Patricia A. Parmelee

Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population

OBJECTIVE: To evaluate the validity of the Cumulative Illness Rating Scale (CIRS) in a geriatric institutional population by examining its associations with mortality, hospitalization, medication usage, laboratory findings and disability.

An interdisciplinary expert consensus statement on assessment of pain in older persons

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

Pain complaints and cognitive status among elderly institution residents.

To examine the association between self‐reported pain and cognitive impairment among frail elderly institution residents.

Psychometric Characteristics of the Minimum Data Set II: Validity

OBJECTIVE: To determine the validity of the Minimum Data Set (MDS).

The relationships among anxiety, depression, and pain in a geriatric institutionalized sample

&NA; This study sought to determine if depression and/or anxiety is uniquely related to pain after controlling for the strong association between anxiety and depression. Both depression and anxiety were assessed in an elderly institutionalized sample using: (1) research‐based diagnoses based on Diagnostic and Statistical Manual‐revised 3rd edition (DSM‐IIIR) criteria, and (2) evaluations of ones recent affective states using the Profile of Moods States (POMS). Pain was assessed by pain intensity and number of pain complaints. A series of path models indicated that: (1) both research‐based anxiety and depression share unique variance with pain, and (2) only POMS anxiety is uniquely related to pain. A path model using both measures of anxiety and depression indicated that only the anxiety measures are significantly related to pain. However, POMS anxiety sustained a significantly greater relationship with pain than did research‐based anxiety.

Psychometric Characteristics of the Minimum Data Set I: Confirmatory Factor Analysis

OBJECTIVE: To determine the structure and statistical reliability of the federally mandated Minimum Data Set (MDS).

Depression and medical illness in late life: Report of a symposium.

Clinically significant depression in older people is an important public health problem. Medical illness is the most consistently identified factor associated with the presence of late‐life depression and is the most powerful predictor of poor depressive outcome. Closer examination of these associations holds promise for revealing insights into depressive pathogenesis at biological, psychological, and social levels of organization.

Predictors of Comprehension during Surgical informed Consent

BACKGROUND Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN Patients scheduled for 1 of 4 elective operations (total hip arthroplasty [n = 137], carotid endarterectomy [n = 178], laparoscopic cholecystectomy [n = 179], or radical prostatectomy [n = 81]) at 7 Department of Veterans Affairs (VA) medical centers were enrolled. All informed consent discussions were performed using iMedConsent (Dialog Medical), the VAs computerized informed consent platform. Using a unique module within iMedConsent, we randomized patients to repeat back (RB), requiring correct reiteration of procedure-specific facts, or standard (STD) iMedConsent. Patient comprehension was tested after the informed consent discussion using procedure-specific questionnaires. Time spent completing the informed consent process was measured using time stamps within iMedConsent. Multiple linear regression identified factors independently associated with improved comprehension. RESULTS We enrolled 575 patients (276 RB, 299 standard); 93% were male, 74% were Caucasian, and 89% had at least a high school education. Independent factors associated with improved comprehension included race (p < 0.01), ethnicity (p < 0.05), age (p < 0.02), operation type (p < 0.01), group assignment (+/- RB; p < 0.05), and total consent time (p < 0.0001). Patient comprehension was maximized when informed consent took between 15 and 30 minutes. RBs positive impact on patient comprehension was weaker in the analysis including consent time. CONCLUSIONS Comprehension during informed consent discussions may be limited in individuals with potential language difficulty due to ethnicity or education. Total consent time was the strongest predictor of patient comprehension. Affording adequate time for informed consent discussions and using informed consent adjuncts such as RB may enhance comprehension in such individuals.

Vulnerability of Older Latino and Asian Immigrants with Limited English Proficiency

OBJECTIVES: To explore the implications of limited English proficiency (LEP) for disparities in health status and healthcare service use of older Latino and Asian immigrants.

Health Status of Older Asian Americans in California

Given the paucity of research on differences between older adults representing the many Asian‐American subcategories, the present study explored physical and mental health status in five subcategories of Asian Americans aged 60 and older: Chinese, Japanese, Korean, Vietnamese, and Filipino. Data were drawn from the 2007 California Health Interview Survey (CHIS). Background characteristics and physical and mental health conditions were compared, with results showing differences cross the five subcategories of older Asian Americans. Specific patterns were identified in chronic diseases, disease comorbidity, and disability rates. Vietnamese and Filipinos tended to have poorer physical health than Chinese, Japanese, and Koreans. The poorest self‐rated health and the highest disability rate were found in the older Vietnamese. Filipinos also exhibited the greatest number of chronic diseases, including the highest rates of asthma, high blood pressure, and heart disease. Although Koreans had the fewest self‐reported chronic diseases and the least evidence of disease comorbidity, they also had the highest psychological distress. The lowest psychological distress was found in older Japanese. Findings suggest that generalizing findings from one particular Asian category or from an aggregate Asian category may be problematic and may not reflect an accurate picture of the burden of health in specific Asian categories. Being aware of these differences in background and health characteristics may help providers to better serve older Asian clients.