Use of the Montreal Cognitive Assessment (MoCA) in a Rural Outreach Program for Military Veterans

The Montreal Cognitive Assessment (MoCA) is a free, easily accessible screener ideal for rural areas where resources are limited. We examined administration and scoring by Veteran Community Outreach Health Workers (VCOHWs); compared positive screening rates using two cutoff scores; and examined predictors of education-adjusted scores in N = 168 rural military Veterans from the Alabama Veteran Rural Health Initiative. Accuracy of administration (95 percent) and scoring (68 percent) was calculated and recommendations are offered. Higher than expected rates of positive screens were observed (40 percent using 24/30 cutoff) in this relatively young (M = 55 years) community-dwelling sample. Age, education, and race but not subjective health predicted differences in domain and total education-adjusted scores on multivariate and univariate tests. This study advances social science research in rural communities by being the first to: (1) examine MoCA scores in a rural, Deep South U.S. sample; and (2) report fidelity administration data for VCOHWs

Alabama Veterans Rural Health Initiative: A Preliminary Evaluation of Unmet Health Care Needs

The Alabama Veterans Rural Health Initiative aims to better understand the health care needs, health status, and barriers to care for rural veterans. Following extensive community outreach, Veteran Community Outreach Health Workers assessed 203 veterans residing in rural counties of Alabama who either: 1) had never enrolled in VA health services, or 2) had not used those services in at least two years. While 71.4 percent of participants reported having utilized non-VHA primary care within the past year, 33.5 percent reported an inability or delay in obtaining needed health care for one or more services: primary care, specialty care, mental health care, addictions treatment, dental care, or prescription medication. The most commonly cited barrier was cost. Among all participants, 56 percent screened positive for at least one Axis I mental disorder. Rurally residing, non-VHA utilizing veterans appear to have fairly good access to primary care, but need dental care, prescription medication, and mental health care

Race/Ethnicity as a moderator of social resources in Alzheimer’s family caregivers

Conference Presentatio

It's not all doom and gloom: Exemplary caregiving as a positive outcome in the stress and coping model

Stress and coping models, such as those developed by Pearlin and by Folkman and Lazarus, have been used frequently in dementia caregiving research to examine the relationships between caregiver contextual variables, stressor variables and outcome variables. Initially these models focused on the relationship between negative aspects of caregiving (e.g. behavioral bother) and negative outcome variables (e.g. depression). Recently, researchers have expanded the stress and coping models to include positive aspects of caregiving as potential mediators of negative caregiving outcomes. Using the Pearlin model, this study seeks to further expand the stress and coping model by examining Exemplary Caregiving (EC), a measure of caregiver affectionate and considerate behavior, as a potential positive outcome. Data from 670 caregivers of individuals with Alzheimer's disease were drawn from the NIH Resources for Enhancing Alzheimer's Caregiver Health (REACH) II study. Using a three-step stepwise multiple regression approach, we examined the relationships between caregiver contextual variables and stressor variables suggested by the Pearlin model and EC. In the final stage, burden, daily care bother, care recipient cognitive impairment, and perceived income adequacy were found to be negatively related to EC and positive aspects of caregiving and dementia education were found to be positively related to EC. Contrary to expectations, both the frequency of behavior problems and vigilance were positively related to EC. The final stage explained 20.3°/o of the variance. These results suggest that stress and coping models used in dementia caregiving research can be expanded to include positive outcomes such as Exemplary Caregiving.Presented at the 60th Annual Meeting of The Gerontological Society of America, San Francisco California, November 16-20, 2007Poster supported by the Center for Mental health and AgingPoster Presentatio

Predicting Alzheimer’s caregivers’ desire to institutionalize: The role of quality of care

Conference Presentatio

Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults

Abstract Objective Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision‐making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life‐sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31–.37, p < .001), and ACP engagement (r's = −.41 to −.37, p < .001) indicated convergent validity. Conclusion A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. Patient or Public Contribution The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life‐limiting conditions and five current or former care partners