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Amid mushrooming net-zero commitments and pledges made by states and non-state entities, a gap remains between those pledges, and the action needed in order to stay within the temperature goals of the Paris Agreement. In response, scholars and policymakers have started to examine physical, technological, economic, and policy pathways to net‐zero emissions across different sectors. This article examines the existing legislation and litigation for a net-zero world in four jurisdictions: Germany, the United States, Brazil, and China. We propose a taxonomy for identifying and comparing existing legal mechanisms to reach net-zero across these jurisdictions. We identify and analyze different legislative and regulatory mechanisms that incorporate net-zero mandates and three net-zero litigation strategies in these countries. These jurisdictions provide a useful snapshot of the variety of legal mechanisms currently being used by, or imposed on, large emitting jurisdictions and entities. We then consider the critical ways in which climate law can contribute to, or hinder, emissions reductions in line with net-zero targets. [ABSTRACT FROM AUTHOR]

Using the 2018-2021 National Health Interview Survey data, we examined the associations between healthcare cost burden and depressive/anxious feelings in older adults. Nearly12% reported healthcare cost burden and 18% daily/weekly depressive/anxious feelings. Healthcare cost burden was higher among women, racial/ethnic minorities, those with chronic illnesses, mobility impairment, and those with Medicare Part D, but lower among individuals with Medicare-Medicaid dual eligibility, Medicare Advantage, VA/military insurance, and private insurance. Daily/weekly depressive/anxious feelings was higher among healthcare cost burden reporters. The COVID-19 pandemic-related medical care access problems were also associated with a higher risk of reporting healthcare cost burden and depression/anxiety. [ABSTRACT FROM AUTHOR]

We examined associations among three measures of caregiver experiences (i.e., positive aspects of caring [PAC], caregiver burden, and mutuality) in 228 dyads involving persons with dementia (PWD) and their informal caregivers. The associations between predisposing, enabling, and need factors and each of these three measures of caregiver experiences were also examined. We used baseline data from a randomized controlled trial of a psychosocial intervention aimed at preventing aggression in PWD. Associations among PAC, caregiver burden, and mutuality were examined. The Behavioral Model of Health Services Utilization guided the selection of predisposing, enabling, and need components. Enabling characteristics (e.g., race/ethnicity, caregiver education and employment and PWD education) and most predisposing characteristics (e.g., caregiver age, PWD age, relationship type) were not associated with any caregiving experience measures. Need characteristics (e.g., levels of memory and functional impairment, behavioral problems, depression, pleasant events) were associated with the caregiving experience. Bivariate correlations between PAC, caregiver burden, and mutuality were between −0.20 and −0.58. Predisposing, enabling, and need factors were differentially associated with outcomes, with need characteristics being most frequently associated with various aspects of caregiving. Assessment of both positive and negative aspects of caregiving is important. Particular attention to depression and interventions that improve depressive symptoms may increase PAC and mutuality and reduce caregiver burden. [ABSTRACT FROM AUTHOR]

To examine experiences and perspectives of low-income homebound older adults (N = 90) who participated in tele-delivered behavioral activation (Tele-BA) treatment for depression by bachelor's-level lay counselors. We used the 11-item Treatment Evaluation Inventory (TEI) to measure participants' acceptability of Tele-BA. We used inductive thematic analysis to explore participants' Tele-BA session goals and activities and unsolicited and solicited comments about their Tele-BA experience. Participant's TEI score averaged 70 out of maximum possible 77. The most frequently chosen Tele-BA goals were to improve self-care management of physical and mental health, engage in self-enrichment/self-enjoyment, improve living environment and daily routine, and to increase social connectedness. The themes that emerged from participants' comments about Tele-BA were: (1) benefits of psychoeducation; (2) importance of and gratitude for working with a counselor; (3) benefits of activity planning; (4) understanding of behavior and mood connection; (5) positive effects of increased activity on health and self-enjoyment; (6) sense of being productive and useful from accomplishing goals; (7) hope for the future; and (8) pride in tele-treatment. Participants' comments show that Tele-BA aimed at reinforcing healthy behaviors that improve both physical functioning and mood is well aligned with these older adults' perception of what treatment should be. The findings also provide support for lay counselors' clinical capacity. Given geriatric mental health workforce shortages, lay counselors may be able to effectively supplement existing professional mental health service systems. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has created a public health crisis, infected millions of people, and caused a significant number of deaths. SARS-CoV-2 transmits from person to person through several routes, mainly via respiratory droplets, which makes it difficult to contain its spread into the community. Here, we provide an overview of the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of COVID-19. Direct person-to-person respiratory transmission has rapidly amplified the spread of coronavirus. In the absence of any clinically proven treatment options, the current clinical management of COVID-19 includes symptom management, infection prevention and control measures, optimized supportive care, and intensive care support in severe or critical illness. Developing an effective vaccine is now a leading research priority. Some vaccines have already been approved by the regulatory authorities for the prevention of COVID-19. General prevention and protection measures regarding the containment and management of the second or third waves are necessary to minimize the risk of infection. Until now, four vaccines reported variable efficacies of between 62–95%, and two of them (Pfizer/BioNTech and Moderna) received FDA emergency use authorization. Equitable access and effective distribution of these vaccines in all countries will save millions of lives. [ABSTRACT FROM AUTHOR]

To examine (1) correlates of religious coping, and (2) associations of religious coping at baseline with evaluation of treatment acceptability and depressive symptom severity outcomes of short-term psychotherapeutic depression treatments among 277 low-income homebound older adults (70% female; 41% non-Hispanic White, 30% African American, and 29% Hispanic) who participated in a treatment effectiveness trial. Religious coping was measured with a 2-item subscale of the Brief COPE. Treatment acceptability was measured with the 11-item Treatment Evaluation Inventory (TEI). Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). We used linear regression modeling to examine correlates of religious coping at baseline and to examine associations of religious coping with treatment acceptability and depression outcome at 12 weeks. Being female and being African American predicted higher religious coping. Additionally, active coping, emotional support coping, and clergy consultation on depression were significantly associated with higher religious coping. Religious coping was not significantly associated with TEI and HAMD scores at 12 weeks. The findings show that once these older adults participate in depression treatment, they find it highly acceptable and benefit from treatment, regardless of their religious coping, and that psychotherapeutic treatment is a highly acceptable and effective addition to those with religious-oriented coping. [ABSTRACT FROM AUTHOR]

Limited evidence supports the use of touch or massage for people with dementia. Interventions incorporating a person-centered approach to touch delivered by staff may benefit residents with dementia and staff in long-term care settings. The Compassionate Touch® (CT) program provides protocol-based, skilled human touch and compassionate presence. The purpose of this qualitative study was to explore experiences and perspectives of staff who provided the CT intervention to residents with dementia three times per week for three weeks. Five staff and five residents with dementia in memory care settings participated in the study. Staff were individually interviewed after the three-week intervention, and NVivo 11 software was used for thematic analysis. Although the findings of the present study are preliminary, staff who delivered the CT program perceived positive impacts on themselves and residents with dementia. Programs such as CT may benefit staff and residents with dementia by promoting positive social interactions and giving joy within staff-resident dyads, increasing staff self-efficacy in caring for residents with dementia and residents' responsiveness and calmness, and meeting residents' needs for human touch and affection. Further rigorous studies are needed to measure effectiveness of the CT program on psychosocial outcomes of residents and care-related outcomes of staff. [ABSTRACT FROM AUTHOR]

Objectives: Limited evidence supports the use of therapeutic touch for people with dementia (PWD). Interventions incorporating a person-centered approach to touch delivered by staff may benefit PWD and staff in long-term care settings. The Compassionate Touch® (CT) program provides skilled human touch and a compassionate presence following a person-centered approach and touch protocol. The purpose of this study was to determine the feasibility of training and delivering CT. Methods: An online survey was sent via email to 112 staff who attended the CT coach training. Descriptive statistics and thematic analysis were used to analyze closed-and open-ended questions of the survey. Results: Twenty-four staff members completed the survey and reported positive perspectives about the training, use of the program, and benefits for PWD and themselves. Five themes emerged, including (1) benefits for residents, (2) challenges in using CT, (3) when to use CT, (4) training staff, and (5) needed support. Conclusions: Preliminary findings from the present research show potential benefits of using the CT program for residents, challenges participants faced in using the program and training other staff, and support needed to overcome these challenges. Clinical Implications: Programs such as CT may benefit PWD and staff in residential care settings. [ABSTRACT FROM AUTHOR]

Certified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-®Serious Mental Illness™training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre–post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned. [ABSTRACT FROM PUBLISHER]

Objectives:We evaluate policy and practice strategies for bolstering the geriatric mental healthcare workforce and describe costs and considerations of implementing one approach. Method:Narrative overview of the literature and policy retrieved from searches of databases, hand searches, and authoritative texts. We identified three proposed strategies to increase the geriatric mental healthcare workforce: (1) production of more geriatric mental health providers; (2) team-based care; and (3) non-licensed providers. We evaluate each in terms of challenges and potential and provide estimates of costs, policy, and practice considerations for training, employing, and supervising non-licensed mental health providers. Results:Use of non-licensed providers is key to reforms needed to allow a more older adults to access necessary mental healthcare. Licensed and non-licensed providers have achieved similar improvements for generalized anxiety disorder among patients, although non-licensed providers did so at a lower cost. Conclusion:Supervised non-licensed providers can extend the reach of licensed providers for specific mental health conditions, resulting in lower costs and increased number of patients treated. Although several barriers to implementation exist, policy and infrastructure changes that may support this type of care delivery model are emerging from reforms in financing and associated delivery initiatives created by the Affordable Care Act. [ABSTRACT FROM AUTHOR]

Background: Hispanic adults aged 55 years and older are the fastest growing ethnic minority group in the United States facing significant mental health disparities. Barriers in accessing care have been attributed to low income, poor education, language barriers, and stigma. Cultural adaptations to existing evidence-based treatments have been encouraged to improve access. However, little is known about mental health treatments translated from English to Spanish targeting anxiety among this Hispanic age group. Objctive: This case study offers an example of how an established, manualized, cognitive-behavioral treatment for adults 55 years and older with generalized anxiety disorder (known as “Calmer Life”) was translated to Spanish (“Vida Calma”) and delivered to a monolingual, Hispanic 55-year-old woman. Results: Pre- and post-treatment measures showed improvements in symptoms of anxiety, depression, and life satisfaction. Conclusion: Findings suggest Vida Calma is a feasible treatment to use with a 55-year-old Spanish-speaking adult woman. Clinical Implications: Vida Calma, a Spanish language version of Calmer Life, was acceptable and feasible to deliver with a 55-year-old participant with GAD. Treatment outcomes demonstrate that Vida Calma improved the participant’s anxiety, depression, and life satisfaction. [ABSTRACT FROM PUBLISHER]

Objective: Determine predictors of reduced worry and anxiety for older adults participating in the pilot phase of Calmer Life, a modular, personalized cognitive-behavioral treatment for worry. Methods: Underserved adults (N = 54) over age 50 participated. Therapists were either experts (Ph.D. or Master’s) or nonexpert providers (case managers, community health workers, and bachelor’s level). Participants completed the Penn State Worry Questionnaire—Abbreviated (PSWQ-A) and the Geriatric Anxiety Inventory—Short Form (GAI-SF) before treatment and at 3 months. Results: Demographic and clinical variables were individually entered into separate regression equations, controlling for pretreatment scores, to determine their associations with post-treatment 1) PSWQ-A and 2) GAI-SF scores. Only younger age and African American race were significant (p < .05) univariate predictors of higher post-treatment PSWQ-A scores. African American race was also a significant predictor of higher post-treatment GAI-SF scores. Conclusions: African American participants had higher post-treatment PSWQ-A and GAI-SF scores than White and Hispanic participants. Younger age was also associated with more severe PSWQ-A post-treatment scores. Clinical Implications: Younger participants may experience additional stressors (e.g., caregiving, working) compared with older participants. Smaller decreases in anxiety in African Americans point to the need for continued focus and additional modification of interventions. [ABSTRACT FROM PUBLISHER]

Objectives:Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans. Methods:Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist. Results:The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program. Conclusions:These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs. Clinical Implications:Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety. [ABSTRACT FROM PUBLISHER]

Objectives: Disabled, homebound individuals tend to suffer both chronic pain and depression; however, low-income, homebound older adults have been underexposed in pain and depression research. We examined the extent of pain frequency, intensity, and interference; the relationship between pain and depressive symptoms; and prescription analgesic use and its association with use of antidepressant and anxiolytic medications among these older adults. Method: The data came from the baseline assessment of 215 homebound individuals aged 50+ who were referred to a clinical trial of depression treatment. Bivariate and multivariate analyses were used to examine the research questions. Results: Almost 87% (n = 186) of the participants reported having had chronic pain in the preceding three months. Of the pain reporters, the mean frequency, intensity, and interference of pain were 8.65 ± 2.05, 7.71 ± 2.10, and 7.80 ± 2.82, respectively, on a 1-10 scale, and 61% were taking a prescription analgesic. Analgesic users and nonusers did not differ in depressive symptoms and in pain frequency and intensity, but analgesic users reported higher pain interference than nonusers (8.22 ± 2.46 vs. 7.14 ± 3.22; t = 2.44, df = 184, p = .016). Pain frequency and interference were significantly associated with depressive symptoms, and pain interference was significantly associated with analgesic use in multivariate analysis. Anxiolytic medication use was also correlated with analgesic use. Conclusion: The findings underscore the significant pain-related problems in these vulnerable individuals and the need for recognizing and treating both pain and depression more effectively using both pharmacologic and nonpharmacologic interventions. [ABSTRACT FROM AUTHOR]

Objectives: To assist researchers and clinicians considering using the Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ) with older-adult samples, the current study analyzed the psychometrics of SCSRFQ scores in two older-adult samples. Method: Adults of age 55 or older who had formerly participated in studies of cognitive-behavioral therapy for anxiety and/or depression were recruited to complete questionnaires. In Study 1 (N = 66), the authors assessed the relations between the SCSRFQ and other measures of religiousness/spirituality, mental health, and demographic variables, using bivariate correlations and nonparametric tests. In Study 2 (N = 223), the authors also conducted confirmatory and exploratory factor analyses of the SCSRFQ, as well as an item response theory analysis. Results: The SCSRFQ was moderately to highly positively correlated with all measures of religiousness/spirituality. Relations with mental health were weak and differed across samples. Ethnic minorities scored higher than White participants on the SCSRFQ, but only in Study 2. Factor analyses showed that a single-factor model fit the SCSRFQ best. According to item response theory analysis, SCSRFQ items discriminated well between participants with low-to-moderate levels of the construct but provided little information at higher levels. Conclusion: Although the SCSRFQ scores had adequate psychometric characteristics, the measure's usefulness may be limited in samples of older adults. [ABSTRACT FROM AUTHOR]

This study investigated the relation between generalized anxiety disorder (GAD) and frequency of bad dreams in older adults. A secondary analysis from a randomized clinical trial comparing cognitive behavioral therapy (CBT) for anxiety to enhanced usual care (EUC) assessed bad dream frequency at baseline, post treatment (3 months), and at 6, 9, 12, and 15 months. Of 227 participants (mean age = 67.4), 134 met GAD diagnostic criteria (CBT = 70, EUC = 64), with the remaining 93 serving as a comparison group. Patients with GAD had significantly more bad dreams than those without, and bad dream frequency was significantly associated with depression, anxiety, worry, and poor quality of life. CBT for anxiety significantly reduced bad dream frequency at post treatment and throughout follow up compared to EUC. [ABSTRACT FROM PUBLISHER]

Due to age-related factors and illnesses, older adults may become vulnerable to elder investment fraud and financial exploitation (EIFFE). The authors describe the development and preliminary evaluation of an educational program to raise awareness and assist clinicians in identifying older adults at risk. Participants (n = 127) gave high ratings for the program, which includes a presentation, clinician pocket guide, and patient education brochure. Thirty-five respondents returned a completed questionnaire at the 6-month follow-up, with 69% (n = 24) of those indicating use of the program materials in practice and also reporting having identified 25 patients they felt were vulnerable to EIFFE. These findings demonstrate the value of providing education and practical tools to enhance clinic-based screening of this underappreciated but prevalent problem. [ABSTRACT FROM PUBLISHER]

Objectives: This article outlines the development of the Calmer Life project, a partnership established between researchers and faith-based and social service organizations to examine the effectiveness of cognitive behavioral therapy (CBT) incorporating religious/spiritual components for older African Americans in low-income communities. Method: The program was designed to bypass several barriers to delivery of CBT within the specified community; it allows multimodal delivery (in person or by telephone) that occurs outside traditional mental health settings through faith-based organizations and neighborhood community centers. It includes religion/spirituality as an element, dependent upon the preference of the participant, and is modular, so that people can select the skills they wish to learn. Established relationships within the community were built upon, and initial meetings were held in community settings, allowing feedback from community organizations. Results: This ongoing program is functioning successfully and has strengthened relationships with community partners and facilitated increased availability of education and services in the community. The lessons learned in establishing these partnerships are outlined. Conclusions: The growth of effectiveness research for late-life anxiety treatments in underserved minority populations requires development of functional partnerships between academic institutions and community stakeholders, along with treatment modifications to effectively address barriers faced by these consumers. The Calmer Life project may serve as a model. [ABSTRACT FROM PUBLISHER]

Objectives: The Rating Anxiety in Dementia (RAID; Shankar, K.K., Walker, M., Frost, D., & Orrell, M.W. (1999). The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging and Mental Health, 3, 39–49.) is a clinical rating scale developed to evaluate anxiety in persons with dementia. This report explores the psychometric properties and clinical utility of a new structured interview format of the RAID (RAID-SI), developed to standardize administration and scoring based on information obtained from the patient, an identified collateral, and rater observation. Method: The RAID-SI was administered by trained master's level raters. Participants were 32 persons with dementia who qualified for an anxiety treatment outcome study. Self-report anxiety, depression, and quality of life measures were administered to both the person with dementia and a collateral. Results: The RAID-SI exhibited adequate internal consistency reliability and inter-rater reliability. There was also some evidence of construct validity as indicated by significant correlations with other measures of patient-reported and collateral-reported anxiety, and non-significant correlations with collateral reports of patient depression and quality of life. Further, RAID-SI scores were significantly higher in persons with an anxiety diagnosis compared to those without an anxiety diagnosis. Conclusion: There is evidence that the RAID-SI exhibits good reliability and validity in older adults with dementia. The advantage of the structured interview format is increased standardization in administration and scoring, which may be particularly important when RAID raters are not experienced clinicians. [ABSTRACT FROM PUBLISHER]

Women make up a growing proportion of the physician workforce, and their career satisfaction may affect their health. The authors hypothesized that many facets adversely affecting career satisfaction in women physicians were extrinsic, therefore, preventable or modifiable. The authors conducted a systematic review of the literature in English published through February 2010 to examine facets of career satisfaction of U.S. women physicians. The authors used the women physician AND job satisfaction OR career satisfaction Medical Subject Headings (MeSH) terms, and reviewed bibliographies of key articles to ensure inclusion of relevant studies. The authors used the “Strengthening the Reporting of Observation Studies in Epidemiology” quality tool. Of an initial 1,000 studies, only 30 met the inclusion criteria. Facets reported most frequently to influence career satisfaction for women physicians were income/prestige, practice characteristics, and personal/family characteristics. Overall, career satisfaction for women and men physicians was 73.4% (range = 56.4% to 90%) and 73.2% (range = 59% to 90%), respectively. When compared with men, women physicians were more concerned with perceived lack of time for relationships with patients, colleagues, and family; less satisfied with mentoring relationships and support from all sources; and less satisfied with career-advancement opportunities, recognition, and salary. Career satisfaction can affect health, as well as health and safety of patients. Many factors adversely affecting career satisfaction for women physicians are extrinsic and, therefore, modifiable. [ABSTRACT FROM AUTHOR]

Objectives: Peaceful Mind, a cognitive-behavioral therapy for treating anxiety in persons with dementia, is a promising new treatment currently under investigation. This article reports results of our examination of a modification of the treatment protocol in two cases that included multiple caregivers in treating two persons with dementia. Method: Two case presentations of the benefits and challenges of including multiple caregivers in treatment are discussed. Treatment outcome data for these cases were collected as part of a larger investigation of Peaceful Mind. Results: The involvement of multiple collaterals resulted in several benefits, including increased family communication, as well as increased opportunities for the practice of new skills. These cases have also presented unique challenges requiring alterations in therapy structure and attention to issues of family conflict. Conclusions: Including multiple collaterals in cognitive-behavioral therapy for treating anxiety in persons with dementia is feasible and may be beneficial in maximizing treatment gains and increasing the family's investment in therapy. [ABSTRACT FROM AUTHOR]

This study focused on the relative contribution of heart failure (HF) disease severity, depression, and comorbid anxiety to quality of life for 96 ambulatory HF veterans (48 with and 48 without depressive symptoms). Primary analyses sought to predict HF quality of life using constructs including depression symptoms, comorbid anxiety symptoms, HF severity, medical-illness burden, and demographic factors. Multiple regression procedures found 3 significant predictors of better quality of life, including HF severity (β = -13.33, p < .001), depressive symptoms (β = -2.34, p = .003), and age (β = 0.76, p < .01). These results suggest that disease severity and depression, but not necessarily comorbid anxiety, significantly affect quality of life for HF patients. As HF is a progressive, deteriorating condition, mental health interventions, especially those that target depression, might offer opportunities for improved quality of life for HF patients. [ABSTRACT FROM AUTHOR]

The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions (decisional autonomy) to the virtual exclusion of the capacity to execute the treatment plan (executive autonomy). However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks associated with chronic care. The purpose of this article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy. [ABSTRACT FROM AUTHOR]

Information regarding older adult emergency center (EC) patient characteristics remains limited, despite its increasing importance in health care delivery systems. This retrospective study encompasses all EC visits over an eight-year period (n?=?825,682) to a large urban county hospital. Only participants with a primary psychiatric diagnosis were examined, and included a total of 53,894 adults, 18–64 years old and 1,478 adults, =65 years old. Despite an increasing aging population, EC visits for older adults with psychiatric disorders did not increase over time. Within the older adult sample, cognitive, psychotic, and bipolar disorders were associated with higher rates of admission to the hospital, while substance use, depressive, and anxiety disorders were associated with lower numbers of inpatient admissions. African-Americans were over-represented in the EC and admitted to the hospital at higher rates, compared to other ethnic groups. Caucasian patients were the group most frequently diagnosed with a substance use disorder. In conclusion, differences in race, and diagnosis support the idea that such variables directly relate to utilization rates, presentation, and disposition within the EC. [ABSTRACT FROM AUTHOR]

This study examined psychological predictors of Global Assessment of Functioning Scale scores (GAF) at intake and at discharge for geropsychiatric inpatients. A total of 301 predominantly male geropsychiatric inpatients were recruited from the Houston Veterans Affairs Medical Center. Path analysis was used to test a model proposing causal paths of psychological predictors (cognitive status, depression, agitation, general psychiatric status) to GAF scores on admission and discharge. At admission, all four psychological predictors had positive paths to the admission GAF scale scores but at discharge, only two (i.e., cognitive status and general psychiatric status) of the four psychological predictors had positive paths to the discharge GAF scale scores. The admission GAF scale scores also had a positive path to the discharge GAF scale scores. The overall functioning level of geropsychiatric inpatients may be predicted by measures which assess overall cognitive status and general psychiatric functioning during hospitalizadon. Results prompt consideration of a modified global scale specifically reflecting an older adult's activities during this period of life. [ABSTRACT FROM AUTHOR]

Objective: The goals of this study are to examine the use of the Cohen-Mansfield Agitation Inventory (CMAI) using several cut-points, and to describe the distribution of agitated behaviors in a community dwelling dementia population. Methods: The study consisted of a one-time interview with 99 community-dwelling dementia patient and caregiver dyads. We described the distribution of the 29 items of the CMAI and its three previously validated subscales: physically agitated aggressive behavior, physically nonaggressive agitated behavior, and verbally agitated behavior, as well as a fourth subscale of total aggression, which we created. Three different cut-points: (2,2), (3,3), and (4,4), representing both frequency and disruptiveness ratings, were compared. Results: The study showed that with a cut-point of (2,2), 57% of the patients displayed at least one aggressive trait, 19% were physically aggressive, 40% were agitated, 51% were verbally aggressive, and 33% were part of the total aggression subscale. With a cut-point of (3,3), 47% of the patients displayed at least one aggressive trait, 10% were physically aggressive, 26% were agitated, 37% were verbally aggressive, and 19% were part of the total aggression subscale. Finally, with a cut-point of (4,4), 31% of the patients displayed at least one aggressive trait, 10% were physically aggressive, 14% were agitated, 19% were verbally aggressive, and 16% were part of the total aggression subscale. Conclusion: This study provides data on the frequency and severity of agitation in dementia patients. Furthermore, it offers cut-points that can potentially aid clinicians and researchers to better assess and treat patients with dementia and agitation. [ABSTRACT FROM AUTHOR]

Behavioral symptoms in dementia are common, and lack of a conceptual model has resulted in the use of treatments that address only the symptoms and not the causes. Our conceptual model proposes that the determinants of behavioral symptoms derive from three sources, the patient, the caregiver, and the environment. These determinants are subdivided into those that are mutable and those that are fixed. By identifying mutable determinants, this conceptual model eventually will lead to a more systematic approach to the treatment of behavioral symptoms in dementia and to quality improvement programs. [ABSTRACT FROM AUTHOR]

This cross-sectional measurement study demonstrates a technique for combining information from several aggression scales into one aggression score using latent variable modeling. Participants included male patients (n = 49) with a DSM-IV diagnosis of dementia at The Veterans Affairs Medical Center Outpatient Geriatric Psychiatry Clinic. Data from seven aggression scales were used to indicate the latent aggression variable. Results provided evidence that a unidimensional latent variable model of aggression adequately represented the data. Reliability of the aggression latent variable was estimated as 0.90, whereas reliability of the separate scales estimated with this sample were less than 0.84. Our findings suggest that combining multiple scales into one aggression score using latent variable modeling results in comprehensive and reliable aggression scores that offer researchers several advantages over current methods for measuring aggression. [ABSTRACT FROM AUTHOR]

A survey was administered to Department of Veterans Affairs (DVA) mental health professionals to determine whether they perceived themselves to be competent in addressing the needs of older veterans, and if not how they believed their deficits could be remedied. Forty-two percent of the 803 surveys were returned and answered in a valid manner. Results indicate that DVA mental health professionals spend 30% of their time with older veterans. Although most have had geriatric training, one-third had none. Almost three-fourths say that they desire more education in geriatrics, particularly in the areas of dementia, depression, grief, substance abuse, and legal and ethical issues. Preferred formats for training varied, suggesting that a number of different venues should be offered to address the geriatric training needs of mental health staff. It appears that most public sector mental health professionals spend a significant portion of their work day with older adults, have received some geriatric training, and would like more training. [ABSTRACT FROM AUTHOR]

This study investigates the prevalence of religiously based coping mechanism use in Alzheimer's caregivers who use support groups and the correlation between the use of these coping mechanisms and caregiver mental health. Caregivers completed scales measuring depression, burden, religiosity, and religious coping. Caregivers reported high levels of spirituality and religious coping mechanism use. Those caregivers that felt anger or distance from God and who questioned their faith or religious beliefs were significantly (p < 0.001) correlated with increased depression and perceived burden. Other measured subscales did not show significant correlations with mental health variables. [ABSTRACT FROM AUTHOR]

Studies kinetic solutions of initial and boundary value problems for the Euler equations of gases. Method of the study; Results and discussion; Conclusion.

Objective: There is increasing evidence and awareness that rheumatoid arthritis symptoms, such as joint pain and activity limitations, are strongly influenced by psychosocial variables. We hypothesized that depression is significantly associated with functional capabilities in rheumatoid arthritis (RA) patients. Method: We examined in a cross-sectional, retrospective data-based study the role of depression, pain severity, and self-efficacy in daily functioning in forty-five adult male veterans aged 55 and older who were patients with RA. Results: The overall RA disablement model of depression, pain severity, and self-efficacy accounted for 67% of predicted variance in disability. All independent variables were significantly associated with functional impairment in RA patients. Conclusions: Psychosocial factors, such as depression and self-efficacy, contribute greatly to disability in RA patients. Clinicians should carefully assess psychiatric and non-disease factors during medical evaluation in patients with RA. [ABSTRACT FROM AUTHOR]

The assessment of and treatment of pain in non-communicative demented patients poses a significant challenge to health care providers. This review discusses the importance of regular pain assessment and treatment for non-communicative demented individuals. We discuss the scope of the problem of under-recognition and under-treatment of pain in geriatric settings, and the unique characteristics of the pain experience in severely demented individuals. Next, we review pain assessment techniques and discuss important barriers to treatment. Finally, we provide recommendations for pain assessment and treatment. [ABSTRACT FROM AUTHOR]

In this descriptive database study, we examine 19 male patients who showed significant deficits in the initiation and perseveration subtest of the dementia rating scale yet scored a 25 or greater on the mini-mental state examination. We compared this I/P impaired group to 42 patients scoring well on the same dementia rating scale subtest, and found no significant differences in demographics, medical burden, agitation or degree of psychosis on hospital admission between the groups. Functioning as assessed by activities of daily living and independent activities of daily living questionnaires was also similar between the two groups on admission. We concluded that executive dysfunction as measured by the I/P subtest of the Dementia Rating Scale, does not impair patients' ability to function independently. Perhaps, the subtleties of executive function are not adequately addressed with the I/P subtest and more detailed instruments may be more useful in predicting independent functioning. [ABSTRACT FROM AUTHOR]

Explores the outcomes of the Houston Veterans Affairs (VA) Medical Center contract nursing home use by elderly veterans with psychiatric disorders in Houston, Texas. Implications of discharge to a nursing home for the quality of life, health and finances of the elderly veteran population; Results of collaborative effort between the VA system and community nursing homes.

Examines patient and family satisfaction on discharge plans from a geropsychiatric unit. Satisfaction on the time and effort spent by the treatment team in discharge planning; Involvement of some patients and caregivers in discharge planning; Common factors associated with satisfaction with discharge to a nursing home; High cost as the factor causing dissatisfaction.

The authors conducted a retrospective review of all admissions to a geropsychiatric unit with a diagnosis of bipolar disorder, manic type during a twenty month period. Seventeen patients were included in the study, their mean age was 71.9 years, the average daily dose was 1044.1 mg, and the average serum valproate level was 53.4 ng per ml. Changes in the general psychiatric symptoms, depression, and agitation using standardized scales were significant (p < 0.01). These results suggest that divalproex sodium is effective and well tolerated in elderly patients with bipolar disorder, manic type. [ABSTRACT FROM PUBLISHER]

This retrospective study examined all admissions from home to the Houston Veterans Affairs Medical Center geropsychiatric inpatient unit during a 20-month period. Mini-Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen-Mansfield Agitation Inventory, and Global Assessment of Functioning were administered on admission and discharge. We found that patients admitted with a diagnosis of dementia were at high risk of placement in a nursing home (94% of cases), particularly those demented patients with more severe, refractory psychiatric and cognitive impairment. Discharge GAF scores appeared to be an important predictor of discharge status for all patients. [ABSTRACT FROM AUTHOR]

The Reminiscence Functions Scale (RFS) was used with 25 male veterans admitted to an inpatient geropsychiatric unit. Pre-post changes on the Mini-Mental State Examination (MMSE), the Brief Psychiatric Rating Scale (BPRS), and the Hamilton Depression Rating Scale (HDRS) were compared to pre-post changes in total reminiscence and the separate factors: (1) Boredom Reduction, (2) Death Preparation, (3) Identity Problem Solving, (4) Conversation, (5) Intimacy Maintenance, (6) Bitterness Revival, and (7) Teach/Inform. The results found a non-significant trend toward a decrease from pre-test to post-test in total reminiscence and on all of the RFS factors except Bitterness Revival. Interestingly, the inpatients reminisced significantly more at admission than the validation sample on RFS total and on most of the RFS factors, but the groups became more similar at discharge. In conclusion, the setting of reminiscence is of prime importance for positive therapeutic change to occur, and the RFS may be a useful tool in identifying ideal treatment contexts for the life review group. [ABSTRACT FROM AUTHOR]

A response by Aanand D. Naik and colleagues to a letter to the editor about their article "Patient Autonomy for the Management of Chronic Conditions: A Two-Component Re-Conceptualization" in the 2009 issue is presented.