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ABSTRACTBackground:In 2014, the state of Oregon established Oregon Care Partners to provide high quality, free training to all dementia caregivers. This study evaluated participants’ changes in knowledge, sense of competency in dementia... more
ABSTRACTBackground:In 2014, the state of Oregon established Oregon Care Partners to provide high quality, free training to all dementia caregivers. This study evaluated participants’ changes in knowledge, sense of competency in dementia caregiving, and ability to identify person-centered caregiving techniques after completing CARES® Dementia Basics online program, one of the educational resources available through this initiative.Methods:A convenience sample of informal and formal caregivers (N= 51) provided data at three points in time; pre-test, post-test, and a follow-up test after an additional 30-day period to determine sustained changes in knowledge, sense of competency, and person-centered care.Results:From pre-test to post-test, modest improvements were detected in sense of competence in performing dementia care (ps< 0.01) and dementia-based knowledge,F(2, 150) = 7.71,p< 0.001, a multivariate effect size ofw2= 0.09. Even though improvements in sense of competency were not universal, three out of five individual items demonstrated positive growth from pre-test to post-test as well as four out of the five items from pre-test to follow-up test. Importantly, gains observed in dementia-based knowledge from pre-test to post-test were largely maintained at the 30-day follow-up. No significant changes were found in the correct identification of person-centered techniques after the trainingF(5, 150) = 1.63,p= 0.19.Conclusions:Future research should investigate how best to maintain educational interventions within the caregiving environment and to assess subsequent skill change.
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Research Interests: Law, Gerontology, Mental Health, Social Support, Medicine, and 15 moreLogistic Regression, Demographics, Face to Face, Applied, Physical Health, Psychological Intervention, Health Law and Policy, Mental health services, Mental Health Care, Clinical Sciences, Depressive Symptoms, Medicine and Health Sciences, Assisted Living, Social Network, and Mental Health Service Use(Logistic Regression, Demographics, Face to Face, Applied, Physical Health, Psychological Intervention, Health Law and Policy, Mental health services, Mental Health Care, Clinical Sciences, Depressive Symptoms, Medicine and Health Sciences, Assisted Living, Social Network, and Mental Health Service Use)
(Logistic Regression, Demographics, Face to Face, Applied, Physical Health, Psychological Intervention, Health Law and Policy, Mental health services, Mental Health Care, Clinical Sciences, Depressive Symptoms, Medicine and Health Sciences, Assisted Living, Social Network, and Mental Health Service Use)
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Background and Objectives Nursing homes (NHs) are serving a large number of residents with serious mental illness (SMI). We analyze the highest (“High SMI”) quartile of NHs based on the proportion of residents with SMI and compare NHs on... more
Background and Objectives Nursing homes (NHs) are serving a large number of residents with serious mental illness (SMI). We analyze the highest (“High SMI”) quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion. Research Design and Methods We used national Certification and Survey Provider Enhanced Reports data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High SMI. Incidence rate ratios (IRRs) and odds ratios (ORs) were reported with 95% confidence intervals. Results High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR: 1.03 [1.00, 1.07]) and Widespread (IRR: 1.07 [1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR: 1.49 [1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR: 1.18 [1.08, 1.30]) in comparison to all other NHs. Discussion and Implications Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental health care needs.
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Background and Objectives Resident satisfaction is an integral part of nursing home (NH) quality of care. However, there is no uniform categorization framework to classify the self-reported satisfaction of older adult residents in NHs.... more
Background and Objectives Resident satisfaction is an integral part of nursing home (NH) quality of care. However, there is no uniform categorization framework to classify the self-reported satisfaction of older adult residents in NHs. This scoping review systematically investigated the studies reporting data on older residents’ satisfaction to evaluate the quality of NH service and to create a conceptual model for older residents’ satisfaction. Research Design and Methods We used Donabedian’s structure–process–outcome model as a theoretical framework. In 3 electronic databases (PubMed, Scopus, and CINAHL), potential studies were searched using specific inclusion criteria identifying original studies that investigated older adult residents’ satisfaction in NHs. Results Fifteen studies, including 264,133 residents and 15,577 NHs, were selected for this review. Although a wide variety of resident satisfaction measures were used in the included studies, all these indicators reflect 5 primary domains: psychological, clinical, social, environmental, and spiritual, with the common focus of improving the quality of life of residents. Though technical competence is a fundamental aspect of health care service, we found autonomy, environment, meaningful activities, and interpersonal quality of professionals as the most important predictors for the resident’s satisfaction. Discussion and Implications The current review has synthesized a broad range of satisfaction measures, which will help future researchers and policymakers provide guidance for further improvement of NH care services and as a heuristic device to spur research. Additional research is needed to apply this conceptual framework for comparisons of self-reported resident satisfaction in other institutional settings across countries.
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Research Interests: Leadership, Dementia, Medical Education, Medicine, Curriculum, and 15 moreHumans, Geriatric Nursing, Nursing Homes, Florida, Assisted living facilities, Geriatric Psychiatry, Psychogeriatrics, Aged, Patient Care Team, Long Term, Alzheimer Disease, Credentialing, Homes for the Aged, Psychology and Cognitive Sciences, and Medical and Health Sciences
Objective: Responding to the increased need for research on older residents in assisted living facilities (ALFs), this study assessed the connections between physical and mental health among 150 older residents in ALF settings. Method:... more
Objective: Responding to the increased need for research on older residents in assisted living facilities (ALFs), this study assessed the connections between physical and mental health among 150 older residents in ALF settings. Method: The major focus of the study was to explore whether individuals' subjective perceptions of their own health mediate the associations between health-related variables (chronic conditions and functional disability) and depressive symptoms. Results: The analyses showed that the adverse effects of chronic conditions and functional disability on depressive symptoms were not only direct but also indirect through negative health perceptions. Discussion: The findings that health perceptions serve as an intervening step between physical and mental health provide important implications for promotion of mental well-being among older residents in ALFs. In addition to disease/disability prevention and health promotion efforts, attention should be paid to ways to enhance older individuals' positive beliefs and attitudes toward their own health and to promote healthful behaviors.
Research Interests: Perception, Health Promotion, Health Behavior, Gerontology, Mental Health, and 15 moreDepression, Medicine, Activities of Daily Living, Humans, Chronic Disease, Female, Male, Assisted living facilities, Health Status, Aged, Depressive Symptoms, Assisted Living, Functional Disability, attitude to health, and Adverse effect
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Background and Objectives Assisted living facilities (ALFs) have experienced rapid growth in the past few decades. The expansion in the number of ALFs may cause markets to become oversaturated, and a greater risk of unprofitable ALFs to... more
Background and Objectives Assisted living facilities (ALFs) have experienced rapid growth in the past few decades. The expansion in the number of ALFs may cause markets to become oversaturated, and a greater risk of unprofitable ALFs to close. However, no studies have investigated ALF closure. This study adapted a model developed for the nursing home market for the ALF market to examine the organizational, internal, and external factors associated with closure. Research Design and Methods Data on 1,939 ALFs operating in 2013 from Florida were used to estimate a logistic regression to examine the organizational, internal, and external factors that were associated with closure between 2013 and 2015. Results During the 2-year study period, 141 ALFs (7.3%) closed. Significant factors associated with increased odds of closure included fewer beds, not accepting Medicaid, and more deficiencies. Two factors (market concentration and population density) were marginally significant. Discussio...
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While acculturation and its implications for mental health have received extensive attention in studies with older immigrant populations, change over time in acculturation less so. This paper examines change over a two-year period in... more
While acculturation and its implications for mental health have received extensive attention in studies with older immigrant populations, change over time in acculturation less so. This paper examines change over a two-year period in levels of linguistic acculturation among Cuban (n = 186) and non-Cuban Hispanic (n = 116) immigrants living in Florida. Data came from the waves of the Survey of Older Floridian (SOF), conducted using a statewide sampling frame based on population densities, with a computer-assisted telephone interview strategy. Calls were initiated through random digit dialing, and a follow-up interview was added approximately two years later. Measures included six acculturation items, one dealing with the participant’s language preference for the interview itself and five items dealing with language ability and usage. Results indicated that non-Cuban Hispanics were significantly more acculturated than Cuban Hispanics, and that at least 75% of Wave 2 acculturation was ...
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OBJECTIVESTo evaluate and contrast 25 content areas essential to the primary care of older adults by medical faculty, thus identifying faculty beliefs and areas of possible improvement.DESIGNUsing measures from the Healthcare... more
OBJECTIVESTo evaluate and contrast 25 content areas essential to the primary care of older adults by medical faculty, thus identifying faculty beliefs and areas of possible improvement.DESIGNUsing measures from the Healthcare Effectiveness Data and Information Set, the Consumer Assessment of Healthcare Providers and Systems, and Healthy People 2020, nine practicing clinical faculty identified 25 content areas essential to the primary care of older adults.SETTINGA large academic health center in southeastern United States.PARTICIPANTSEighty‐two university medical faculty.MEASUREMENTSFaculty rated importance, knowledge, and confidence in teaching the 25 content areas on a scale from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings for importance and confidence in teaching were calculated and assessed. The survey had high internal consistency within each of the three domains—Cronbach's α > .94.RESULTSThe most important content areas were being able to explai...
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Geropsychology is a vibrant field of scientific study, pedagogy, and clinical practice, and the need for more geropsychologists will only expand as the population ages. This study involved in-depth, semi-structured telephone interviews... more
Geropsychology is a vibrant field of scientific study, pedagogy, and clinical practice, and the need for more geropsychologists will only expand as the population ages. This study involved in-depth, semi-structured telephone interviews with 30 clinical geropsychologists about their training and current work. Qualitative coding of interviews was undertaken using an inductive coding approach. Results revealed four major themes: factors influencing entry into the field of geropsychology, the rewards of being a geropsychologist, competing demands on time and money, and barriers to involvement in leadership. These results suggest some possible points of intervention to attract people to the field of aging and promote their professional development and success.
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There are many important unanswered issues regarding the occurrence of cognitive impairment in physicians, such as detection of deficits, remediation efforts, policy implications for safe medical practice, and the need to safeguard... more
There are many important unanswered issues regarding the occurrence of cognitive impairment in physicians, such as detection of deficits, remediation efforts, policy implications for safe medical practice, and the need to safeguard quality patient care. The authors review existing literature on these complex issues and derive heuristic formulations regarding how to help manage the professional needs of the aging physician with dementia. To ensure safe standards of medical care while also protecting the needs of physicians and their families, state regulatory or licensing agencies in collaboration with state medical associations and academic medical centers should generate evaluation guidelines to assure continued high levels of functioning. The authors also raise the question of whether age should be considered as a risk factor that merits special screening for adequate functioning. Either age-related screening for cognitive impairment should be initiated or rigorous evaluation afte...
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Research Interests: Nursing, Qualitative Methods, Dementia, Qualitative Research, Medicine, and 15 moreHumans, Nursing Homes, Florida, Male, Medicare, Medicaid, Middle Aged, Questionnaires, Antipsychotic, Homes for the Aged, Inappropriate Prescribing, Health Care Surveys, Antipsychotic agents, Psychology and Cognitive Sciences, and Medical and Health Sciences
... Psychoanal. Studies 4(2): 144169 (2007) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/aps.131 The Transitional Object in Dementia: Clinical Implications SHEILA LOBOPRABHU, VICTOR MOLINARI, AND JAMES... more
... Psychoanal. Studies 4(2): 144169 (2007) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/aps.131 The Transitional Object in Dementia: Clinical Implications SHEILA LOBOPRABHU, VICTOR MOLINARI, AND JAMES LOMAX ABSTRACT ...
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Research Interests: Nursing, Mental Health, Medicine, Humans, Nursing Homes, and 15 moreFemale, Florida, Male, Mental Disorders, Mental Health Care, Health Status, Medicaid, Nursing Home, Clinical Sciences, Aged, Ethnic Group, Geriatric Assessment, Ethnic Difference, Homes for the Aged, and Health services for the aged
Caregiver spouses struggle to cope with the multiple demands of caregiving and complexities of medical care. In this article, the emotional, marital, attachment, and spiritual aspects of spousal caregiving for patients with dementia are... more
Caregiver spouses struggle to cope with the multiple demands of caregiving and complexities of medical care. In this article, the emotional, marital, attachment, and spiritual aspects of spousal caregiving for patients with dementia are addressed. This paper explores what keeps spouses together during this devastating illness. The literature has been reviewed to identify value systems that enable spouses to continue
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This study examines plans for future caregiving made by family members of younger ( n = 59) and older adults ( n = 16) with serious mental illness (SMI). An online survey was advertised through a newsletter of the National Alliance on... more
This study examines plans for future caregiving made by family members of younger ( n = 59) and older adults ( n = 16) with serious mental illness (SMI). An online survey was advertised through a newsletter of the National Alliance on Mental Illness. Qualitative analyses yielded four areas of caregiver concern: health of the care recipient over time, ability of caregivers to sustain support, social support available for the care recipient, and financial burden of care. Despite these concerns, few caregivers reported completed plans for future caregiving. One fourth of the caregivers had made no plans, nor had they discussed future caregiving with others. Although most would prefer other relatives to assume care in the event they could not sustain support, these expectations may not be communicated openly. Generating discussion on this pertinent topic has implications for the aging society regarding how best to care for those with SMI and their caregivers.
Research Interests: Psychology, Communication, Health Communication, Mental Health, Social Support, and 13 moreMedicine, Mental Illness, Older Adults, Caregiving, Applied, Social and Behavioral Sciences, Alliance, Caregiver burden, Clinical Sciences, Serious Mental Illness, Family caregivers, Online survey, and Older Adult
ABSTRACTBackground: Florida is a leader in requiring that all direct care staff employed in assisted living, nursing homes, hospice, adult day care and home health undergo Alzheimer's disease (AD) training. Legislative requirements... more
ABSTRACTBackground: Florida is a leader in requiring that all direct care staff employed in assisted living, nursing homes, hospice, adult day care and home health undergo Alzheimer's disease (AD) training. Legislative requirements prescribe the curricula components and require a review of curricular content and minimum standards for the training providers.Methods: We describe Florida's AD training program review process, and report the results of our review of 445 curricula received over four and a half years.Results: On initial submission, over 90% of curricula submitted did not include learning objectives, time formats or didactic approach. During a review of content we often found inaccurate information, language that was not person-centered, and missing required training components.Conclusion: Form and content problems were prevalent across all curricular types. We propose the Florida credentialing program as a model to ensure that accurate and educationally sound curri...
Research Interests: Leadership, Dementia, Medical Education, Medicine, Curriculum, and 15 moreHumans, Geriatric Nursing, Nursing Homes, Florida, Assisted living facilities, Geriatric Psychiatry, Psychogeriatrics, Aged, Patient Care Team, Long Term, Alzheimer Disease, Credentialing, Homes for the Aged, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Cognitive Science, Long Term Care, Cognition, Behavioral Science, Activities of Daily Living, and 15 moreHumans, Male, Care, Longitudinal, Clinical Sciences, Geriatric Psychiatry, Geriatric, Aged, Longitudinal Studies, Cognitive impairment, Longitudinal Study, Behavior Problems, Department of Veterans Affairs, Cognition disorders, and Activity of Daily Living
Research Interests: Nursing, Gerontology, Mental Health, Focus Groups, Medicine, and 15 moreMental Illness, Aggressive Behavior, Interviews, Humans, Nursing Homes, Florida, Focus Group, Education Systems, Attitudes, Mental Disorders, Nursing Home, Aged, Continuity of Patient Care, Homes for the Aged, and Inservice training
Research Interests: Clinical Psychology, Geriatrics, Primary Care, Gerontology, Mental Health, and 15 moreLong Term Care, Medical Education, Public Health, Medicine, Curriculum, Humans, Internship, Florida, Education Systems, Knowledge base, Educational Models, Geriatric Psychiatry, Aged, Older Adult, and Disadvantaged
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David Chiriboga, Ph.D. Lisa Brown, Ph.D. Soyeon Cho, Ph.D. Mary Ann Watson, MSN, ARNP Victor Molinari, Ph.D. Donna Cohen, Ph.D. Larry Dupree, Ph.D. Amber Gum, Ph.D. Yuri Jang, Ph.D. William Kearns, Ph.D. Glenn Mitchell II, Ph.D. Bruce... more
David Chiriboga, Ph.D. Lisa Brown, Ph.D. Soyeon Cho, Ph.D. Mary Ann Watson, MSN, ARNP Victor Molinari, Ph.D. Donna Cohen, Ph.D. Larry Dupree, Ph.D. Amber Gum, Ph.D. Yuri Jang, Ph.D. William Kearns, Ph.D. Glenn Mitchell II, Ph.D. Bruce Stegner, Ph.D. Kristen ...
Suggested citation: Chiriboga, D., Becker, M., Brown, L., Anderson, S., A., Cohen, D., Dupree, L., et al. (2005) The Florida Alzheimer's Disease Medicaid waiver program: An evaluation of Alzheimer's beneficiaries prior to... more
Suggested citation: Chiriboga, D., Becker, M., Brown, L., Anderson, S., A., Cohen, D., Dupree, L., et al. (2005) The Florida Alzheimer's Disease Medicaid waiver program: An evaluation of Alzheimer's beneficiaries prior to program initiation. Tampa FL: University of South ...
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As a means of establishing the characteristics of Medicaid beneficiaries with Alzheimer's disease during a time prior to the implementation of the new waiver program, two sets of investigations were conducted. The first looked at... more
As a means of establishing the characteristics of Medicaid beneficiaries with Alzheimer's disease during a time prior to the implementation of the new waiver program, two sets of investigations were conducted. The first looked at some general questions ...
Research Interests: Law, Assessment, Mental Health, Evaluation, Medicine, and 12 moreBehavioral Science, Health Service utilization, Social Work and Mental Health, Health Science, Service Delivery, Health Law and Policy, Medicaid, Ethnic Group, Medicine and Health Sciences, Waiver, Mental Health and Psychiatric Nursing, and Service Utilization
The authors discuss clinical and teaching aspects of a telephone call by the treating clinician to family members after a patient dies. A MEDLINE search was conducted for references to an after-death call made by the treating clinician to... more
The authors discuss clinical and teaching aspects of a telephone call by the treating clinician to family members after a patient dies. A MEDLINE search was conducted for references to an after-death call made by the treating clinician to family members. A review of this literature is summarized. A clinical application of the after-death call is proposed, with emphasis on a "no regrets" approach. The authors also discuss the management of "at risk" situations, and end with teaching points. The after-death call is an example of "best practices" in the care of every patient, and can be used to teach residents and students of all disciplines. Primary care providers and consultation psychiatrists may find this valuable as they communicate with families in the sensitive and often traumatic context after a patient dies.
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Recommended citation for the report: Boothroyd, RA, Armstrong, MI, Gomez, A., Haynes, D., Ort, R., Chen, R, Best, KA (2004). Welfare reform: Adolescent girls in transitionA two year follow-up study. Tampa, FL: Louis de la Parte Florida... more
Recommended citation for the report: Boothroyd, RA, Armstrong, MI, Gomez, A., Haynes, D., Ort, R., Chen, R, Best, KA (2004). Welfare reform: Adolescent girls in transitionA two year follow-up study. Tampa, FL: Louis de la Parte Florida Mental Health Institute, University of ...
Research Interests: Psychiatry, Mental Health, Medicine, Multivariate Analysis, Humans, and 15 moreFemale, Male, Psychological Intervention, Mental Disorders, Mental health services, CIDI, African Americans, Clinical Sciences, Aged, Middle Aged, Adult, Cross Sectional Studies, Logistic Models, Psychiatric Status Rating Scales, and Help seeking behavior
In this paper, we discuss the value of an after-death telephone call made by the treating mental health clinician to family members, after the death of a geriatric patient with a psychiatric disorder. We outline the process of the... more
In this paper, we discuss the value of an after-death telephone call made by the treating mental health clinician to family members, after the death of a geriatric patient with a psychiatric disorder. We outline the process of the after-death call including the optimal method, nature, and content. We note the psychotherapeutic value of an after-death telephone call in addressing complex emotions, and helping the family to cope with bereavement. We also discuss institutional, legal, and ethical ramifications. We conclude that an after-death call may be of sufficient benefit to be considered as a "best practice" approach in the care of every patient.
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Mental health problems are pervasive in nursing homes (NHs), but little is known regarding the delivery of mental health services in these settings. To fill this gap in knowledge, we conducted a survey of NH administrative personnel views... more
Mental health problems are pervasive in nursing homes (NHs), but little is known regarding the delivery of mental health services in these settings. To fill this gap in knowledge, we conducted a survey of NH administrative personnel views on mental health services use. We analyzed 146 surveys from NH administrative personnel, reflecting 70% of the NHs that sent representatives to training conferences held at four Florida locations. There is substantial provision of mental health services (approximately half of the NHs have psychologists, psychiatrists and other MDs consulting on a weekly basis) and high satisfaction with services currently offered. Mental health services are typically provided by outside consultants who most frequently address behavior problems, anxiety/fears and depression. Sub-analyses of mental health service usage by types of NHs were largely non-significant. Almost half of the NHs reported the involuntary hospitalization of at least one resident during the previous year. No barriers to mental health services were rated as serious, and no mental health services were viewed as very difficult to provide. Top perceived barriers to mental health services delivery were resident and family attitudes towards mental health services; administrator and staff attitudes were perceived to be less problematic. Specialty psychotherapeutic services were the most difficult to provide in NHs, with psychopharmacological interventions the least difficult to provide. Administrators report a variety of mental health services provided by a diverse group of professionals in NHs, and are generally satisfied with the treatment provided.
Research Interests: Nursing, Mental Health, Nonparametric Statistics, Medicine, Anxiety, and 15 moreHumans, Nursing Homes, Florida, Psychological Intervention, Mental Disorders, Mental health services, Nursing Home, Aged, Behavior Problems, ANXIETY, Boolean Satisfiability, Health services for the aged, Health Care Surveys, Administrative Personnel, and Medical and Health Sciences
This article focuses on justification of psychoactive medication prescription for NH residents during their first three months post-admission. We extracted data from 73 charts drawn from a convenience sample of individuals who were... more
This article focuses on justification of psychoactive medication prescription for NH residents during their first three months post-admission. We extracted data from 73 charts drawn from a convenience sample of individuals who were residents of seven nursing homes (NHs) for at least three months during 2009. Six focus groups with NH staff were conducted to explore rationales for psychoactive medication usage. Eighty-nine percent of the residents who received psychoactive medications during the first three months of residence had a psychiatric diagnosis, and all residents who received psychoactive medications had a written physician's order. Mental status was monitored by staff, and psychoactive medications were titrated based on changes in mental status. One concern was that no Level II Preadmission Screening and Annual Resident Review (PASRR) evaluations were completed during the admissions process. Further, while 73% had mental health diagnoses at admission, 85% of the NH residents were on a psychoactive medication three months after admission, and 19% were on four or more psychoactive medications. Although over half of the residents had notes in their charts regarding non-psychopharmacological strategies to address problem behaviors, their number was eclipsed by the number receiving psychopharmacological treatment. While the results suggest that NHs may be providing more mental health care than in the past, psychopharmacological treatment remains the dominant approach, perhaps because of limited mental health training of staff, and lack of diagnostic precision due to few trained geriatric mental health professionals. A critical review of the role of the PASRR process is suggested.