[show abstract][hide abstract] ABSTRACT: This study examined the assumption of measurement invariance of the SAMSHA Mental Health and Alcohol Abuse Stigma Assessment. This is necessary to make valid comparisons across time and groups. The data come from the Primary Care Research in Substance Abuse and Mental Health for Elderly trial, a longitudinal multisite, randomized trial examining two modes of care (Referral and Integrated). A sample of 1,198 adults over the age of 65 who screened positive for depression, anxiety, and/or at-risk drinking was used. Structural equation modeling was used to assess measurement invariance in a two-factor measurement model (Perceived Stigma, Comfort Level). Irrespective of their stigma level, one bias indicated that with time, respondents find it easier to acknowledge that it is difficult to start treatment if others know they are in treatment. Other biases indicated that sex, mental quality of life and the subject of stigma had undue influence on respondents' feeling people would think differently of them if they received treatment and on respondents' comfort in talking to a mental health provider. Still, in the present study, these biases in response behavior had little effect on the evaluation of group differences and changes in stigma. Stigma decreased for patients of both the Referral and Integrated care groups.
[show abstract][hide abstract] ABSTRACT: This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
[show abstract][hide abstract] ABSTRACT: Aims of the study were to describe behavioral health treatment utilization patterns of community-dwelling older adults with depressive symptoms over a six-month period and to identify factors associated with treatment use, guided by a theoretical model emphasizing the dynamic nature of treatment use patterns over time and social context.
A total of 144 participants ≥65 years old with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes at each follow-up included the use of antidepressants or counseling. Covariates included personal and social context variables.
Approximately half of the participants (N=70, 48%) received no formal treatment (antidepressant prescription or counseling). Treatment use or nonuse did not change for most participants. More participants with severe symptoms received antidepressants (25%-37%) than did those with milder symptoms (10%-14%), although more participants in the latter group started (milder, 62%,versus severe, 49%) and stopped (milder, 77%, versus severe, 26%) antidepressant treatment at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, treatment use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new treatment at baseline, and receipt of advice to seek treatment.
Over a six-month period, most older adults with depressive symptoms in this study continued their use or nonuse of mental health treatment. Demographic, need, attitudinal, and social variables were related to treatment use over time. Addressing intentions and providing advice may facilitate treatment seeking.
[show abstract][hide abstract] ABSTRACT: This article focuses on justification of psychoactive medication prescription for NH residents during their first three months post-admission.
We extracted data from 73 charts drawn from a convenience sample of individuals who were residents of seven nursing homes (NHs) for at least three months during 2009. Six focus groups with NH staff were conducted to explore rationales for psychoactive medication usage.
Eighty-nine percent of the residents who received psychoactive medications during the first three months of residence had a psychiatric diagnosis, and all residents who received psychoactive medications had a written physician's order. Mental status was monitored by staff, and psychoactive medications were titrated based on changes in mental status. One concern was that no Level II Preadmission Screening and Annual Resident Review (PASRR) evaluations were completed during the admissions process. Further, while 73% had mental health diagnoses at admission, 85% of the NH residents were on a psychoactive medication three months after admission, and 19% were on four or more psychoactive medications. Although over half of the residents had notes in their charts regarding non-psychopharmacological strategies to address problem behaviors, their number was eclipsed by the number receiving psychopharmacological treatment.
While the results suggest that NHs may be providing more mental health care than in the past, psychopharmacological treatment remains the dominant approach, perhaps because of limited mental health training of staff, and lack of diagnostic precision due to few trained geriatric mental health professionals. A critical review of the role of the PASRR process is suggested.
Aging and Mental Health 06/2011; 15(7):904-12. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Focusing on misconceptions and personal beliefs associated with depression, the present study explored predictors of attitudes toward mental health services in a sample of 297 Hispanic older adults living in public housing (M age = 76.0 years, SD = 7.74). Results from a hierarchical regression analysis showed that negative attitudes towards mental health services were predicted by advanced age, belief that having depression would make family members disappointed, and belief that counseling brings too many bad feelings such as anger and sadness. Findings suggest that interventions designed to promote positive attitudes toward mental health services of older Hispanics should address misconceptions and personal beliefs.
Community Mental Health Journal 04/2011; 47(2):164-70. · 1.03 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to examine factors associated with the mental health service use of Latino and Asian immigrant elders. Adapting Andersen's behavioral health model of health service utilization, predisposing, enabling, and mental health need factors were considered as potential predictors for use of mental health services.
Data were drawn from a nationally representative dataset, the National Latino and Asian American Survey (NLAAS). Hierarchical logistic regression analyses of mental health service use were conducted for Latino (N = 290) and Asian (N = 211) immigrant elders.
For both groups of immigrant elders, poor self-rated mental health was associated with significantly greater mental health service use, even after controlling for all other variables. For Latinos, use of mental health services was significantly associated with both predisposing factors (being younger and female) and mental health need factors (having any mood disorders and poor self-rated mental health). Among Asians, only mental health need factors (having any mood disorders and poor self-rated mental health) significantly affected mental health service use. In addition, poor self-rated mental health mediated the association between mood disorders and mental health service use only in Latino immigrant elders.
Results highlight an important role of self-rated mental health as a potential barrier in the use of mental health services, and suggest intervention strategies to enhance service use.
Aging and Mental Health 05/2010; 14(5):535-42. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: The study explored determinants of depressive symptoms among 297 Hispanic older adults living in public housing (Mage = 76.0, SD = 7.74). Following a basic stress model, the focus was on the effects of demographic variables, risk factors (functional disability, self-perceived health, and acculturation), and social resources (network of relatives and network of friends). Hierarchical regression analyses revealed that financial status, which was a significant predictor in the initial model, became non-significant when risk factors were taken into consideration. All three risk factors were found to be significant; depressive symptoms were predicted by greater levels of functional disability, more negative self-perceived health, and lower levels of acculturation. In the final model, networks of both relatives and friends were shown to be significant even after we controlled for the effects of demographics and risk factors. Findings discussed in the article were made in the context of culture and residential setting.
Journal of Applied Gerontology 01/2010; 29(2):180-195. · 0.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: To explore the extent of and factors associated with male residents who change wandering status post nursing home admission.
Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior.
One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States.
Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004.
MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals.
The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status.
A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.
International Journal of Geriatric Psychiatry 07/2009; 25(2):166-74. · 2.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers.
Agencies in 4 counties conducted screenings among 3497 older adults for alcohol, medications, and illicit substance misuse problems and for depression and suicide risk. Screening occurred in elders' homes, senior centers, or other selected sites. Individuals who screened positive for substance misuse were offered brief intervention with evidence-based practices and rescreened at discharge from the intervention program and at follow-up interviews.
Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Depression was prevalent among those with alcohol and prescription medication problems. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures.
The BRITE program effectively shaped state policy by responding to legislative mandates to address the needs of an increasing, but underserved, elder population. The pilot paved the way for obtaining a federally funded grant to expand BRITE to 27 sites in 17 counties in Florida.
American Journal of Public Health 06/2009; 100(1):108-14. · 3.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: Older adults' recognition of a behavioral health need is one of the strongest predictors of their use of behavioral health services. Thus, study aims were to examine behavioral health problems in a sample of older adults receiving home-based aging services, their recognition of behavioral health problems, and covariates of problem recognition.
The study design was cross-sectional. Older adults (n = 141) receiving home-based aging services completed interviews that included: Structured Clinical Interview for DSM-IV; Brief Symptom Inventory-18; attitudinal scales of stigma, expectations regarding aging, and thought suppression; behavioral health treatment experience; and questions about recognition of behavioral health problems.
Thirty (21.9%) participants received an Axis I diagnosis (depressive, anxiety, or substance); another 17 (12.1%) were diagnosed with an adjustment disorder. Participants were more likely to recognize having a problem if they had an Axis I diagnosis, more distress on the BSI-18, family member or friend with a behavioral health problem, and greater thought suppression. In logistic regression, participants who identified a family member or friend with a behavioral health problem were more likely to identify having a behavioral health problem themselves.
Findings suggest that older adults receiving home-based aging services who recognize behavioral health problems are more likely to have a psychiatric diagnosis or be experiencing significant distress, and they are more familiar with behavioral health problems in others. This familiarity may facilitate treatment planning; thus, older adults with behavioral health problems who do not report familiarity of problems in others likely require additional education.
International Journal of Geriatric Psychiatry 10/2008; 24(4):400-8. · 2.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate nursing home residents with psychiatric diagnoses who wander and who are not diagnosed with dementia.
A national cross-sectional study was conducted in a male Veterans Administration Nursing Home Care Unit population using a retrospective review of the MDS.
Eleven thousand six hundred and nineteen residents were identified as having a psychiatric diagnosis without significant cognitive impairment; just under 1% (n = 113) wandered. Using rare events logit regression, we determined that a diagnosis of schizophrenia/bipolar disorder or comorbid psychiatric conditions were associated with increased risk of wandering compared to residents diagnosed with anxiety/depression. Psychiatric wanderers were also more likely to, have symptoms of delirium, exhibit socially inappropriate behavior, manifest problems in decision-making, take anti-psychotic medications, and to be more independent in locomotion.
Psychiatric wanderers may be conceptualized better as exhibiting ambulatory concomitants of unremitted neurological/psychiatric symptoms or medication side effects of their treatment. Findings have implications for addressing treatable causes of wandering.
International Journal of Geriatric Psychiatry 07/2008; 23(7):748-53. · 2.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the prevalence and correlates of wandering in persons with traumatic brain injury (TBI) in nursing homes (NHs).
Using a cross-sectional design, logistic regression modeling was used to analyze a national database.
One hundred thirty-four NH facilities operated by the Veterans Health Administration.
NH residents (N=625) with TBI as well as a sample (n=164) drawn from a larger dataset of NH residents without TBI using 1:K matching on age.
Wanderers with and without TBI did not differ significantly overall. The prevalence of wandering among patients with TBI was 14%, compared with 6.5% of the general nursing home population. The results of the multivariate logistic regression suggested that wandering was associated with poor memory, poor decision making, behavior problems, independence in locomotion and ambulation, and dependence in activities of daily living related to basic hygiene.
Wandering is relatively common in NH residents with TBI. As expected, it is associated with cognitive, social, and physical impairments. Further research with a larger sample should examine those with comorbid dementia and/or psychiatric diagnoses.
Archives of physical medicine and rehabilitation 03/2008; 89(2):244-50. · 2.18 Impact Factor
[show abstract][hide abstract] ABSTRACT: With the aging of America, interest on improving behavioral health services for older adults has increased, including attention
to those with alcohol abuse problems. Early studies focused on the possible benefits of elder-specific, group treatment programs
(Kofoed, Tolson, Atkinson, Toth, & Turner, 1987; Schonfeld, Dupree, & Rohrer, 1995) or evaluating the benefits of group treatment
approaches for older adults (Carstensen, Rychtarik, & Prue, 1985; Dupree, Broskowski, & Schonfeld, 1984; Graham, Brett, &
Baron, 1997; Schonfeld et al., 2000).
[show abstract][hide abstract] ABSTRACT: Responding to the increased need for research on older residents in assisted living facilities (ALFs), this study assessed the connections between physical and mental health among 150 older residents in ALF settings.
The major focus of the study was to explore whether individuals' subjective perceptions of their own health mediate the associations between health-related variables (chronic conditions and functional disability) and depressive symptoms.
The analyses showed that the adverse effects of chronic conditions and functional disability on depressive symptoms were not only direct but also indirect through negative health perceptions.
The findings that health perceptions serve as an intervening step between physical and mental health provide important implications for promotion of mental well-being among older residents in ALFs. In addition to disease/disability prevention and health promotion efforts, attention should be paid to ways to enhance older individuals' positive beliefs and attitudes toward their own health and to promote healthful behaviors.
Journal of Aging and Health 07/2007; 19(3):439-52. · 1.56 Impact Factor
[show abstract][hide abstract] ABSTRACT: To explore the extent of and factors associated with male nursing home residents who wander.
Cross-sectional design with secondary data analyses.
One hundred thirty-four nursing home facilities operated by the Department of Veterans Affairs.
Fifteen thousand ninety-two nursing home residents with moderate or severe cognitive impairment admitted over a 4-year period.
Selected variables from the Minimum Data Set included ratings recorded at residents' admission to the nursing home (cognitive impairment, mood, behavior problems, activities of daily living, and wandering).
In this sample of residents with moderate or severe cognitive impairment, the proportion of wanderers was found to be 21%. Wanderers were more likely to exhibit severe (vs moderate) cognitive impairment, socially inappropriate behavior, resistance to care, use of antipsychotic medication, independence in locomotion or ambulation, and dependence in activities of daily living related to basic hygiene. A sizable proportion of wanderers were found to be wheelchair users (25%) or were wanderers with dual dementia and psychiatric diagnoses (23%), characteristics that are not well documented in the literature.
These results support previous clinical understanding of wanderers to be those who are more likely to exhibit more-severe cognitive impairment. Based on a statistical model with variables generated from prior research findings, classification as a wanderer was found to be associated with other disruptive activity such as socially inappropriate behavior and resisting care. Two understudied populations of wanderers were documented: wheelchair wanderers and those with comorbid dementia and psychiatric diagnoses. Future longitudinal studies should examine predictors of wandering behavior, and further research should explore the understudied subpopulations of wheelchair and dual-diagnosis wanderers who emerged in this study.
Journal of the American Geriatrics Society 06/2007; 55(5):692-9. · 3.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment.
We compared Medicaid and Medicare claims data for two groups of older adults: those using health services and identified within a statewide abuse hotline information system and those claimants not identified within the hotline database.
Behavioral health service use was greater among those identified in the abuse hotline database. The penetration rate (percentage of service users out of all enrollees) for Medicaid behavioral health service claims was more than twice that of other service users, with costs of services about 30% greater. Analyses of Medicare data revealed that the penetration rate for those in the hotline data was almost 6 times greater at approximately twice the cost compared to other service users.
The results provide evidence for previous assumptions that mistreated individuals experience a higher rate of behavioral health disorders. As mental health screening by adult protective services is rarely conducted, the results suggest the need to train investigators and other service providers to screen older adults for behavioral health and substance-abuse issues as well as physical signs of abuse. Further research on the relationship of abuse to behavioral health might focus on collection of additional data involving more specific victim-related characteristics and comparisons of cases of mistreatment versus self-neglect.
The Gerontologist 05/2006; 46(2):193-9. · 2.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: Responding to the dramatic growth in Assisted Living Facilities (ALFs), the present study focused on mental health among older residents in ALFs. We assessed the effects of physical health constraints (chronic conditions, functional disability, and self-rated health) and psychosocial resources (social network, sense of mastery, religiosity, and attitude toward aging) on depressive symptoms. A sample of 150 residents (Mage = 82.8, SD = 9.41) from 17 facilities in Florida was used for analyses. Higher levels of depressive symptoms were observed among older residents with a greater level of functional disability, poorer self-rated health, lower sense of mastery, less religiosity, and less positive attitude towards aging. In addition, the linkages between physical and mental health were modified by psychosocial resources. For older residents with more positive beliefs and attitudes (a higher sense of mastery, greater religiosity, and more positive attitudes toward aging), the adverse effects of functional disability or poorer self-rated health on depressive symptoms were attenuated. The protective roles of psychosocial resources against physical health constraints yield important implications for designing prevention and intervention strategies for the mental health of older populations in ALF settings.
The International Journal of Aging and Human Development 02/2006; 63(4):299-315. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care settings. Addressing the bio-psycho-social needs of frail, poor, and minority older adults within an interdisciplinary framework exposes geropsychology Fellows to the complex nature of mental health problems of older adults and the need for collaborative efforts across professional lines. The program builds on prior geropsychology training at the graduate and internship levels by providing an integrated framework to achieve clinical, didactic, program evaluation, and advocacy goals: (1) delivery of state-of-the-art evidence-based psychological services to disadvantaged older adults in geriatric public sector primary care sites; (2) mastery of the knowledge base on diversity and interdisciplinary teamwork as they relate to providing services to older adults, including those residing in rural areas; (3) gaining competence in the evaluation of services to disadvantaged older adults; and (4) experience in public health advocacy for improvement of the LTC system.
[show abstract][hide abstract] ABSTRACT: The purpose of this article is to examine Florida's Adult Protective Services database (APS) to determine the characteristics of those who have been referred to the APS system, and the trends in reporting of types of elder mistreatment between 1993 and 1998. Comparative data are used to examine gender and racial differences, and longitudinal analysis is conducted to examine trends in reported mistreatment and different types of mistreatment. We find increasing trends in reported mistreatment that are not consistent for different categories; neglect rates declined while abuse and financial exploitation rates rose. As the Florida APS data differed from other national and state studies of elder mistreatment in ways that support the study conclusions from the National Elder Abuse Incidence Study-that the most effective way to report mistreatment may come from local agencies, rather than through the state hotline mechanism.
Journal of Elder Abuse & Neglect 01/2004; 16(1):1-22.