model, associated with lower PD, whereas received SS was unexpectedly associated with heightened PD. Reciprocal exchanges of SS (equity model) or exchanges where Hispanic elders provided more SS than they received (protective health outcomes of providing SS model) were also associated with lower PD. The feasibility of a 6th model in which the effects of SS are contingent upon the elder's preexisting PD level is proposed. Limitations, implications, and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Extending neuropsychological assessments into the primary mental ability space.

A battery of 17 neuropsychological tests (including the CERAD battery) and 17 psychometric ability tests were administered to a sample of 499 participants of the Seattle Longitudinal study who had been given the psychometric ability tests seven and 14 years earlier. The neuropsychological tests were projected into a 5-factor psychometric ability space by means of extension analysis. The concurrent regressions of the neuropsychology tests on the psychometric ability tests were then used to estimate neuropsychology test scores from the psychometric ability tests administered in 1984, 1991 and 1998. Neuropsychologists then rated the study participants as either normal, suspect or cognitively impaired in 1998. Changes in estimated test scores were computed over seven and fourteen years. Significant odds ratios between normal and cognitively impaired groups were found for all neuropsychological tests over the proximal period and for most tests over the 14-year period. Similar findings occurred for the odds ratios between the normal and suspect groups for the most proximal 7-year changes.

Congruence of self-reported medications with pharmacy prescription records in low-income older adults.

PURPOSE: This study examined the congruence of self-reported medications with computerized pharmacy records. DESIGN AND METHODS: Pharmacy records and self-reported medications were obtained for 294 members of a state pharmaceutical assistance program who also participated in ACTIVE, a clinical trial on cognitive training in nondemented elderly persons. The average age of the sample participants was 74.5 years (range = 65-91); 87.8% were females. RESULTS: Congruence between self-report and pharmacy data was generally high. Self-reports omitted drug classes in the pharmacy records less often than the pharmacy records did not include self-reported drug classes. The percentage of individuals with perfect agreement between self-reports and pharmacy records varied from 49% for major drug classes to 81% for specific cardiovascular and central nervous system drugs. Within a drug class, agreement tended to be higher for individuals without a prescription in that class. Poorer health was consistently related to poorer self-report of medications. IMPLICATIONS: Self-reported medications are most likely to be congruent with pharmacy records for drugs prescribed for more serious conditions, for more specific classes of drugs, and for healthier individuals.

The Seattle longitudinal study: relationship between personality and cognition.

This article reviews the history, measures and principal findings of the Seattle Longitudinal Study. This study began in 1956 focusing upon age differences and age changes in cognitive abilities. Its sampling frame is a large HMO in the Pacific Northwest. The study has been expanded to investigate various influences on cognitive aging including, cognitive styles, personality traits, life styles, and family environment. Current interest is also in the early detection of risk for dementia. In addition, this article reports original analyses of the relation of personality dimensions to cognitive abilities (both concurrent and longitudinal). While personality remains relatively stable over the adult life span, modest proportions of variance are shared between various personality traits and the cognitive abilities.

Reasoning training in the ACTIVE study: how much is needed and who benefits?

OBJECTIVE: To characterize change through 5-year follow-up, associated with training, booster, adherence, and other characteristics. METHODS: Sample included all individuals randomly assigned to reasoning training (N = 699). Piecewise latent growth modeling was used to examine trajectory of performance on outcome measures. RESULTS: Training resulted in improved reasoning performance through Year 5. A significant third annual booster effect was one-half the size of the training effect. Training adherence resulted in greater training effects. Higher education, Mini-Mental State Exam (MMSE), better health, and younger age related to higher baseline performance. Higher MMSE was related to larger training effects, larger linear slopes, and smaller booster effects. Significant functional outcomes included a training effect for complex reaction time (CRT), and first annual booster effects for the CRT and observed tasks of daily living. DISCUSSION: Initial training gain was comparable with magnitude of age-related cognitive decline over 5 years with no training. Neither age nor gender predicted training or booster effects, indicating the generality of training effects across age (65-90 years).

The relation of hypertension to changes in ADL/IADL limitations of Mexican american older adults.

Hypertension, highly prevalent and often undiagnosed among older Mexican Americans, is associated with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that can lead to greater dependency for older adults. Using data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly study, the rate of increase in ADL/IADL limitations for a 7-year period was examined for 3,046 older Mexican Americans classified either as reporting hypertension at baseline, first reporting hypertension at subsequent waves, or never reporting hypertension. Latent growth models indicated increased ADL/IADL limitations over time; individuals with hypertension evidenced greater increases than those without hypertension. Age, comorbidities, and depression were positively related to greater ADL/IADL limitations at baseline for all groups; only age was consistently related to ADL/IADL change over time. Development of hypertension may increase the risk of ADL/IADL decline, but early diagnosis and treatment may attenuate this effect.

Congruence of medication information from a brown bag data collection and pharmacy records: findings from the Seattle longitudinal study.

The validity of health information obtained through participants' reports of current medications (e.g., the brown bag method) is an important, but under-studied, area. In the current study, we examined the congruence of medication reports from a brown bag data collection with the pharmacy prescription records for 1430 participants (ages 23 to 97 years) of the seventh wave of the Seattle Longitudinal Study. Overall, the congruence of the brown bag data and pharmacy records was high. Congruence was better for younger participants, healthier participants, and for medications taken for serious conditions or on a regular basis. When the focus is on assessing participants' medications at a specific point in time (e.g., on the day of testing), brown bag data may provide more complete information than pharmacy records. Age and health status of the participants as well as the type of medications of interest should be considered when determining the validity of medication information reported by participants.