The Interview for Decisional Abilities (IDA): a tool to assess the decisional capacity of abused and neglected older adults.

We present the Interview for Decisional Abilities (IDA), a semi-structured tool for use by adult protective services (APS) workers as part of their comprehensive assessments of clients. The IDA was created in response to a Federal mandate to standardize the procedures and competencies of APS agencies with a view to improving client assessments and facilitating cross-jurisdictional research on adult mistreatment. The proximal aim of the IDA is to guide workers in gathering information on the ability of suspected victims of adult mistreatment to make decisions about the risks they face.

The Abrams geriatric self-neglect scale: introduction, validation and psychometric properties.

OBJECTIVE: Self-neglect is an imprecisely defined entity with multiple clinical expressions and adverse health consequences, especially in the elderly. However, research has been limited by the absence of a measurement instrument that is both inclusive and specific. Our goal was to establish the psychometric properties of a quantitative instrument, the Abrams Geriatric Self-Neglect Scale (AGSS). METHODS: We analyzed data from a 2007 case-control study of 71 cognitively intact community-dwelling older self-neglectors that had used the AGSS. The AGSS was validated against two "gold standards": a categorical definition of self-neglect developed by expert consensus; and the clinical judgment of a geriatric psychiatrist using chart review. Frequencies were examined for the six scale domains by source (Subject, Observer, and Overall Impression). Internal consistency was estimated for each source, and associations among the sources were evaluated. RESULTS: Internal consistency estimates for the AGSS were rated as "good," with the Subject responses having the lowest alpha and omega (0.681 and 0.692) and the Observer responses the highest (0.758 and 0.765). Subject and Observer scores had the lowest association (0.578, p < 0.001). Using expert consensus criteria as the primary "gold standard," the Observer and Overall Impression subscales were "good" at classifying self-neglect, while the Subject subscale was "fair." CONCLUSIONS: The AGSS correctly classified and quantified self-neglect against two "gold standards." Sufficient correlations among multiple sources of information allow investigators and clinicians to choose flexibly from Subject, Observer, or Overall Impression. The lower internal consistency estimates for Subject responses are consistent with self-neglectors' propensity to disavow symptoms. Copyright © 2017 John Wiley & Sons, Ltd.

Improving Quality of Care in Hospitals for Victims of Elder Mistreatment: Development of the Vulnerable Elder Protection Team.

PROBLEM DEFINITION: Hospitals have an opportunity to improve the quality of care provided to a particularly vulnerable population: victims of elder mistreatment. Despite this, no programs to prevent or stop elder abuse in the acute care hospital have been reported. An innovative, multidisciplinary emergency department (ED)-based intervention for elder abuse victims, the Vulnerable Elder Protection Team (VEPT), was developed at NewYork-Presbyterian / Weill Cornell Medical Center (New York City). APPROACH: The VEPT is a consultation service available 24 hours a day/7 days a week to improve identification, comprehensive assessment, and treatment for potential victims of elder abuse or neglect. All ED providers have been trained on how to recognize signs of elder mistreatment. Any provider can activate the VEPT via a single page/telephone call, which triggers the VEPT's often time-consuming, complex assessment of the potential mistreatment victim. First, the ED social worker on duty performs the initial bedside assessment and separately interviews the potential perpetrator and/or caregiver. He or she then contacts the on-call VEPT medical provider to discuss next steps and other team members' potential involvement. For patients admitted to the hospital, the VEPT connects with the inpatient social workers and medical team to ensure appropriate follow-up and care planning. NEXT STEPS/PLANNED EVALUATION: The VEPT program was launched in April 2017 after comprehensive training. Its impact will be measured by tracking the short-term and long-term mistreatment-related outcomes, as well as medical, mental health, functional, psychosocial, and legal outcomes of the vulnerable ED patients for whom the team provides care.

A proof-of-concept randomized crossover clinical trial of a first-in-class vasopressin 1a receptor antagonist for PTSD: Design, methods, and recruitment.

Background: Almost eight million Americans suffer from Posttraumatic Stress Disorder (PTSD). Current PTSD drug therapies rely on repurposed antidepressants and anxiolytics, which produce undesirable side effects and have recognized compliance issues. Vasopressin represents a promising and novel target for pharmacological intervention. Logistical issues implementing a clinical trial for a novel PTSD pharmaceutical are relatively uncharted territory as trials concerning a new agent have not been published in the past several decades. All published trials have repurposed FDA-approved psychoactive medications with known risk profiles. Our recruitment challenges are discussed in this context. Methods: An 18-week proof-of-concept randomized crossover clinical trial of a first-in-class vasopressin 1a receptor antagonist (SRX246) for PTSD was conducted. All participants received SRX246 for 8 weeks, the placebo for 8 weeks, and the drug vs. placebo arms were compared. Participants were assessed every 2 weeks for PTSD symptoms as well as other medication effects. Results were expected to provide an initial demonstration of safety and tolerability in this clinical population and potentially clinical efficacy in SRX246-treated patients measured by Clinician Administered PTSD Scale (CAPS) score changes, clinical impression, and other indices compared to placebo. The primary hypothesis was that SRX246 would result in a clinically meaningful 10-point reduction in mean CAPS score compared to placebo. Discussion: This study is the first to investigate an oral vasopressin 1a receptor antagonist for PTSD. As a wave of PTSD clinical trials with new pharmaceutical compounds are beginning now, lessons learned from our recruitment challenges may be invaluable to these endeavors.

Is Pet Ownership Helpful in Reducing the Risk and Severity of Geriatric Depression?

Many community-dwelling older adults are searching for ways to remain mentally and physically healthy as they age. One frequently offered suggestion is for older people to adopt a pet to avoid loneliness, to stay socially engaged, and to stave off depression. Despite the ubiquity of this advice in popular culture, research findings are equivocal on whether pet ownership is beneficial to the physical and psychological health of older adults. This article evaluates published data relating to pet ownership and its possible impact on depression and related symptoms in the elderly.

Hypersexual behavior in hasidic jewish inpatients.

Although no published studies explore rates of sexual symptoms among mentally ill Hasidic Jews, anecdotal observations led to the lead author's hypothesis that male Hasidic Jewish psychiatric inpatients often demonstrated hypersexual behavior. We examined whether male Hasidic Jewish psychiatric inpatients had higher reported rates of hypersexual behavior than controls. We reviewed charts of all Hasidic Jews admitted in 1998 to one inpatient psychiatric hospital and age/diagnosis/gender-matched comparisons for evidence of reported hypersexual behavior. Sixty-nine percent of male Hasidic patients and 40% of female Hasidic patients had staff reports of hypersexual behavior compared with 19% of male and 20% of female comparisons. There was statistically significant discordance between male (p <.04) but not female pairs. Increased rates of reported hypersexual behavior in Hasidic male inpatients suggest a link between culture and symptom presentation, which further studies of this unique population group should explore.