David C. Speer

Five Methods for Computing Significant Individual Client Change and Improvement Rates: Support for an Individual Growth Curve Approach.

Interest has been renewed in methods for determining individual client change. Currently, there are at least 4 pretreatment-posttreatment (pre-post) difference score methods. A 5th method, based on a random effects model and multiwave data, represents a growth curve approach and was hypothesized to be more sensitive to detecting significant (p < .05) change than the pre-post methods. The change rates produced by the 5 methods were compared in a sample of 73 older outpatients with 3 to 5 assessments per client on a measure of well-being (H. J. Dupuy, 1977). Results indicated that the growth curve approach improvement rate was the highest (68.5%). The growth curve and the Edwards-Nunnally (63.0%) methods produced significantly (p < .05) higher improvement rates than the other 3 methods, with 1 exception.

Older adult users of outpatient mental health services

Descriptive demographic, clinical and interview data from clients of an outpatient mental health clinic for older adults are presented. These clients are better educated and have a more frequents history of marital difficulties than older adults in general. Although a significant minority received V code and Adjustment Disorder diagnoses, the majority were depressed and had histories of prior mental health services. Economic factors are a major issue in seeking services.

Dual diagnosis among older adults: a new array of policy and planning problems.

Case finding and successfully engaging and treating older adults with substance abuse disorders continue to be enigmatic processes. Because of the adverse consequences on health of substance abuse among the elderly, substance abuse has serious implications not only for the well-being of the elderly but also for the future costs and resources of the mental health and health care systems for older adults. However, older adults with concurrent mental and substance abuse disorders are appearing in the public gerontogical mental health system. This system is both unprepared and ill-equipped to manage and treat these often difficult clients. Further complicating the situation is the seeming lack of knowledge about “dual diagnosis” among the elderly. Policy and planning issues necessary to address this newly discovered array of problems are discussed.

Ethnic, Demographic, and Social Differences among Middle and Older Adults with HIV/AIDS

Although the prevalence of AIDS among middle and older adults is increasing, little is known about them. The objective of this study was to obtain basic demographic and social information about people with HIV/AIDS (PWAs) over the age of 44 years. This was a descriptive, cross-sectional survey of convenience samples of 76 African-American (AA) and 80 White older PWAs. Participants were interviewed by trained peer interviewers using a structured and largely objective schedule. Participants and interviewers were each paid

Mental Health and HIV

35 per completed interview. The schedule consisted of wide-ranging demographic, HIV/AIDS, stressor, coping, social, and support questions. Although both ethnic groups had incomes significantly below national norms and poverty rates three times their national rates, AA PWAs were markedly disadvanted socioeconomically relative to White PWAs. Although over 60% of all PWAs reported that having enough money to live on was a problem, AAs also reported significantly more Stressors, many related to economics, then White PWAs. AA PWAs reported being predominantly heterosexual, while the largest group of Whites was homosexual or bisexual. Sources of infection paralleled sexual orientation. Both groups used relatively effective coping strategies and reported moderate levels of social support and activity. It was concluded that the course of illness, treatment, and quality of life of middle and older PWAs are likely to be complicated by economic factors, and this will be particularly serious among AA PWAs.

Age and mental health status differences in medical service utilization in an integrated primary care setting

Publisher Summary This chapter discusses the distinction between mental-health problems that existed prior to human immunodeficiency virus (HIV) infection and those with post-HIV onset. Pre-existing problems are conceptualized as producing or contributing to risk behavior and thus to HIV infection; postinfection mental-health problems may also interfere with treatment for HIV and contribute to infection of others. The mental health and HIV/AIDS literature, some studies of older adults, the West-central Florida Older Adult project findings, treatment issues, and suicide factors are reviewed. Considering the tremendous number of stressors that people living with HIV (PLWHIV) must deal with and the high prevalence of mood disorders, suicide is a reasonable concern with this population. Psychiatric morbidity, alcohol and drug abuse, and behavioral disorder have also been viewed as risk factors for suicide. There is no disagreement that mental-health problems, disorders, and psychological distress are highly prevalent among both PLWHIV and people at risk for HIV infection. Even though suicide rates among PLWHIV are not clear, this issue is a serious concern for a variety of reasons. The chapter lists recommendations and encourages increased investment of resources in the prevention programs.

The Experience of Older Adults Living with HIV

Abstract This study explored age and mental health referral status effects on a variety of patient, medical, and medical service utilization variables among adults seen in a rural integrated (mental health) primary care practice. The study cohort consisted of the first 150 consecutive patients referred for brief MH service, and a comparison group of 150 general medical patients not referred for MH service, as well as 34 matched older MH patients and controls. Results showed that older medical patients had significantly more medical problems and used more prescribed medications than younger medical patients (p > .05). Older patients referred for mental health services had experienced significantly more deaths among significant others, more adverse life events, and more family caregiver responsibilities than their younger counterparts (p > .05). In contrast to medical patients, younger and older patients referred for mental health care did not differ on medical variables or service utilizations variables, except for prescribed medication. Referred elders also had more medical problems than matched older medical patients. The presence of integrated mental health services appeared to markedly reduce age and mental health status differences on most medical service variables.

Clinically significant change: Jacobson and Truax (1991) revisited: Correction.

This chapter depicts graphically the diversity of older people impacted by human immunodeficiency virus (HIV) disease and the varied responses that they may have to their diagnosis. It is based on extensive and relatively unstructured narrative interviews with 15 older people living with HIV (PLWHIV), and provides a personal glimpse of the impact the HIV diagnosis has on their lives. The chapter opens with a biographical overview of the participants, followed by excerpts from their interviews, reflecting the range of their experiences pertaining to frequently mentioned aspects of living with HIV. The participants described the circumstances leading them to testing and their initial responses to the HIV diagnosis. Although at the time of their diagnosis, most of the participants had little understanding of HIV disease and what it might mean for them, they shared a sense that they had somehow become tainted or diminished because of it. The narrative research participants experienced a high degree of anxiety at the time of their HIV diagnosis. A number of specific issues were mentioned by the participants as being particularly stressful as they confront life as an older adult with HIV disease.

HIV/AIDS in Middle-Aged and Older Adults: A Research Response

The relationship between statistically and clinically significant change has been enigmatic. Jacobson and Truax (1991) have proposed an important step toward rapprochement. However, their suggested index of clinically significant change neglects possible confounding of improvement rate estimates by regression to the mean. An alternative method is described that incorporates an adjustment that minimizes this confounding when statistical regression has been shown to be present. If regression is not present, the Jacobson and Truax method is more appropriate; if regression is present, the Edwards-Nunnally method (Edwards, Yarvis, Mueller, Zingale, & Wagman, 1978) is more appropriate. The two methods are compared, and the effects of instrument reliability and sample deviance on estimated improvement rates are demonstrated using general well-being test-retest data from a sample of older adult mental health outpatients.

HIV/AIDS in Middle-Aged and Older Adults

The chapter presents a case study of an individual infected by human immunodeficiency virus (HIV).. It illustrates a number of issues that have been raised while working with older people living with HIV disease (PLWHIV). It states that postdiagnosis, many older people are too often found forced to live their lives in a manner that differs greatly from the way they had planned—their reality often falls far short of the dreams toward which they worked throughout their careers. People who are considered to be middle-aged are often at the greatest risk of economic hardship after an HIV diagnosis. In the ≥ 40 age groups, which capture the age range of 45 and older, AIDS cases have increased steadily from 30.9% of the total cases diagnosed between 1981 and 1987 to 41.8% of the total cases diagnosed between 1996 and 2000. The increasing incidence and prevalence of HIV/AIDS among older people are likely to continue into the future because of a number of factors. HIV disease in older adults mostly stems from sexual behavior and this aspect of their lives needs to be addressed with older adults if further transmission of the virus is to be halted.