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Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide. Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012–2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository. 2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion. Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression. [ABSTRACT FROM AUTHOR]

Background and Objectives Evidence-based practices to manage distress behaviors in dementia (DBD) are not consistently implemented despite demonstrated effectiveness. The Veterans Health Administration (VA) trained teams to implement Staff Training in Assisted Living Residences (STAR)-VA, an intervention to manage DBD in VA nursing home settings, or Community Living Centers (CLCs). This paper summarizes multiyear formative evaluation results including challenges, adaptations, and lessons learned to support sustained integration into usual care across CLCs nationwide. Research Design and Methods STAR was selected as an evidence-based practice for DBD, adapted for and piloted in VA (STAR-VA), and implemented through a train-the-trainer program from 2013 to 2018. Training and consultation were provided to 92 CLC teams. Evaluation before and after training and consultation included descriptive statistics of measures of clinical impact and survey feedback from site teams regarding self-confidence, engagement, resource quality, and content analysis of implementation facilitators and challenges. Results STAR-VA training and consultation increased staff confidence and resulted in significant decreases in DBD, depression, anxiety, and agitation for Veterans engaged in the intervention. Implementation outcomes demonstrated feasibility and identified facilitators and barriers. Key findings were interpreted using implementation frameworks and informed subsequent modifications to sustain implementation. Discussion and Implications STAR-VA successfully prepared teams to manage DBD and resulted in improved outcomes. Lessons learned include importance of behavioral health–nursing partnerships, continuous engagement, iterative feedback and adaptations, and sustainment planning. Evaluation of sustainment factors has informed selection of implementation strategies to address sustainment barriers. Lessons learned have implications for integrating team-based practices into system-level practice. [ABSTRACT FROM AUTHOR]

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society. (Contains 1 table.)

Psychology internship and fellowship years are exciting yet challenging times of professional development, as geropsychologists-in-training transition to independent practice and work to consolidate their identities as professional geropsychologists. Geropsychology supervisors help interns and fellows to develop and refine attitude, knowledge, and skill competencies for geropsychology practice. "Transformational" geropsychology supervisors also serve as mentors. They offer professional role modeling, acknowledgement of unique strengths and areas for growth, socialization to the geropsychology community, and communication of confidence and support for the professional development of interns and fellows.

The aging of the population will increase demand for psychological services for older adults, which challenges the profession of psychology to provide those services. In response to that challenge, professional geropsychology has been developing over the past few decades to meet current and prepare for anticipated future demand. The development of a range of training opportunities is important to enable psychologists to work effectively with older adults. This article describes the Pikes Peak model for training in professional geropsychology. The model is an aspirational, competencies-based approach to training professional geropsychologists that allows for entry points at multiple levels of professional development.

There is a growing need for professional psychology training in nursing home settings, and nursing homes provide a rich environment for teaching geropsychology competencies. We describe the nursing home training component of our Department of Veterans Affairs (VA) Predoctoral Internship and Geropsychology Postdoctoral Fellowship programs. Our training objectives for Interns and Fellows include: increased exposure and interest in nursing home practice; increased competencies in assessment, intervention, and consultation in this setting; and increased confidence in the role of the psychologist in medically oriented, geriatric care settings. We describe the local VA nursing home training setting and our training model, including expected competencies, training activities, special issues in supervision, and evaluation of competencies. We have found group supervision and peer support to be an important component of our nursing home training program. The VA healthcare system allows great flexibility for psychologists to provide both psychological services and training in the nursing home setting.

Purpose: The purpose of this study was to compare adults with and without dementia on capacities to consent to treatment as assessed by three instruments. Design and Methods: Eighty-eight older adults with mild to moderate dementia were compared with 88 matched controls on four indices of legal competency to consent to medical treatment as assessed with three capacity instruments. Results: Mean performance of adults with dementia on a legal standard of understanding treatment information was impaired relative to controls on all instruments, and it was also impaired for an appreciation standard on one instrument and a reasoning standard on two instruments. However, in categorical ratings, most adults with dementia were within the normal range on all decisional capacities. Legal standards were operationalized differently across the three instruments for the capacities of appreciation and reasoning. Implications: Most adults with mild dementia can participate in medical decision making as defined by legal standards, although memory impairments may limit demonstration of understanding of diagnostic and treatment information. In dementia, assessments of reasoning about treatment options should focus on whether a person can describe salient reasons for a specific choice, whereas assessments of appreciation of the meaning of diagnostic and treatment information should focus on whether a person can describe the implications of various choices for future states. More research is needed to establish the reliability and validity of assessment tools and of capacity constructs.

Have psychologists who have pursued postdoctoral training in geropsychology viewed such training as a worthwhile professional investment? As the population is aging, psychologists are increasingly working with older adults. For many psychologists, competent practice with the elderly will require some continuing education, whereas other psychologists may choose to secure specialty-level training in the field. A survey of psychologists who completed such specialized postdoctoral training found a high level of satisfaction with the training and a sense of professional competence in most of the geropsychology competency areas set forth by the American Psychological Association. The need for increased opportunities for both proficiency and specialty-level training in applied geropsychology is discussed.

Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans. Methods: Articles included those published in 2009–2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models. Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising. Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention. Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans. [ABSTRACT FROM AUTHOR]