Marilyn Luptak

A Controlled Trial of Outpatient Geriatric Evaluation and Management

Objective: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM).

The Role of Grief in Dementia Caregiving

The literature examining issues of caregiver stress, burden, or depression has focused on the stress-process model of caregiving, which posits that there are characteristics inherent in dementia and in the course of caregiving for a person with dementia that can cause stress in the caregiver’s life. A more recent literature has emerged that argues that issues of loss and grief play a significant role in a caregiver’s ability to cope with the stressors of caregiving. This article reviews the caregiver stress and grief literatures, and proposes a conceptual model of dementia caregiving that outlines pathways of stress and grief in dementia caregiving. Issues specific to caregiver grief are proposed for future research and intervention design.

Complicated Grief in Older Adults: A Randomized Controlled Trial of Complicated Grief Group Therapy

PURPOSE This study compared the efficacy of complicated grief therapy (CGT; Shear, K. [2003]. Complicated grief: A guidebook for therapists [Liberty Version]. New York State Office of Mental Heath; Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. 3rd [2005]. Treatment of complicated grief: A randomized controlled trial. The Journal of the American Medical Association, 293, 2601-2608) administered as group therapy (CGGT) with standard group therapy (treatment as usual [TAU]) in older adults presenting with complicated grief (CG). METHODS The design was a 2×4, prospective, randomized controlled clinical trial. The independent variable was group type, with 1 group receiving experimental methods based on the work of Shear et al. (Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. 3rd. [2005]. Treatment of complicated grief: a randomized controlled trial. The Journal of the American Medical Association, 293, 2601-2608), CGGT versus. TAU. The dependent variable was treatment response. RESULTS CGGT participants demonstrated higher treatment response than TAU participants. Although participants in both groups showed improvement in CG measures, CGGT participants realized significantly greater improvement. More importantly, when CG was measured on Prolonged Grief Disorder Scale, nearly half of CGGT participants realized clinically significant improvement. All CGGT completers had Brief Grief Questionnaire scores upon follow-up that, had they scored at that level at pretest, would have disqualified them for study enrollment. IMPLICATIONS The high level of clinical significance suggests that CGGT participants were effectively treated for CG. This study offers evidence that CGGT holds promise for treatment of CG in older adults and merits inquiry in other populations.

Understanding Older Adults' Perceptions of Internet Use: An Exploratory Factor Analysis.

The current study examined factors related to older adults’ perceptions of Internet use. Three hundred ninety five older adults participated in the study. The factor analysis revealed four factors perceived by older adults as critical to their Internet use: social connection, self-efficacy, the need to seek financial information, and the need to seek health information. Key differences were found between previous research and the factors extracted in this study. The regression analysis demonstrated that variables like health condition, financial status, computer experience, and life satisfaction significantly predict, at various levels, factors perceived by the older adults to affect Internet use. The significance of the study as well as its implications for research and practice are discussed. Suggestions are made for future research and practice.

Effectiveness of Psychodynamic Psychotherapy With Older Adults: A Longitudinal Study

Using a longitudinal, time-series design, this effectiveness study analyzed archival data collected as a routine part of clinical services and program evaluation at a community mental health clinic utilizing psychodynamic therapy with older adult clients (N = 106) in its Seniors Program. An empirical measure, the Outcome Questionnaire 45.2, was used to track progress and to examine the nature of change over time at 3-month intervals across 12 time points. The effect size was large (ES = .8) and participants showed little deterioration. Findings suggest that older clients can and do benefit from psychodynamic treatment offered in this format.

Supporting Caregivers of Rural Veterans Electronically (SCORE)

BACKGROUND The increasing prevalence of dementia, including among rural veterans, highlights the improved outcomes possible for caregivers who receive effective support. However, providing these complex interventions in rural areas presents challenges. Internet-based and telephone-based caregiver support can potentially expand access to effective support. METHODS We designed a multisite intervention for caregivers of veterans with dementia. Caregivers were stratified into 2 cohorts based on their use or nonuse of the Internet. Each cohort was then randomized to either a technology or telephone-delivered support group within each cohort. All groups had a care manager who monitored the 4- to 6-month multicomponent program of assessments, educational content, and skills training. Caregiver outcome measures included burden, anticipatory grief, depression, family conflict, and a desire to institutionalize the care recipient. RESULTS The majority of comparative effectiveness outcomes were not different between caregivers receiving technology interventions versus those receiving telephone-delivered support. This was true for the 68% of caregivers using home Internet and the 32% nonusers, as well as the 53% rural versus 47% urban caregivers. For experienced Internet users, a meaningful difference in the Marwit Grief Inventory was noted for caregivers receiving Internet versus telephone support, particularly for the Isolation Subscale. CONCLUSION This study demonstrates the feasibility and acceptability of using a variety of modalities to deliver caregiver support to a group of largely older, rural, spousal caregivers of veterans with dementia. The potential for reducing isolation for caregivers capable of receiving this intervention through the Internet is a promising finding.

The Effects of High and Low Technologies on Emotional Support for Caregivers: An Exploratory Study

Understanding the role of modern technology in providing adjunctive emotional support to caregivers has been a focus in contemporary caregiving research. However, it remains largely unknown 1 whether there are differences regarding the technologies used in caregiving support to achieve this objective and 2 which factors influence the outcome of emotional support. The current research describes a framework to address this issue and examines the role of different technologies in supporting caregiver emotional needs. Sixty older caregivers were recruited in the current study and randomly assigned to high and low technology guided caregiver support conditions. The findings revealed a significant impact in the high technology guided intervention for emotional support as measured by burden reduction. The discussion on the use of high technology guided support strategies for older caregiver training is offered with implications for future research and practice.

Predictors of Attrition in Older Users of a Home-Based Monitoring and Health Information Delivery System

OBJECTIVE This retrospective study evaluated predictors of attrition in data from veterans with chronic medical conditions who were enrolled in a Veterans Administration Care Coordination Home Telehealth program. SUBJECTS AND METHODS Data were collected over a 4-year period. The enrolled sample was 73 veterans, 55.3% of whom discontinued enrollment during this period. RESULTS Among the selected variables examined, program discontinuation was assessed within the first 30 days of enrollment by response frequency to the home telehealth device. Intermittent device response was associated with earlier dropout. Enrollment in the program via telephone (rather than in person) was the largest predictor of premature dropout. CONCLUSIONS To ensure sustained home telehealth utilization, it is essential to engage patients through encouraging active and regular responding to the provider through the home telehealth device within the first 30 days of program initiation.

Reaching Out to Older Veterans in Need: The Elko Clinic Demonstration Project

CONTEXT The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas. PURPOSE This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic. The clinic, located in Elko, Nevada, was created to meet the health care needs of veterans who expressed a desire for greater access to VA services. METHODS The Elko Telehealth Outreach Clinic is a specific example of the real-life implementation of the community-as-partner model as an operational framework for coordinating local, regional, and VA resources. The Elko Clinic provides a limited set of health care services including medication management, health education, prescription refills, routine lab tests, and specialty services through telehealth. FINDINGS From December 2006 to December 2007, a total of 84 unique veterans received health care services through the Elko Clinic. CONCLUSIONS Our findings support the usefulness of an expanded community-as-partner model to guide a process for addressing the health care needs of veterans in Elko, Nevada, and they have implications for the development and maintenance of outreach clinics in other rural settings.

Individual versus interprofessional team performance in formulating care transition plans: A randomised study of trainees from five professional groups

ABSTRACT Health professions trainees’ performance in teams is rarely evaluated, but increasingly important as the healthcare delivery systems in which they will practice move towards team-based care. Effective management of care transitions is an important aspect of interprofessional teamwork. This mixed-methods study used a crossover design to randomise health professions trainees to work as individuals and as teams to formulate written care transition plans. Experienced external raters assessed the quality of the written care transition plans as well as both the quality of team process and overall team performance. Written care transition plan quality did not vary between individuals and teams (21.8 vs. 24.4, respectively, p = 0.42). The quality of team process did not correlate with the quality of the team-generated written care transition plans (r = −0.172, p = 0.659). However, there was a significant correlation between the quality of team process and overall team performance (r = 0.692, p = 0.039). Teams with highly engaged recorders, performing an internal team debrief, had higher-quality care transition plans. These results suggest that high-quality interprofessional care transition plans may require advance instruction as well as teamwork in finalising the plan.