Von O. Leirer

Development and validation of a geriatric depression screening scale: A preliminary report

A new Geriatric Depression Scale (GDS) designed specifically for rating depression in the elderly was tested for reliability and validity and compared with the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale (SDS). In constructing the GDS a 100-item questionnaire was administered to normal and severely depressed subjects. The 30 questions most highly correlated with the total scores were then selected and readministered to new groups of elderly subjects. These subjects were classified as normal, mildly depressed or severely depressed on the basis of Research Diagnostic Criteria (RDC) for depression. The GDS, HRS-D and SDS were all found to be internally consistent measures, and each of the scales was correlated with the subjects number of RDC symptoms. However, the GDS and the HRS-D were significantly better correlated with RDC symptoms than was the SDS. The authors suggest that the GDS represents a reliable and valid self-rating depression screening scale for elderly populations.

Adherence and Medication Instructions Review and Recommendations

Prescription medication nonadherence among the elderly is a serious medical problem. Nonadherence is primarily caused by poor communication between health professionals and elderly patients. More specifically, nonadherence often reflects the inability of patients to understand and remember their medication instructions. Therefore, adherence can be increased by designing instructions that enable elders to easily construct a clear and simple mental model of how to take their medication. Inexpensive microcomputer-based hardware and software makes it possible for pharmacists to provide elderly patients with effective instructions.

When expertise reduces age differences in performance.

The authors examined whether aviation expertise reduces age differences in a laboratory task that was similar to routine air traffic control (ATC) communication. In Experiment 1, older and younger pilots and nonpilots read typical ATC messages (e.g., commands to change aircraft heading). After each message, they read back (repeated) the commands, which is a routine ATC procedure requiring short-term memory. Ss also performed less domain-relevant tasks. Expertise eliminated age differences in repeating heading commands, but did not reduce age differences for the less relevant tasks. In Experiment 2, expertise reduced but did not eliminate age differences in repeating heading commands from spoken messages. The results suggest that expertise compensates age declines in resources when the task is highly domain relevant.

The influence of list format and category headers on age differences in understanding medication instructions.

We examined whether instructions are better understood and remembered when they contain organizational cues. Our previous research found that older and younger adults organize medication information in similar ways, suggesting that they have a schema for taking medication. In the present study, list formats (vs. paragraphs) emphasized the order of information and category headers emphasized the grouping of information specified by this schema. Experiment 1 examined whether list and header cues improve comprehension (answer time and accuracy) and recall for adults varying in age and working memory capacity (measured by a sentence span task). List instructions were better understood and recalled than paragraphs, and reduced age differences in answer time and span differences in accuracy. Headers reduced paragraph comprehension for participants with lower levels of working memory capacity, presumably because they were not salient cues in the paragraphs. Experiment 2 investigated if headers were more effective when more saliently placed in paragraphs and lists, and if list and header cues helped readers draw inferences from the instructions. List formats again reduced age differences in comprehension, especially reducing the time needed to draw inferences about the medication. While headers did not impair comprehension, these cues did impair recall. The present study suggests that list-organized instructions provide an environmental support that improves both older and younger adult comprehension and recall of medication information.

Automated telephone reminders in tuberculosis care.

This study assessed the impact of automated telephone reminders in a population of 2,008 patients scheduled for appointments in a public health tuberculosis clinic. Overall, reminders increased appointment attendance from 52% to 62%. Reminders were more effective for some applications than others, but the effectiveness of reminders did not differ significantly across patient age, sex, or ethnicity. Counter to theoretical predictions, neither attribution of the reminder message to an authority nor a statement stressing the importance of the appointment significantly increased the effectiveness of the reminder above the level obtained without these enhancements.

Medication instruction design: younger and older adult schemas for taking medication

We examined whether older and younger adults share a schema for taking medication and whether instructions are better recalled when they are organized to match this schema. Experiment 1 examined age differences in schema organization. Participants sorted medication items (e.g., purpose, dose, possible side effects) according to similarity and then ordered the items to create a preferred instruction set. Cluster analysis of the sort and order data showed that younger and older adults share a schema for taking medication. Secondary regression analyses found that verbal ability (i.e., vocabulary scores) predicted individual differences in schema organization. In Experiment 2 participants recalled instructions that were either compatible with this schema in terms of grouping and order of items or were presented in nonpreferred orders. Younger participants remembered more information than did older participants, but both age groups better remembered and preferred the more schema-compatible instructions. Secondary analyses showed that recall was also positively related to verbal ability. Along with our earlier research, this study suggests that older and younger adults possess a schema for taking medication and that instructions that are compatible with this schema provide an environmental support that improves memory for medication information.

Increasing Influenza Vaccination Adherence Through Voice Mail

The number of influenza and influenza‐related deaths is alarmingly high, yet mean vaccination adherence rates among the high‐risk elderly population remain at only 20%. The present study investigates the use of an inexpensive voice‐mail system, TeleMinderTM, as a method of increasing influenza vaccination adherence among a subpopulation of elders identified as low adherers. The first group of older people received no intervention. Group 2 received a voice‐mail message informing them of the cost, time, date, and location of an influenza vaccination clinic. Group 3 was exposed to posted and verbal announcements alone. Group 4 both received voice mail and was exposed to posted and verbal announcements. Vaccination adherence levels for groups 1 through 4 were 1.5%, 11.8%, 7.4%, and 37.5%, respectively. Voice mail significantly increased vaccination adherence either alone or in combination with posted and verbal announcements. These findings suggest that voice mail provides an inexpensive means of increasing influenza vaccination rates.

Memory skills elders want to improve

While many research studies have investigated memory training for elders, none have asked which specific memory skills elders would like to improve. This study investigates two related questions. First, which memory skills elders would like to improve? Second, is there a common set of these memory skills? Elders completed a three-part questionnaire. First, it asked for subject demographics. Second, it asked for the first, second, third, and then all other memory skills they would most like to improve. Finally, it asked elders to rate the importance of 10 specific memory skills. The results indicate that elders share a common set of memory skills they wish to improve. They are: (a) peoples names, (b) important dates, (c) location of household objects, (d) recent and past events, (e) meetings and appointments, (f) information and facts, (g) general improvement, and (h) medication. One conclusion from these findings is that at least some memory training research should focus on these specific memory skills.

Repetition Improves Older and Younger Adult Memory for Automated Appointment Messages

Automated telephone messaging systems have dramatically expanded communication about health service appointments, but few studies have directly investigated these messages. The present study investigated whether message repetition (1, 2, or 3 presentations) and listener age (mean age = 71 or 19 years) improved memory for automated appointment messages. Repetition improved older and younger adult memory for appointment information. Moreover, 2 presentations reduced age differences in accuracy of answering questions about the messages. This was not the case for free recall, suggesting that older adults differentially benefited from repetition only when provided with additional retrieval support. These findings show that older as well as younger adults benefit from at least 1 repetition of appointment messages. Actual or potential applications of this research include the use of repetition to improve comprehension of automated telephone messages.

Using icons to convey medication schedule information

We examined older adult comprehension and memory for medication schedules conveyed by different types of visual icons as well as text. Three icons were compared: a timeline, a pair of 12 h clocks (one for AM and one for PM hours) and a 24 h clock. In Experiment 1, older and younger participants paraphrased and then recalled schedules that were conveyed by the three icons or by text. Text and timeline schedules were paraphrased more accurately than either clock icon. Paraphrase errors suggested that subjects had trouble integrating schedule information across the two 12 h clocks. Analysis of paraphrase times showed that the text schedule was paraphrased most quickly, followed by the timeline, the 24 h clock and the 12 h clock. No differences were found for the accuracy of recalling the icon and text schedules. Experiment 2 examined free and cued recall after limited study time by older adults. Because text superiority in Experiment 1 may have reflected greater familiarity with text than with icons, recall was examined across four trials in Experiment 2. Text was recalled most accurately, followed by the timeline, the 24 h clock and the 12 h clock. Study-test trials did not influence recall. Text schedules may have been generally more effective than the icons because of their greater familiarity. The timeline may have been the most effective icon because it was more compact and familiar than the clock icons used in the study. The findings suggest that including such icons in medication instructions requires training.