Cynthia Gruman

Attrition in an Exercise Intervention: A Comparison of Early and Later Dropouts

OBJECTIVE: To identify reasons for dropout and factors that may predict dropout from an exercise intervention aimed at improving physical function in frail older persons.

Physicians-in-training attitudes toward caring for and working with patients with alcohol and drug abuse diagnoses.

Introduction: Physicians in all specialties commonly encounter patients who abuse alcohol or illegal drugs. Working with these patient populations can be challenging and potentially engender negative attitudes. This study is designed to identify the progression of attitudinal shifts over time of physicians-in-training toward caring for substance abusing patients. Methods and Materials: A 31-item survey was designed to capture demographic information of participants, attitudes toward treating patients with substance abuse diagnoses, previous participant education, experience in and comfort with diagnosing and treating substance abuse, and satisfaction achieved in working with this patient population. Medical students in their third and fourth years of education as well as residents in training, years one through four, were surveyed. Responses to the surveys attitudinal items were analyzed across years of training, looking for changes associated with time and experience. Results: Fifty-seven percent of eligible participants anonymously completed the survey. There was general agreement across all years of training that health care professionals should be allowed continued employment in their professions when in recovery from alcohol abuse (P= 0.424) and drug abuse (P = 0.409). Across years of training there was agreement that patients can recuperate and provide meaningful contributions to society when recovering from alcohol (P = 0.847) and drug (P = 0.859) abuse. From medical school years through residency there were enhanced beliefs that alcohol-abusing patients (P = 0.027) and drug-abusing patients (P = 0.009) overutilize health care resources. Most trainees, despite year of education, believe patients who abuse alcohol (P = 0.521 and illegal drugs (P = 0.356) have challenging medical and social issues from which they can learn. There was consistency across years in the perception that providing care to alcohol-abusing patients (P = 0.679) and drug-abusing patients (P = 0.090) is repetitive and detracts from the care of others. All felt their training was adequate to care for alcohol (P = 0.628) and drug-abusing patients (P = 0.484). Satisfaction achieved in caring for alcohol (P = 0.017) and illegal drug-abusing patients (P = 0.015) consistently diminishes over years in training. Conclusions: There are positive as well as negative aspects for physicians-in-training to caring for patients with alcohol and illegal drug abuse problems. Combining effective education strategies with the needs of physicians at specific points in their education may be effective in reversing the negative trends seen in attitudes toward caring for patients with substance abuse problems.

Medical conditions and medication use in adults with Down syndrome: A descriptive analysis

BACKGROUND We examined the presence of medical conditions and medication use within a sample of adults with Down syndrome. METHODS Retrospective chart review using a sample of 141 adults with Down syndrome and age range of 30 to 65 years. RESULTS We identify 23 categories of commonly occurring medical conditions and 24 categories of medications used by adults with Down syndrome. CONCLUSION Approximately 75 of older adults with Down syndrome in our sample experience memory loss and dementia. Hypothyroidism, seizures, and skin problems also occur commonly. The prevalence of cancer (i.e., solid tumours) and hypertension is extremely low. Older adults with Down syndrome use anticonvulsant more often than younger adults with Down syndrome. The use of multivitamins and medications such as pain relievers, prophylactic antibiotics, and topical ointments is common.

Falls in an Inpatient Geriatric Psychiatric Population

BACKGROUND: Falls are a major health care concern for older adults in hospital settings. The incidence of falls on psychiatric units tends to be higher than that on general acute care hospital units, with estimated rates of 13.1 to 25 per 1,000 inpatient days compared to 3 to 5 per 1,000 inpatient days, respectively. OBJECTIVE: The purposes of this study were to quantify the number and types of falls and identify the associated risk factors relevant to a psychiatric inpatient setting. DESIGN: This was a descriptive study. Data were collected over a 6-month time period. Patients on a 28-bed acute care geriatric psychiatric unit provided the sampling frame. RESULTS: Twenty-eight patients fell during the study period for a total 45 falls. Six patients experienced multiple falls during their stay. Most of the falls that occurred did not result in serious injury. Individuals who experienced a fall were about 3 years older than nonfallers (73.6 years versus 76.36 years). There was no difference by gender as to rate of falls. Activity level was higher for the patients who had a fall, and medication had the strongest relationship to a falls episode. When census was low, the fall rate was slightly higher. CONCLUSIONS: There are many variables that contribute to the phenomenon of falls in an acute geriatric psychiatric inpatient unit. Use of research findings will allow the development of a fall risk prevention protocol to provide the safest environment and best quality of care possible for the geriatric patient.

Efficacy of a Geriatrics Team Intervention for Residents in Dementia-Specific Assisted Living Facilities: Effect on Unanticipated Transitions

OBJECTIVES: To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia.

Depression in Later-Life Puerto Rican Primary Care Patients: The Role of Illness, Stress, Social Integration, and Religiosity

BACKGROUND Older Puerto Ricans belong to two rapidly growing demographic groups known to have high rates of depression: the aging and Hispanic populations. Studies of depression in Puerto Ricans have primarily focused on the impact of demographic factors and health. This study expands previous research, examining the relationships between depression and social stressors, social support, and religiosity, for Puerto Rican primary care patients aged 50 and older. PATIENTS Participants included 303 Puerto Ricans from six primary care clinics in a northeastern city. METHODS Patients completed in-person interview in Spanish. The Composite International Diagnostic Interview indicated depressive disorders meeting DSM-IV criteria. Bivariate and multivariate relationships between depression and demographics, health, social stress and support, and religiosity were explored. RESULTS One fifth of participants met DSM-IV criteria for major depression or dysthymia. Participants with the lowest income, more recent migration, and poor subjective health were significantly more likely to be depressed. In addition, rates of depression increased steeply for patients caring for grandchildren and those with personal or family legal problems. Seeing few relatives each month and needing more instrumental, emotional, or financial support were also related to higher rates of depression. Unexpectedly, low objective illness severity correlated with increased depression, whereas religiosity and religious participation had no relationship to depression. CONCLUSIONS The findings presented here indicate the potential for social stressors and inadequate supports to substantially increase the risk of depression in older Puerto Ricans in primary care settings. Further studies should explore incorporating these social risk factors into improved prevention, clinical detection, and culturally sensitive treatment of older depressed Puerto Ricans.

Individualized care: perceptions of certified nurse's aides.

Despite substantial attention devoted to the development of individualized care in nursing homes during recent years, empirical research assessing progress is limited. Further, few studies have explored the experiences of certified nurses aides (CNAs) in this regard. This survey examines the perceptions and experiences of CNAs in providing individualized care. CNAs (n = 254) were asked to describe a number of current practices and obstacles to implementing individualized care in nursing homes. The majority of respondents reported experiencing: flexibility to change daily schedules; supervisor assistance with challenging residents; active participation in care planning; freedom to test new approaches to care; and supervisors who are open to CNA suggestions. Several barriers to individualized care were also described, including: inadequate staffing; poor team communication; staff attitudes; and a lack of knowledge and training in alternative approaches. These findings provide important insights into the supports and obstacles to implementing individualized care in nursing homes from the perspective of CNAs.

Improving mental health services for latino and asian immigrant elders

Given the changing demographics of the aging population in the United States, it is likely that professional psychologists will encounter elderly clients from diverse backgrounds in their practice. Asians and Latinos represent the 2 fastest growing groups of elderly immigrants. This article offers information and practical suggestions to assist clinicians working with elderly Asian and Latino immigrant clients. Specific recommendations for enhancing assessment and treatment efficacy with these populations are also provided.

Developing Individualized Care in Nursing Homes

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Correlates of Complaints Made to the Connecticut Long-Term Care Ombudsman Program The Role of Organizational and Structural Factors

Using Long-Term Care Ombudsman Program complaint data (N = 3,360) from all of Connecticuts 261 nursing facilities, this study investigated facility characteristics that may be correlated with resident complaints. Complaints per 100 beds and four subcategories of complaints established by the Administration on Aging (AoA) were the dependent variables. The presence of volunteers trained by the Ombudsman Pro-gram significantly predicted total complaints. At the bivariate level, profit status, size, location, citations, and the presence of a volunteer resident advocate were associated with the rate of complaints. However, multivariate analysis exposed a more complex pattern of relationships. The strongest model explained slightly more than 9% of the variance using the nine predictors. This indicates that other factors such as psychosocial characteristics of complainants may influence complaint reporting, rather than structural/organizational components of the facility.