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ObjectiveGiven a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples.MethodParticipants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants’ cognitive status and PC needs.ResultsOur results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08.Significance of resultsThis study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.

Previous research suggests some psychologists may not consider academic careers because of doubts about their teaching competency, and this is especially true for psychologists interested in aging (i.e., geropsychologists). To enhance competencies in the practice of education, we developed a webinar series, Advancing Your Confidence as an Educator, to bolster skills and attitudes toward teaching and improve attitudes about careers in aging. Seven hour-long webinars addressed key skills in developing and executing courses and professional presentations, and 2 panel sessions addressed attitudes toward teaching by featuring early- and later-career professionals discussing their paths to and satisfaction with jobs as educators. Attendance across the highly interactive sessions was robust (M = 50). Evaluation data suggest the webinar was effective in meeting educational needs. To promote sustainable impact, the webinars are archived and freely available online. Challenges in marketing and evaluation arose, but overall, this effort is one way of cultivating a more vigorous interest and self-confidence in teaching.

Objective: Purpose in life tends to decline in older adulthood and it is thought that intact cognitive functioning is required for purposeful living. Thus, it is likely that individuals may perceive older adults who are experiencing cognitive declines associated with dementia as having a reduced sense of purpose. Biases such as these may influence how individuals, especially care partners, interact with those with dementia.Method: This study examined how sense of purpose changed following a dementia diagnostic appointment for both the person receiving a diagnosis and their care partner. This study also explored how each individual perceived the other member of the dyad’s sense of purpose. Older adults (47 care recipients and 75 care partners, 57% female; Mage = 68.5 years, SDage = 12.0 years) provided self- and other-report ratings of sense of purpose before and after their appointment at a specialized memory clinic.Results: Overall, both care recipients and care partners’ sense of purpose declined following a dementia diagnostic appointment [t(85) = 7.01, p < 0.001]. However, when comparing self-reports and other-reports of purpose, care partners reported that care recipients experienced a lower sense of purpose in life than the care recipients reported about themselves.Conclusions: Care recipients and partners reported less purpose in life following their dementia diagnostic appointment. Care partners may hold certain biases regarding sense of purpose toward care recipients. These findings can inform future work regarding how care recipients and care partners can plan purposeful lives following a dementia diagnosis.

Objective: The Verbal Naming Test (VNT) is a nonvisual measure of word finding with stimuli chosen based on rare frequency of usage in spoken English. The purpose of the current study was to evalua...

This chapter describes one of the five risk areas, namely, caregiver physical health. Outcomes in caregiver intervention research commonly have focused on the mental health or psychosocial consequences of caregiving. Caregiving can be a prolonged stressor, however, and caregivers may be at risk for conditions such as high blood pressure or other negative physical health symptoms. This chapter focuses on basic education regarding caregiver health by referring clinicians and caregivers to the Healthy Lifestyle Guide, located in the Appendix. When caregiver health issues are identified through the risk assessment, clinicians can reference this chapter as they create their Action Plans targeting improvement in caregiver physical health.

This chapter describes the basic tenets of the REACH OUT protocol and how they came to be. It begins with an overview of the development of the REACH OUT protocol and details the program’s evolution over more than two decades. The chapter describes the five risk areas around which the REACH OUT program revolves: home safety, physical health, emotional well-being, behavior management, and social support. Following this, it provides a brief description of the tools available to the clinician as well as the intervention strategies utilized on a session-by-session basis. The chapter ends with a sample intervention schedule to help the clinician organize a potential timeline for treatment.

This chapter describes one of the five risk areas, namely, home safety. It aims to lead clinicians and caregivers through the process of ensuring personal safety for both the person with dementia and the caregiver. Clinicians are given a brief list of home safety items to check, arranged by area of the home, and referenced to an Appendix of this manual where a full Home Safety Checklist can be found. When safety problems are identified through the risk assessment, clinicians can incorporate items from these lists into their Action Plans in order to promote home safety. This chapter may be revisited throughout the REACH OUT protocol as new issues related to safety are identified.

This chapter describes one of the five risk areas, namely, caregiver emotional well-being. Caregiving for a person with dementia often is associated with increased levels of depression, stress, anxiety, and anger. This chapter focuses on two strategies designed to improve caregiver emotional well-being: relaxation to reduce stress and increasing engagement in pleasant events. Clinicians are given instructions to teach caregivers the Signal Breath technique, a deep breathing skill to help increase alertness and reduce stress. The chapter also includes worksheets designed to be filled out with the caregiver in order to identify and plan pleasant events for both the caregiver and the person with dementia.

Our nation increasingly relies on family members or friends (i.e., informal caregivers) for needed care and support as we age. Family caregivers typically assume their caregiving role willingly and reap personal fulfilment from helping a family member, developing new skills, and strengthening family relationships. For these benefits, however, caregivers often sacrifice their own health and well-being. Depression, anxiety, poor physical health, and compromised immune function are more common among family caregivers than in adults not providing such care. The REACH OUT (Resources for Enhancing Alzheimer’s Caregiver Health: Offering Useful Treatments) program is a multicomponent, tailored, and flexible intervention for caregivers of people with dementia focused on the evidence-based therapeutic strategy of problem solving. This work is designed to guide clinicians through the process and provide them the necessary tools to share with caregivers with the goal of enhancing caregiver physical and mental health. Five common risk areas (home safety, caregiver health, social support, challenging behaviors, and emotional well-being) are described in the manual; and interventions are described that respect the nuances of each risk area. By beginning with an individualized risk assessment and being flexible to the needs and issues of the caregiver, the REACH OUT intervention helps clinicians identify risk areas and provide caregivers with tailored action plans to reduce risk and promote well-being.

This chapter describes the first session and the basic components of the REACH OUT intervention. The first session focuses on risk appraisal, conducted using two standardized measures, which helps the clinician and caregiver jointly establish a hierarchy of needs and goals for treatment and organize them according to the five risk areas. The chapter then outlines, step-by-step, the core process of REACH OUT: the creation of formal Action Plans. The goal of this intervention is to engage the caregiver in joint problem solving with the objective of creating written Action Plans targeting specific caregiving problems (e.g., improving caregiver health, addressing hazards in the physical environment). The chapter ends with tips for the clinician to keep in mind when working with caregivers to develop Action Plans.

This chapter highlights and reiterates important clinical issues, REACH OUT materials, and roadblocks to success. It begins with a few clinical suggestions and a list of materials to bring to each session in order to help clinicians fill in the gaps and increase the likelihood of a successful REACH OUT intervention. This chapter also discusses common barriers faced over the course of the intervention as well as possible solutions. Clinicians will find this chapter helpful when faced with issues that commonly arise, such as dealing with off-topic discussions, caregiver limitations in hearing or vision, or low literacy levels.

This chapter describes one of the five risk areas, namely, managing challenging behaviors. The chapter begins with a description of the ABC Process of Behavior Management. Learning this process will help clinicians structure the development of individualized Action Plans and target behavior with the greatest likelihood of success. The chapter also includes instructions to format Challenging Behavior Action Plans as well as guidelines for presenting these Action Plans to the caregiver. The chapter ends with tips, reminders, and advice for clinicians on working with caregivers to reduce and manage challenging behaviors of the person with dementia.

This chapter describes one of the five risk areas, namely, social support. The chapter is designed to address problems regarding social isolation and to help caregivers maintain contact with their social network. The goal of this chapter is to help caregivers receive the assistance they need with both caregiving and noncaregiving tasks from both formal (e.g., community services or agencies) and informal (e.g., family and friends) sources. When issues of isolation or low social support are identified in the risk appraisal, this chapter will be used to guide Action Plan development in order to provide caregivers with the resources and information they need to improve social support.

Objectives Receiving a diagnosis of dementia has major implications. Although protocols for disclosing difficult information have been developed for other health conditions, no such evidence-based method exists for dementia. As a step toward that goal, this study analyzed the discourse within dementia diagnosis disclosure sessions to identify conversational features associated with psychological outcomes. Method The Roter Interaction Analysis System (RIAS) was used to code the discourse among patients, their companions, and providers during 84 dementia diagnosis disclosure sessions following an initial evaluation at an Alzheimer's Disease Research Center. Results Providers dominated the conversation in terms of overall time spent talking. With more severe dementia, patients spoke less and companions spoke more. Provider-positive rapport building was associated with lower patient depression and anxiety following the disclosure session. Patient-positive rapport building was associated with higher companion anxiety, but only when the patient was not suspected to have dementia. No associations were found between other types of discourse and patient or companion psychological outcomes. Discussion A relatively small amount of positive rapport building by providers can lead to reduced distress following dementia disclosure. Dementia disclosure best practices should emphasize patient-centered communication techniques in order to minimize psychological distress following diagnosis.

The current chapter provides a foundation for considering purpose as it pertains to older adults and, in so doing, explores the implications of promoting sense of purpose for healthy aging. First, we describe what it means to have a purpose, or feel a sense of purpose, as well as the normative developmental trends for the construct during adulthood. Second, we describe the benefits associated with having a sense of purpose during older adulthood, in order to speak to the value of purpose in the context of older adults. And finally, we consider how promoting sense of purpose may be worked into the areas of role-transitions that older adults often experience such as changes in employment, living situation, health, and cognition. We conclude with future directions for exploring these considerations more fully in order to inform directives for promoting purposefulness among older adults.

Objective Frontotemporal dementia (FTD) accounts for ∼10% of dementia cases and is the most common cause of early-onset dementia. However, no well-validated instrument currently exists to measure knowledge about FTD. In this study, we used systematic scale development procedures to create a scale to measure knowledge of FTD based on a contemporary understanding of the disease. Methods Standard scale development methods were used to create items and evaluate their psychometric properties. A total of 72 health care professionals and 102 caregivers of people with FTD responded to items measuring FTD knowledge, general dementia knowledge, crystallized intelligence, experience with FTD, and demographic information. Results The Frontotemporal Dementia Knowledge Scale (FTDKS) contains 18 items that cover key, basic knowledge about FTD in the domains of risk factors, symptoms, course, caregiving, and treatment. The scale uses a 4-point True/False format with a Don't Know option and takes ∼5 minutes to complete. In the current sample the FTDKS had good psychometric properties in terms of reliability and validity. Implications The FTDKS can be used with health care professionals and caregivers of people with FTD to assess their knowledge about the disease. The scale may be useful to evaluate knowledge in clinical care and educational program contexts.

Purpose in life has been linked with better well-being and reduced risk for major illness. As such, work has focused on understanding what leads to changes in sense of purpose during adulthood, with a focus on major life events. Receiving a dementia diagnosis is a major life event that could affect purpose in life both for older adults with dementia and their potential caregivers. To examine this issue participants answered questions at two timepoints, before their diagnostic appointment at a specialized memory clinic, and between two days and two weeks after the appointment. Participants provided self-report ratings of sense of purpose and as well as open-ended answers regarding their purpose in life. Data is available from both caregivers and patients and qualitative coding was performed on participants’ open-ended responses. Our analysis revealed discordance between patients and caregivers, such that caregivers’ ratings of patients were lower in terms of purpose in life (t = -5.63, p < .001) and being in worse health (t = -3.41, p < .001) than patients’ ratings of themselves on the same measures. Discordance between caregiver and patient in the context of a dementia diagnostic appointment and outcomes associated with this discordance are discussed.

Purpose in life has been linked with better well-being and reduced risk for major illness. As such, work has focused on understanding what leads to changes in sense of purpose during adulthood, with a focus on major life events. Receiving a dementia diagnosis is a major life event that could affect purpose in life both for older adults with dementia and their potential caregivers. To examine this issue participants answered questions at two timepoints, before their diagnostic appointment at a specialized memory clinic, and between two days and two weeks after the appointment. Participants provided self-report ratings of sense of purpose and as well as open-ended answers regarding their purpose in life. Data is available from both caregivers and patients and qualitative coding was performed on participants’ open-ended responses. While there was no significant, mean-level change in purpose in life for patients (t = -.14, p = .88) or caregivers (t = .73, p = .46), some participants exhibited reliable change in sense of purpose. Factors underlying individual increases and decreases in sense of purpose following a dementia diagnostic appointment are explored and discussed.

Comments on an article by S. F. Lang and B. J. Fowers (see record 2018-24691-001). In Lang and Fowers' (2019) article, they provide multiple arguments for why dementia caregiving persists despite the seemingly great evolutionary risk. Adding to their list of considerations, the current commentary provides another potential explanation, namely, that individuals may enact dementia caregiving because it provides engagement toward purposeful aims. Having a sense of purpose predicts multiple evolutionary benefits, including greater longevity, and we discuss here 2 routes by which dementia caregiving may fulfill the role of purposeful engagement. First, it provides a mechanism for suiting some individuals' broader goals of helping others in need. Second, it may allow individuals an opportunity for reflection upon what constitutes personally meaningful pursuits. The commentary ends with a consideration of why adding purpose to the discussion of dementia caregiving can assist researchers and practice professionals interested in helping promote caregiver well-being. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

To educate generalists for work with older adults, geriatric specialists will increasingly be used as educators and consultants. Recent work found many Geropsychologists felt well trained as clinicians and researchers, but they did not feel as prepared to educate; further few choose primarily educational careers. To address these issues, Geropsychologists from the VA and University partnered to develop a national webinar entitled “Advancing your Confidence as an Educator in geriatrics and gerontology” 9/2017 to 5/2018. Monthly session attendance ranged between 40–70 individuals. On average, 69% of attendees were psychologists, 13% were nurses, and 13% were social workers; 74% of attendees reported specialty training in aging, 14% reported some training in aging, and 12% reported no training in aging. 45% were faculty/staff in hospital settings, 28% were faculty/staff in academic settings, and 23% were students/trainees. In our presentation we will describe the development and implementation of the webinar in further detail.

The shortage of clinical geropsychologists is further imperiled by the shortage of geropsychologists entering academia. The current study analyzed data collected during the implementation of a national webinar series (Advancing your Confidence as an Educator in Geriatrics and Gerontology). The development and implementation of the series has been previously reported. In the current study, we report on n=66 psychologists’ and psychology trainees’ responses to academia. Results included quantitative ratings of feelings towards imaging oneself in an academic role. Feelings rated included Excitement (41%), Intimidated (18%), Overwhelmed (30%), and Enthusiastic (30%), among others. These results were triangulated with open-ended qualitative responses on the frustrations and rewards of being an educator. Results are discussed in the context of the geropsychology pipeline shortage and implications for the future of clinical geropsychology. Suggestions for how to remedy this concern will be discussed.