Goal pursuits and mental health in later life

Grounded in life span theory, this study explored how personal goals (as measured by possible selves) related to depressive symptoms in older adults. Possible selves represent individuals' ideas of what they would like to become (hoped-for selves) and what they are afraid of becoming (feared selves). Possible selves are also considered a dynamic aspect of the personality system that have the potential to elicit behavioral change. Because goals can moderate an individual's response to age related loss and promote positive adult development, older adults' ability to manage health and family related possible selves were examined. In addition, teleonomic relevance (i.e., how related one's current projects are to one's future goals) was investigated and associated with depressive symptoms. Eighty-five adults who ranged in age from 60 to 92 (M = 74) were recruited from two primary health care clinics and interviewed face-to-face by the researcher. Poisson regression models based on the count of depressive symptoms reported by participants were analyzed. The results provided initial evidence that the content of older adults' possible selves was associated with depressive symptoms. The presence of health related possible selves was moderately related to fewer depressive symptoms when accounting for one's age, gender, and perceived health status. In addition, the absence of health related possible selves was associated with feeling more worthless and the absence of family related possible selves was associated with feeling helpless and feeling like life was empty. The self-regulatory processes associated with possible selves (e.g., self-efficacy, outcome expectancy) were also related to depressive symptoms. For example, older adults who felt more efficacious in achieving their health and family related hoped-for selves and spent more time thinking about their hoped-for selves reported fewer depressive symptoms. The self-regulation of feared selves was not as significantly associated with depressive symptoms as the self-regulation of hoped-for selves. Finally, teleonomjc relevance was not significantly related to depressive symptoms in this study, but was associated with other goal constructs, such as the manageability and meaningfulness of personal projects, and the number of possible selves. Implications of the study and future research directions are discussed

Learning Through Loss: Implementing Lossography Narratives In Death Education

Students may have a greater willingness to discuss issues of death and loss through written assignments; however, there is little guidance for instructors regarding how to manage these sensitive assignments, nor how students benefit from them. The authors implemented and evaluated a “lossography” assignment in an undergraduate thanatology course in which students wrote about their losses and anonymously shared these narratives with their classmates. Although many themes of loss emerged, the most frequently reported significant loss was death of a grandparent. Additionally, most significant losses occurred in childhood/adolescence. Prominent themes related to student learning included gaining self-awareness, knowledge about grief responses, and compassion for others. Students (N = 64) also completed a survey reflecting on their course learning. Of all aspects of course delivery, 44% identified the lossography as the most beneficial, whereas 97% recommended this assignment for future students. The implications of the assignment for death education are also discussed

The Role of Caregivers in Physical Activity for Older Adults With Alzheimer's Disease

This study examined the determinants of physical activity (PA) for older adults with Alzheimer's disease (AD) to learn more about how to promote PA in this population. Caregivers of older adults with AD (N = 99) provided information related to care recipient's PA, as well as addressed sociodemographics and perceptions about their care recipient's PA. Gender of care recipient was a significant predictor of PA (β = .80, P < .05); men with AD participated in more PA than women with AD. Also, caregiver's outcome expectation for care recipient's PA also predicted more PA (β = .82, P < .05). Caregiver's perceived benefits of PA (outcome expectation) for their care recipient partially mediated the relationship between self-efficacy for care recipient's PA and the reported levels of PA for the care recipient. This study demonstrated the importance of caregiver perceptions about care recipient's PA

Suicide risk management: development and analysis of a telephone-based approach to patient safety

Research-based queries about patients’ experiences often uncover suicidal thoughts. Human subjects review requires suicide risk management (SRM) protocols to protect patients, yet minimal information exists to guide researchers’ protocol development and implementation efforts. The purpose of this study was to examine the development and implementation of an SRM protocol employed during telephone-based screening and data collection interviews of depressed primary care patients. We describe an SRM protocol development process and employ qualitative analysis of de-identified documentation to characterize protocol-driven interactions between research clinicians and patients. Protocol development required advance planning, training, and team building. Three percent of screened patients evidenced suicidal ideation; 12% of these met protocol standards for study clinician assessment/intervention. Risk reduction activities required teamwork and extensive collaboration. Research-based SRM protocols can facilitate patient safety by (1) identifying and verifying local clinical site approaches and resources and (2) integrating these features into prevention protocols and training for research teams

Dual use of VA and non-VA services among primary care patients with depression

Depression treatment requires close monitoring to achieve optimal, long-term control. Use of multiple sources of health care can affect coordination and continuity of treatment for depression. To assess levels of non-Veterans Health Administration (VA) use among depressed primary care patients by service type and examine patient factors associated with non-VA use. Cross-sectional comparison of dual and VA-only users among depressed primary care patients. Depression was defined as PHQ-9 >or=10. Five hundred fifty depressed patients from the baseline sample of a group-randomized trial of collaborative care for depression in ten VA primary care practices. VA and non-VA outpatient utilization for physical and emotional health problems in the prior 6 months, patient demographics, and co-morbid conditions. All measures were self-reported and obtained at the baseline interview. Overall, 46.8% of VA depressed primary care patients utilized non-VA care. Dual users were more likely to use acute care services (emergency room or inpatient), especially for physical health problems. Dual users of physical health services had more total visits, but fewer VA visits than VA-only users, while dual users of emotional health services had fewer total and VA visits. Factors associated with dual use were urban clinic location, having other insurance coverage, and dissatisfaction with physical health care in general. Almost half of depressed primary care patients used non-VA care, with most of their non-VA use for physical rather than emotional health problems. Care management strategies for depressed patients should include communication and coordination with non-VA providers

Gender, Sexual Identity, and Families: The Personal is Political

Pamela B. Teaster, Virginia Vincenti, Axton Betz-Hamilton, Cory Bolkan, and Cynthia Jasper are contributing authors, Themes From Elder Financial Exploitation by Family Member Powers of Attorney. Book Description: Volume 5: Gender, Sexual Identity, and Families: The Person is Political Gender is a fundamental organizing principle of families and is a complex mix of biology, identity and behavioral expression. Similarly, sexual identity includes a wide range of identification of sexual attraction and expression, and is also fundamental to understanding families. In 2016 Groves Conference program built on the Groves Conference\u27s past and recognized the social change has been swift in some areas, such as marriage equality with the 2015 Supreme Court ruling. However, full equality for all individuals and families throughout the U.S. is still not present and counter movements to social change are many, such as turning back the clock on fertility decisions, voting rights, even the definition of citizenship. For professionals who do research, who participate in policy, and who conduct prevention and intervention, the work presented in this volume is refreshed by new perspectives, new information, and new commitments.https://openprairie.sdstate.edu/consumer-sci_book/1004/thumbnail.jp

Addressing the Needs of Nicaraguan Older Adults Living on the Edge: A University-community Partnership in International Service-learning

Nicaragua is a very low-income country entering a period of rapid aging with limited geriatric training for health care professionals. To help build capacity and to enhance student learning, a short-term international service-learning program was implemented in 2004 in partnership with the Jessie F. Richardson Foundation and Nicaraguan community stakeholders. Graduate and undergraduate students at Portland State University complete coursework for one term in the United States then travel to Nicaragua for about two weeks to participate in educational, research, and service activities, primarily in group homes for older Nicaraguans. Students learn about global aging, gerontology, community development, service learning, and Nicaraguan history and culture, then apply their gerontology-related knowledge by training direct care staff, older adults and their family members, and students. The authors describe the impetus for and evolution of the program, students’ evaluation of the program, faculty observations on program benefits and challenges, lessons learned, and future plans

Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign

BACKGROUND: Meta-analyses show collaborative care models (CCMs) with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA). Evidence-based quality improvement (EBQI) uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. METHODS: The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC) predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. RESULTS: Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01), but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003). CONCLUSIONS: Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0010582

Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression

Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. This study tests whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Relative to low-stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement