Michele J. Karel

An Empirical Test of Telephone Screening to Identify Potential Dementia Cases

Thirty-seven subjects, 15 with a clinical diagnosis of Alzheimers disease and 22 normal controls, participated in a study of the accuracy of telephone screening in identifying potential dementia cases. The telephone protocol and scoring algorithm resulted in 100% sensitivity and 91% specificity. The findings suggest that a brief telephone interview can serve as an efficient screening device to locate dementia cases in the context of a large-scale community-based investigation.

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

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.

Cognitive performance predicts treatment decisional abilities in mild to moderate dementia

Objective: To examine the contribution of neuropsychological test performance to treatment decision-making capacity in community volunteers with mild to moderate dementia. Methods: The authors recruited volunteers (44 men, 44 women) with mild to moderate dementia from the community. Subjects completed a battery of 11 neuropsychological tests that assessed auditory and visual attention, logical memory, language, and executive function. To measure decision making capacity, the authors administered the Capacity to Consent to Treatment Interview, the Hopemont Capacity Assessment Interview, and the MacCarthur Competence Assessment Tool—Treatment. Each of these instruments individually scores four decisional abilities serving capacity: understanding, appreciation, reasoning, and expression of choice. The authors used principal components analysis to generate component scores for each ability across instruments, and to extract principal components for neuropsychological performance. Results: Multiple linear regression analyses demonstrated that neuropsychological performance significantly predicted all four abilities. Specifically, it predicted 77.8% of the common variance for understanding, 39.4% for reasoning, 24.6% for appreciation, and 10.2% for expression of choice. Except for reasoning and appreciation, neuropsychological predictor (β) profiles were unique for each ability. Conclusions: Neuropsychological performance substantially and differentially predicted capacity for treatment decisions in individuals with mild to moderate dementia. Relationships between elemental cognitive function and decisional capacity may differ in individuals whose decisional capacity is impaired by other disorders, such as mental illness.

Aging and depression: Vulnerability and stress across adulthood

This paper reviews research on the relationship between age and depression in adulthood, with a focus on depression in late life. Age differences in prevalence rates of major depression and depressive symptomatology raise questions about presentation and measurement of depression across adulthood, and suggest a changing salience of risk factors for depression from young adulthood through old age as well as to cohort differences in risk for depression. Applying a developmental perspective on biological change, psychological adaptation, and stress processes throughout adulthood shows that risk for depression onset in young adults is typified more through psychological vulnerability and stress, as well as genetic factors, while risk for depression in older adults typified more through comorbid medical and neurological disorder. Implications for research and clinical practice are discussed. This review of the relationship of age to depression shows that the study of psychopathology and adult development can inform each other.

Treatment of depression in late life: Psychotherapeutic interventions

Depression affects only a minority of older adults, but is a costly illness in terms of suffering, excess medical disability, increased use of health services, and mortality. Both pharmacological and psychotherapeutic interventions are effective for treating depression in late life. This paper reviews the background and empirical support for the efficacy of various psychotherapies for treating late life depression, including cognitive-behavioral, interpersonal, psychodynamic, life review, group, and family interventions. To date, cognitive-behavioral and interpersonal psychotherapies have most empirical support yet most studies have been conducted with relatively young, healthy, and White elderly. Studies of the efficacy of psychotherapeutic interventions for treating depression in minority and frail elderly are needed, as well as further studies of combination treatments across a range of care settings.

Individual Change in Perceived Control over 20 Years.

Perceptions of personal control were studied in 1267 individuals who represented four generations of families participating in a large longitudinal study spanning 1971 to 1991. Cross-sectional, longitudinal, and sequential analytic strategies were employed. Over 20 years, mean levels of personal control became more internal in the 560 respondents who participated at all four times of measurement, probably as a reflection of contextual factors in the culture. Developmental changes toward greater internality were indicated for young adults as they progressed into middle age. Cross-sectional differences in middle-aged and older adults did not appear to represent developmental differences. The oldest generation of women was consistently the most external subgroup, suggesting a cohort effect reflective of their socio-historical reality.

Neuropsychological Predictors of Decision‐Making Capacity over 9 Months in Mild‐to‐Moderate Dementia

AbstractBACKGROUND: Older adults with dementia may have diminished capacity to make medical treatment decisions. OBJECTIVE: To examine rates and neuropsychological predictors of treatment decision making, or consent capacity, among older adults with dementia over 9 months. DESIGN: Consent capacity was assessed initially and 9 months later in subjects with and without dementia using a longitudinal repeated measures design. PARTICIPANTS: Fifty-three older adults with dementia and 53 similarly aged adults without dementia. MEASUREMENTS: A standardized measure MacArthur Competence Assessment Tool-Treatment of 4 legal standards for capacity (Understanding, Appreciation, Reasoning, and Expressing a Choice) and a neuropsychological battery. RESULTS: In the dementia group, 9.4% had impaired capacity initially, and 26.4% had impaired capacity at 9 months. Mean scores in the dementia group were impaired relative to controls initially and at 9 months for Understanding (initial t=2.49, P=.01; 9-month t=3.22, P<.01) and Reasoning (initial t=2.18, P=.03; 9-month t=4.77, P<.01). Declining capacity over 9 months was attributable to a further reduction in Reasoning (group × time F=9.44, P=.003). Discriminant function analysis revealed that initial scores on naming, delayed Logical Memory, and Trails B were associated with impaired capacity at 9 months. CONCLUSIONS: Some patients with mild-to-moderate dementia develop a clinically relevant impairment of consent capacity within a year. Consent capacity in adults with mild-to-moderate dementia should be reassessed periodically to ensure that it is adequate for each specific informed consent situation. Interventions that maximize Understanding and Reasoning by supporting naming, memory, and flexibility may help to optimize capacity in this patient group.

Three Methods of Assessing Values for Advance Care Planning: Comparing Persons With and Without Dementia

Advance care planning ideally includes communication about values between patients, family members, and care providers. This study examined the utility of health care values assessment tools for older adults with and without dementia. Adults aged 60 and older, with and without dementia, completed three values assessment tools—open-ended, forced-choice, and rating scale questions—and named a preferred surrogate decision maker. Responses to forced-choice items were examined at 9-month retest. Adults with and without dementia appeared equally able to respond meaningfully to questions about values regarding quality of life and health care decisions. People with dementia were generally as able as controls to respond consistently after 9 months. Although values assessment methods show promise, further item and scale development work is needed. Older adults with dementia should be included in clarifying values for advance care planning to the extent that they desire and are able.

Health Values and Treatment Goals of Older, Multimorbid Adults Facing Life-Threatening Illness

To identify a taxonomy of health‐related values that frame goals of care of older, multimorbid adults who recently faced cancer diagnosis and treatment.