Erin L. Woodhead

Older Adult Psychological Assessment : Current Instrument Status and Related Considerations

Abstract The psychological assessment of older adults is often challenging due to the frequent co-morbidity of mental and physical health problems, multiple medications, interactions among medications, age-related sensory and cognitive deficits, and the paucity of assessment instruments with psychometric support for use with older adults. First, psychological assessment instruments for examining five important clinical areas (suicide ideation, sleep disorders, anxiety, depression, and personality) are discussed in light of the most current research regarding their psychometric properties and suitability for use with older adults. Instruments developed specifically for older adults are distinguished from instruments developed for younger adults that have some psychometric support for their use with older adults. Second, the potential sensory deficits that could compromise assessment, factors to consider in light of these deficits, and accommodations that can be made to minimize their effects are discussed.

Stress, Social Support, and Burnout Among Long-Term Care Nursing Staff

Long-term care nursing staff are subject to considerable occupational stress and report high levels of burnout, yet little is known about how stress and social support are associated with burnout in this population. The present study utilized the job demands–resources model of burnout to examine relations between job demands (occupational and personal stress), job resources (sources and functions of social support), and burnout in a sample of nursing staff at a long-term care facility (N = 250). Hierarchical linear regression analyses revealed that job demands (greater occupational stress) were associated with more emotional exhaustion, more depersonalization, and less personal accomplishment. Job resources (support from supervisors and friends or family members, reassurance of worth, opportunity for nurturing) were associated with less emotional exhaustion and higher levels of personal accomplishment. Interventions to reduce burnout that include a focus on stress and social support outside of work may be particularly beneficial for long-term care staff.

Behavioral and psychological symptoms of dementia: The effects of physical activity at adult day service centers

Adult day services (ADS) are an increasingly popular option for caregivers of people with dementia, but there is little research on the effects of activities on the behavior and mood of the client. This study examines participation by 94 individuals in different types of adult day-care activities and their association with changes in behavior and psychological symptoms of dementia (BPSD) for the client during a three-month span. Three domains of BPSD were examined: restless behaviors, mood behaviors, and positive behaviors. Using growth curve modeling, results show that the restless and mood behavior domains, on average, were stable over three months, whereas positive behaviors increased. For all three behavior domains there were individual differences in average level of BPSD. Average rate of change for individuals also varied from the mean for restless and mood behaviors. Physical activities, social activities, engaging activities, and watching and listening activities, along with a day-care dosage variable, were used as covariates to explain these individual differences in change. Engaging activities explained some of the individual variance for restless behaviors; as individuals increased one increment in engaging activities, they had fewer restless behavior problems over time. These results suggest that some features of programming may be related to improvements in restless behavior.

Coping Strategies Predictive of Adverse Outcomes among Community Adults

OBJECTIVES To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations. METHOD Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking problems, and suicidal ideation). RESULTS At the follow-up (N = 521), more use of avoidance coping was associated with more drinking problems and suicidal ideation at follow-up. Men high in avoidance coping reported more alcohol consumption and suicidal ideation at follow-up than did men low on avoidance coping. Younger adults high in avoidance coping reported more negative life events at follow-up than did younger adults low on avoidance coping. CONCLUSIONS Reliance on avoidance coping may be especially problematic among men and younger adults.

Decisional Strategy Determines Whether Frame Influences Treatment Preferences for Medical Decisions

Decision makers are influenced by the frame of information such that preferences vary depending on whether survival or mortality data are presented. Research is inconsistent as to whether and how age impacts framing effects. This paper presents two studies that used qualitative analyses of think-aloud protocols to understand how the type of information used in the decision making process varies by frame and age. In Study 1, 40 older adults, age 65 to 89, and 40 younger adults, age 18 to 24, responded to a hypothetical lung cancer scenario in a within-subject design. Participants received both a survival and mortality frame. Qualitative analyses revealed that two main decisional strategies were used by all participants: one strategy reflected a data-driven decisional process, whereas the other reflected an experience-driven process. Age predicted decisional strategy, with older adults less likely to use a data-driven strategy. Frame interacted with strategy to predict treatment choice; only those using a data-driven strategy demonstrated framing effects. In Study 2, 61 older adults, age 65 to 98, and 63 younger adults, age 18 to 30, responded to the same scenarios as in Study 1 in a between-subject design. The results of Study 1 were replicated, with age significantly predicting decisional strategy and frame interacting with strategy to predict treatment choice. Findings suggest that framing effects may be more related to decisional strategy than to age.

Life stressors and resources and the 23-year course of depression

BACKGROUND Life stressors and personal and social resources are associated with depression in the short-term, but little is known about their associations with the long-term course of depression. The current paper presents results of a 23-year study of community adults who were receiving treatment for depression at baseline (N=382). METHODS Semi-parametric group-based modeling was used to identify depression trajectories and determine baseline predictors of belonging to each trajectory group. RESULTS There were three distinct courses of depression: high severity at baseline with slow decline, moderate severity at baseline with rapid decline, and low severity at baseline with rapid decline. At baseline, individuals in the high-severity group had less education than those in the moderate-severity group, and more medical conditions than those in the moderate- and low-severity groups. Individuals in the high- and moderate-severity groups evidenced less psychological flexibility, and relied more on avoidance coping than individuals in the low-severity group. LIMITATIONS Results are limited by use of self-report and lack of information about depression status and life events in the periods between follow-ups. CONCLUSIONS These results assist in identifying groups at high risk for a long-term course of depression, and will help in selecting appropriate interventions that target depression severity, coping skills and management of stressors.

Attitudes and Experiences With Older Adults: A Case for Service Learning for Undergraduates

The current study examined whether relationship quality with older adults currently and in childhood, as well as experience with older adults, was associated with biases toward older adults and interest in working with older adults as a possible career area. The authors sampled undergraduate students (N = 753, M = 18.97 years, SD = 2.11 years) from a Northern California university. In hierarchical regression analyses, higher perceived quality of relationships with older adult family members, higher perceived social support, and lower perceived conflict from relationships with older adults was significantly associated with positive attitudes toward older adults. Interest in working with older adults was significantly associated with taking courses in aging, providing care to an older adult, and volunteering with older adults. These results suggest that positive relationships with older adults are useful in reducing biases, though student interactions with older adults are key in helping to promote interest in working with older adults.

Decreasing Physical Aggression and Verbal Abuse in a Brain-Injured Nursing Home Resident

Following a traumatic brain injury, patients often suffer a series of psychological and psychiatric sequalae. This study presents the case of Mr. K, a 52-year-old brain-injured nursing home resident who exhibited problematic physical aggression and verbal abuse toward staff and residents. His problem behaviors were intertwined with an ethical issue involving a heterosexual relationship with another resident who also was brain injured. Following a functional assessment of antecedents and consequences, a differential reinforcement of other behavior (DRO) schedule was implemented. Specifically, the resident was rewarded with short-term and long-term reinforcers following periods of time during which behaviors other than the target behavior were emitted. Although the behavior plan was successful, it resulted in a more noticeable decrease in physically aggressive behaviors than verbally abusive behaviors. Implications include increasing awareness of use of behavior plans in nursing homes and of ethical and behavioral issues associated with sexuality among nursing home residents.

Dual Diagnosis, Mutual-Help Use, and Outcomes: A Naturalistic Follow-Up

Objective: Individuals with dual diagnoses benefit from participation in mutual-help groups, though it is unclear how much such participation contributes to outcomes when accounting for utilization of treatment. Methods: We used mixed-model regressions to examine associations between participation in mutual-help groups reported at 6-month, 1-year, and 2-year follow-ups with substance use and psychiatric outcomes among outpatients with dual diagnoses (N = 304), while controlling for amounts of substance use disorder and mental health outpatient treatment. Results: Follow-up rates were 81%, 82%, and 84% at 6 months, 1 year, and 2 years, respectively. Mean involvement in mutual-help groups (scale of 0 to 14) ranged between 4.6 (SD = 4.5) and 6.1 (SD = 4.5). When controlling for baseline status and treatment amounts, more mutual-help group meeting attendance, F = 13.98, p < .001, and involvement, F = 19.32, p < .001, were associated with fewer days of alcohol use. Likewise, after controlling for baseline status and treatment amounts, more mutual-help group meeting attendance, F = 4.57, p = .03, and involvement, F = 5.94, p = .02, were associated with less drug use. Mutual-help group participation was not associated with number of psychiatric symptoms. Mental health treatment was associated with fewer days of alcohol use, F = 4.58, p = .03. Conclusions: Facilitating mutual-help group involvement among individuals with dual diagnoses, as well as attendance at more meetings, is of potential benefit to reducing alcohol and drug use.

Age-Related Concomitants of Obtaining Mental Health Care in Adulthood

OBJECTIVE To examine the associations between predisposing and need factors and receipt of mental health care and to examine age as a moderator of these associations. METHODS Participants (N=521) were surveyed as part of a larger study on health and adaptation. RESULTS Obtaining mental health care was predicted by more reliance on approach coping, and more depressive and medical symptoms. Interactions of age x depressive symptoms and age x gender revealed that middle-aged adults with more depressive symptoms and middle-aged men were less likely to obtain care. CONCLUSIONS Middle-aged men and middle-aged adults with depression may not be obtaining needed mental health care.