Abstract
By older adulthood, nearly all older adults will have been exposed to at least one potentially traumatic event, and the majority (93%) of older veterans report exposure to at least one ...event. Some may have developed posttraumatic stress disorder (PTSD) during their lifetimes; however, most do not, as the prevalence of PTSD in later adulthood is low. Nevertheless, the long-lasting psychological effects of trauma may manifest in later life, exacerbated by the normative experiences of aging (e.g., medical illness, loss of loved ones, and retirement) and encounters with medical settings. Receiving care in skilled nursing settings may trigger traumatic memories or may aggravate PTSD of symptoms. As the population ages, more individuals will receive care in long-term care environments, leading to increased risk of worsening PTSD. Staff and facilities may not have skills or knowledge needed to address symptoms or reduce retraumatization. Implementing trauma-informed care practices can mitigate these effects and is mandated in skilled nursing facilities; however, no models of trauma-informed care practice in long-term care exist. This article reviews the effects of trauma and PTSD in later life, the effects of medical settings on PTSD, and provides a framework for implementing trauma-informed care in long-term care settings.
Demonstrations of the effectiveness of interventions requires evidence that the model can be implemented with fidelity. Caregiving interventions that are tailored to the individual or family require ...flexibility, which adds some challenges to the assessment of fidelity. This paper outlines the components necessary for examining treatment fidelity and common barriers to implementing fidelity studies, offers considerations for designing fidelity studies with tailored caregiver interventions, and aims to provide a set of procedures that can be used to guide future fidelity studies.
Case study methods are used to illustrate the processes and findings, drawing on two research studies of fidelity in tailored caregiver interventions.
Fidelity studies consist of core components (i.e. training on intervention delivery, adherence to the intervention, therapist competence, acceptability and outcomes) that should be maintained and monitored throughout the study to elucidate the relationship between the intervention and outcomes. These components are applicable to tailored caregiver interventions and can be implemented with the consideration of some key issues that are addressed prior to the evaluation. The two cases presented utilized similar methods to evaluate fidelity of two different tailored caregiver interventions.
Treatment fidelity can be assessed for tailored caregiving interventions, which increases confidence about the potency of the active ingredients in the interventions. Standard fidelity guidelines can be implemented with minor additional considerations.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
We characterize rates and correlates of PTSD and of trauma re-engagement without PTSD in medically ill older Veterans, as well as supportive strategies, with the goal of advancing trauma-informed ...care.
We interviewed medically ill older Veterans (N = 88, M age 75.13, SD = 6.14) with primary care screening measures for PTSD and trauma re-engagement, and open-ended questions to assess supportive strategies.
One-fifth (20.5%) presented with probable PTSD, associated with greater trauma exposures (r=.57, p<.001), whereas two-fifths (43.2%) reported re-engagement with military memories without PTSD, associated with having a spouse/partner (t = 2.27, p=.028). Of those who experienced trauma, half reported thinking more about the trauma recently and becoming more emotional on certain days. In response to the question 'What gives you strength as you think about the future with your illness' Veterans described support of family, healthcare, worldview, personal control, acceptance, and health behaviors.
Memories of trauma are common with medical illness. Age-friendly trauma-informed care could consider factors that patients describe as sources of strength with illness.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The Caregiver Reaction Scale (CRS) is a multi-dimensional measure of the family caregiving experience that assesses role conflict, challenges, and positive aspects of caregiving. The CRS has been ...validated in a sample of older adult caregivers who sought counseling, but its validity and reliability in a broader population of caregivers had not been established. This study aimed to explore how well the CRS assesses the multiple dimensions of the caregiving experience in a sample of family caregivers who match the national profile of caregivers and to confirm the validity and structure of the subscales.
Family caregivers (N = 452), age 18-89 (M
= 48.56, SD = 17.15) were recruited online and completed the CRS and questionnaires of burden and positive aspects of caregiving. A confirmatory factor analysis (CFA) was conducted to confirm the underlying factor structure of the CRS, and convergent and discriminant validity was examined.
CFA supported the existing structure of the CRS; all subscales demonstrated very good internal consistency reliability (α ≤.88), convergent validity (r ≥.39), and discriminant validity (r ≤.12).
The CRS offers a valid and reliable assessment of the caregiving experience as evidenced by the convergent and discriminant validity of CRS subscales with well-validated measures of burden and positive aspects of caregiving.
The CRS assesses multiple dimensions of caregiving that can be used to better understand the caregiver's experience, guide clinical interventions and referrals, and identify caregiver strengths.
Abstract
Background and Objectives
Dissemination-implementation.org outlines 110 theories, models, and frameworks (TMFs): we conducted a citation analysis on 83 TMFs, searching Web of Science and ...PubMed databases.
Research Design and Methods
Search terms were broad and included “aging,” “older,” “elderly,” and “geriatric.” We extracted each TMF in identified articles from inception through January 28, 2022. Included articles must have used a TMF in research or quality improvement work directly linked to older adults within the United States.
Results
We reviewed 2,681 articles of which 295 articles cited at least one of 56 TMFs. Five TMFs represented 50% of the citations: Reach, Effectiveness, Adoption, Implementation, and Maintenance 1.0, Consolidated Framework for Implementation Research, Greenhalgh Diffusion of Innovation in Service Organizations, Quality Enhancement Research Initiative, Community-Based Participatory Research, and Promoting Action on Research Implementation in Health Services. TMF application varied and there was a steady increase in TMF citations over time, with a 2- to 3-fold increase in citations in 2020–2021. We identified that only 41% of TMF use was meaningful.
Discussion and Implications
Our results suggest TMF utilization is increasing in aging research, but there is a need to more meaningful utilize TMFs. As the population of older adults continues to grow, there will be increasing demand for effective evidence-based practices and models of care to be quickly and effectively translated into routine care. Use of TMFs is critical to building such evidence and to identifying and evaluating methods to support this translation.
Abstract Background Skilled nursing facilities (SNFs) are an ideal setting to implement the Age‐Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) ...centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs. Methods A 112‐bed VA SNF implemented a facility‐wide AFHS initiative including the following: (1) participating in a national IHI Age‐Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods. Clinical (life‐sustaining treatment, falls, disruptive behaviors, and medication deprescribing) and quality outcomes (rehospitalization, emergency department utilization, and discharge to the community) in addition to patient satisfaction were compared pre‐ and post‐AFHS implementation (bed days of care BDOC 17413) to post‐implementation (BDOC 20880). Results Clinical outcomes demonstrated improvements in the 4Ms, including: (1) what matters: 14% increase in life‐sustaining treatment documentation (82%–96%; p < 0.01); (2) mobility: reduction in fall rate by 34% (8.15 falls/1000 BDOC to 5.41; p < 0.01); (3) mentation: decrease in disruptive behavior reporting system (DBRS) by 62% (5.11 DBRS/1000 BDOC to 1.96; p = 0.04); (4) medications: 53% increase in average potentially inappropriate medications (PIMs) deprescribing (0.38–0.80 interventions/patient; p < 0.01). Quality outcomes improved including rehospitalization (25.6%–17.9%) and emergency department utilization (5.3%–2.8%) within 30 days of admission. Patient satisfaction scores improved from a mean of 77.2 ( n = 31, scale 1–100) to 81.3 ( n = 42). Conclusions Implementation of the AFHS initiative in a SNF was associated with improved clinical and quality outcomes and patient satisfaction. We describe here a sustainable, interprofessional approach to implementing the AFHS in a SNF.
Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. ...Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit. Through problem identification and needs assessment, we identified 6 goals and 28 specific content objectives presented through cinematic action with flashbacks or voice-over narration with graphics. Videos were evaluated through a survey (N = 155) and analysis of "chat" responses (N = 186) to targeted questions during a webinar presentation to clinicians (N = 345). Approximately 75% rated videos as "very much" relevant to needs, having helped learn something new, and realistic. Analysis of chat responses showed videos conveyed most content objectives (92%). In addition, participants stated videos were helpful in demonstrating nursing skills of listening, responding, and displaying empathy, as well as showing case presentations involving cognitive impairment and the patient experience. Participants expressed a desire for longer videos/more information including a wider range of PTSD presentations and comorbidities.
Many individuals who present for hospice or palliative care might have experienced trauma during their lives, with some progressing to post-traumatic stress disorder. As these individuals face ...life-limiting illness, trauma might resurface. Consequently, physical and emotional health might suffer due to exacerbation of trauma-related symptoms, such as anxiety, irritability, or flashbacks. Providing trauma-informed care can help mitigate the effects of trauma for those facing life-limiting illness who might not be able to tolerate formal trauma treatment due to limited prognosis, fatigue, or lack of willingness to engage in treatment. The goal of this narrative review is to describe how aging and the end-of-life experience can lead to a re-engagement with previous traumatic experiences and, using case-based examples, provide recommendations for all members of the interprofessional hospice or palliative care team on how to elicit and respond to a history of trauma to minimize the potential negative impact of trauma at end-of-life.
The Veterans Health Administration (VA) provides services to growing numbers of Veterans with dementIa, individuals at heightened risk for hospitalizations and nursing home placement. Beginning in ...2010, the VA funded 12 innovative pilot programs to improve dementia care and help Veterans remain at home. We conducted a retrospective qualitative analysis of program materials and interviews with physicians, nurses, social workers, and other personnel (n = 33) to understand the strategies these programs adopted. Interviews were conducted every 6 months between 2010-2013 (4-5 interviews per program) and focused on factors affecting program design and implementation, challenges, and strategies to reduce hospitalizations and nursing home placements. Programs varied considerably yet shared three overarching strategies to improve dementia care: involving and supporting family caregivers; engaging interdisciplinary teams; and improving coordination with other healthcare providers. Our results highlight the importance of adapting common dementia care strategies based on the local context and needs of individuals served.
•Behavioral interventions for behavioral and psychological symptoms of dementia are possible in acute care•STAR-VA is applicable to acute care units with minimal modifications needed•Behavioral ...interventions for behavioral and psychological symptoms of dementia increase staff efficacy and confidence responding to and managing distress behaviors in dementia•Behavioral interventions on an acute care unit decrease behavioral rapid responses
As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.
