Michael Duffy

Pikes Peak Model for Training in Professional Geropsychology.

The aging of the population will increase demand for psychological services for older adults, which challenges the profession of psychology to provide those services. In response to that challenge, professional geropsychology has been developing over the past few decades to meet current and prepare for anticipated future demand. The development of a range of training opportunities is important to enable psychologists to work effectively with older adults. This article describes the Pikes Peak model for training in professional geropsychology. The model is an aspirational, competencies-based approach to training professional geropsychologists that allows for entry points at multiple levels of professional development.

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65) and younger (18‐64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans.

Geriatric mental health policy: Impact on service delivery and directions for effecting change

The treatment of mental health problems in older adults has advanced considerably over the past several decades. Nevertheless, the mental health needs of the nations elderly population remain substantially unmet. This article identifies the significant but previously neglected role of regulatory policies and administrative practices in limiting the use and provision of geriatric mental health services. Such factors are the least recognized and understood by psychologists, although they are the very factors on which psychologists can have the most potential influence. This article subsequently identifies salient legislative proposals and regulatory developments, while addressing the importance of advocacy on agenda setting and policy change. The final section provides specific proposals and mechanisms at micro and macro levels for improving the geropsychology service system.

Integrating Practice Guidelines Into Professional Training Implications for Diversity Competence

The authors present the findings of a special task group (STG) organized to explore effective training strategies for the practice guidelines focused on diverse populations. They provide a brief literature review and summarize survey data from academic training directors regarding current use of practice guidelines. The authors then describe the Integrative Training Model (ITM), developed by the STG, as a framework for students and professionals to incorporate the complex array of information contained in each set of guidelines. Unique challenges associated with incorporating the ITM are described, as well as pedagogical considerations for both students and current professionals. The authors believe the ITM may help students and professionals increase their diversity competence by developing a more holistic understanding of the various dimensions and social group experiences that affect their clients and themselves.

Influences of Physical Environment on Corridor Walking Among Assisted Living Residents Findings From Focus Group Discussions

Walking has multiple physical and psychological benefits for older people. This study explores corridor walking behaviors and perceptions of corridor walkability in assisted living residents. Focus groups were conducted with 50 residents in six assisted living facilities in Texas. The data were analyzed by the constant comparative method. The findings revealed three types of corridor walking: walking to destination, walking for exercise, and walking for interaction. Residents’ perception of corridor walkability was related to the themes of safety, comfort/convenience, and aesthetics. Qualities of design elements that residents used to judge corridor walkability included continuity and graspability of handrails, coverage of carpeted floor, availability of seating, appropriate size of the corridor (i.e., width and length) and the elevator, appropriate locations of activity spaces and restrooms, and presence of artwork, window views, and plants. The findings provide insights to environmental interventions that may promote walking among sedentary residents.

Gender Differences in Adjustment to Nursing Home Care

Two hundred nursing home residents were assessed for adjustment, using life satisfaction and service quality measures. Multiple regression analyses by gender showed that for men, length of stay in the nursing home significantly predicted satisfaction with life and with the nursing home, positive self-concept, and perceptions of service received. No significant predictions for women were found.

The Role of Design Factors of the Residential Environment in the Physical and Mental Health of the Elderly

This study examined the relationship between selected dimensions of architectural design and measures of physical and mental health and morale among 171 elderly residents of congregate public housing and private housing. Several indices of social interaction were also investigated as possible mediators of the effects of the design factors on health. Design factors included congregate public housing versus private housing; high-rise versus low-rise; floor level; position on corridor; length of corridor; distance from elevator; number of bedrooms; and home ownership versus renting. Residents of congregate housing, high-rise buildings and those living at the end sections of corridors were found to be significantly higher in morale, but not in physical or mental health. Social interaction was not found to contribute significantly to this relationship.

Confidentiality and informed consent versus collaboration: Challenges of psychotherapy ethics in nursing homes.

Abstract Conventional prescriptions for ethical psychotherapy practice are largely based on outpatient, office-based procedures. Maintaining confidentiality and insuring informed consent in nursing homes, however, becomes considerably more complex. These are situations in which following ethical norms inflexibly will detract from quality of care. This article discusses the conflict of values and ethics that can sometimes exist. Case examples are used to illustrate the tension between confidentiality and optimal therapeutic strategy; between informed consent and urgent needs of the patient.

Effect of Physical Activity, Social Support, and Skills Training on Late-Life Emotional Health: A Systematic Literature Review and Implications for Public Health Research

Purpose Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults’ emotional health. Methods A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions – physical activity, social support, and skills training – given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). Results In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention–outcome pairings yielded insufficient evidence. Conclusion Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

Utility of the Salamon-Conte Life Satisfaction in the Elderly Scales (LSES) in Measuring Life Satisfaction in Great Britain and United States Nursing Homes Residents

Abstract The purpose of this study was to examine the comparative utility and reliability of the LSES in measuring life satisfaction in elderly residents in comparable samples of Great Britain (GB) and United States (US) nursing home residents. Included in the study were 100 residents from 15 GB nursing homes and 207 residents from 10 US nursing homes. As well as an overall measure of life satisfaction, the LSES gives a multidimensional portrait of 8 dimensional subscales. The LSES proved convenient and user-friendly to administer by the trained interviewers in a one-to-one verbal administration fashion and a novel method of handling the 5-point Likert scaling was found successful. Results indicated no significant differences between the samples on the relevant demographic variables. Reliabilities on the original 8 factor scale were high for the overall scales with Cronbach Alpha reliability coefficients of .92 for the US sample and .90 for the GB sample. A Lisrel approach was used to determine the best fitting scale. Subsequent analysis compared the scale across the two countries. The results revealed a shorter five-factor scale which was invariant across GB and US samples and which is well adjusted to measuring life satisfaction in nursing home residents.