Search

Major life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care. Observational, cross-sectional. A total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July 2021. We developed a "TRAUMA" framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48 hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ2 tests. All data were analyzed using SPSS v. 28. Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ2 (1) = 5.206, P =.022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (β = −0.037; SE = 0.11; P <.001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions. Our experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions. [ABSTRACT FROM AUTHOR]

Objectives: The number of people living with dementia is growing and most patients go years without receiving a specific diagnosis or support services, leading to suboptimal care, negative impacts on the quality of life, and increased costs of care. To address these gaps, the State of Georgia Department of Human Services collaborated with academic and community partners to create the Georgia Memory Net (GMN). Design: GMN is a hub and spoke model partnered with Emory University's Cognitive Neurology Clinic and Emory Goizueta Alzheimer's Disease Research Center to provide training and support for best practices in diagnosis and management to Memory Assessment Clinics (MACs) throughout the state. Setting: Communities across the State of Georgia. Participants: GMN is a mix of academic and community providers, hospital systems, state and community agencies. Patients and families are evaluated at the MACs and connected to community services. Intervention: A dedicated clinic workflow: primary care providers (PCPs) identify a memory problem and refer to the MACs for diagnostic evaluation; meeting with a community services educator, and development of a care plan. The patient is reconnected with the PCP for continuity of care. Measurements: Initial metrics include numbers of unique patients, total patient visits, and referrals to state agency partners for community services. Results: GMN established five MACs across Georgia with annual state funding. Partners at Emory University provided initial training; refined patient workflows for best practices; and provide ongoing support, guidance, and continuing education for MAC teams. Local PCPs and community services partners demonstrated strong engagement with the new model. Conclusions: GMN is an innovative care model to improve access to accurate and timely diagnosis in patients with memory loss. GMN may help improve the quality of life for patients and families through preventive and early care. [ABSTRACT FROM AUTHOR]

Assisted living (AL) is an expanding site of end-of-life (EOL) care in the United States. Understanding determinants of quality of life (QoL) for AL residents near EOL is vital to optimize care for this growing population, most of whom have some degree of cognitive impairment (CI). This analysis aimed to identify factors associated with QoL in a diverse sample of AL residents with CI approaching EOL. Observational cross-section design. Data are from a 5-year study funded by the National Institute on Aging examining EOL care of residents in 7 diverse AL communities in metropolitan Atlanta (n = 67). CI was assessed with the Montreal Cognitive Assessment (scores ≤ 26) and QoL was determined with the self-reported QoL in Alzheimer's disease survey adapted for use in AL. Psychological distress was assessed using the Patient Health Questionnaire–4 and fatigue was assessed using the 13-item Functional Assessment of Chronic Illness Therapy Fatigue Scale. Initial descriptive analyses were followed by backward stepwise regression analyses to select a best-fitting model of QoL. The final model predicted 27% of the variance in QoL. CI was not significantly correlated with QoL and was not retained in the final model. Pain and functional limitation also did not meet inclusion criteria (P ≤.10) and were sequentially removed, producing a final model of QoL in terms of psychological distress (β = −0.28, P =.032), fatigue (β = −0.26, P =.048), and race (β = 0.21, P =.063). The lack of a significant correlation between degree of CI and self-reported QoL suggests that AL residents have the potential to experience high QoL, despite CI. Interventions to reduce psychological distress and manage fatigue could be implemented during EOL care to attempt to improve QoL for AL residents with CI. The correlation between race and QoL warrants investigation into possible racial disparities in AL and EOL care. [ABSTRACT FROM AUTHOR]

Objectives Assisted living (AL), a popular long-term care setting for older Americans, increasingly is a site for end-of-life care. Although most residents prefer AL to be their final home, relatively little is known about end-of-life preferences and advance care planning, especially among African American residents. Our research addresses this knowledge gap. Methods Informed by grounded theory, we present an analysis of qualitative data collected over 2 years in a 100-bed AL community catering to African American residents. Data consisted of field notes from participant observation conducted during 310 site visits and 818 observation hours, in-depth interviews with 25 residents, and a review of their AL records. Results Residents varied in their end-of-life preferences and advance care planning, but united in the belief that God was in control. We identified "Turning it over to God" as an explanatory framework for understanding how this group negotiated end-of-life preferences and advance care planning. Individual-level resident factors (e.g. age, pain, and function) and factors reflecting broader cultural and societal influences, including health literacy and care experiences, were influential. Discussion Contradictions arose from turning it over to God, including those between care preferences, planning, and anticipated or actual end-of-life outcomes. [ABSTRACT FROM AUTHOR]

Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and 38 direct care workers (DCWs) in 7 diverse settings. As assisted living administrators and DCWs experienced resident death, they engaged in a dynamic and individualized process of "managing the normalization of death," which refers to the balance of self-identity and workplace identity. The process of reconciling these opposing contexts in AL involved several individual- and community-level conditions. Administrators and DCWs would benefit from additional resources and training around death. Increasing collaboration with hospice and clarifying policies about death communication would better prepare the workforce to acknowledge the end of life in assisted living. • Assisted living is increasingly a site of end-of-life care, but it is not often openly discussed • Direct care workers provide important hands-on care at end of life. • Administrators and direct care workers regularly experience resident death in assisted living. • Administrators and direct care workers desire more resources and training around death and grief in assisted living. [ABSTRACT FROM AUTHOR]

The article focuses on the approach in developing a branding and marketing strategy to bolster the effectiveness of the 2019-2024 U.S. Health Resources and Services Administration (HRSA) Geriatric Workforce Enhancement Program (GWEP). Topics discussed include the names, logos and taglines proposed to established the program's identity, Brand identity, position and strategy, and the program's marketing strategy for its partners.

Background and Objectives Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to (a) identify residents' opportunities for, and experiences with, getting out; (b) understand the significance of getting out; and (c) explain influential factors. Research Design and Methods Guided by grounded theory methods, we analyzed qualitative data collected over a 1-year period in 4 diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review. Results We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of "working out" engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, care convoy-, assisted living community-, and neighborhood-level factors. Discussion and Implications We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention recommends PrEP (pre-exposure prophylaxis) for people who use drugs, yet uptake remains low. This study explores the acceptability and potential uptake of PrEP among participants in an opioid treatment program (OTP). We conducted 26 in-depth, semistructured interviews with staff and patients at an OTP in Baltimore, Maryland. Overall, participants felt that providing PrEP within the program would be beneficial, but they noted competing priorities among populations engaging in high-risk behaviors and lack of willingness among groups with lower risk behaviors. Participants reported several barriers to PrEP use among people who use drugs and who use medications for opioid use, including cost, competing priorities, stigma, and misconceptions about who should use PrEP. Facilitators to PrEP use were described as health benefits, trusted relationships with providers, and existing resources in the opioid treatment program. Practitioners should consider addressing barriers to access and stigma within an OTP setting for HIV prevention tools. [ABSTRACT FROM AUTHOR]

Objectives: In contrast to nursing homes, assisted living (AL) facilities emphasize independence and autonomy as part of their mission. However, we do not know to what extent this extends to sexual freedom and autonomy. Method: Using grounded theory methodology and symbolic interactionism, we examine how staff and administrators in AL facilities discuss residents' rights to sexual freedom and how this influences the environment of AL. Results: Staff and administrators engage in a contradictory discourse of residents' rights that simultaneously affirms the philosophy of AL while behaving in ways that create an environment of surveillance and undermine those rights. Discussion: A discourse of residents' rights masks a significant conflict between autonomy and protection in regards to sexual freedom in AL. [ABSTRACT FROM AUTHOR]

Background: Over the past 10 years, incidence of sexually transmitted infections (STIs) has increased to record numbers in the United States, with the most significant increases observed among adolescents and young adults. The US military, where the majority of active duty personnel are 18-30 years old, has seen similar increases. However, the US military does not yet have a standardized, service-wide program for STI education and prevention.Methods: The KISS intervention (Knocking out Infections through Safer-sex and Screening) was adapted from an evidence-based intervention endorsed by the US Centers for Disease Control and Prevention and consisted of a one-time, small group session. Content included STI/HIV knowledge and prevention, condom use skills, and interpersonal communication techniques. The intervention was pilot tested for feasibility and acceptability among a population of service members and medical beneficiaries at Joint Base Lewis-McChord in Washington state.Results: A total of 79 participants aged 18-30 years were consented to participate in the pilot study and met entry criteria, 66/79 (82.5%) attended the intervention session, and 46/66 (69.7%) returned at 3 months for the final follow-up assessment. The intervention sessions included 31 male (47.0%) and 35 female (53.0%) participants. Almost all participants felt comfortable discussing sexual issues in the group sessions, reported that they intended to practice safer sex after the intervention, and would also recommend the intervention to friends. Knowledge about STI/HIV prevention significantly increased after the intervention, and intervention effects were maintained at 3 months. About one-fifth of participants tested positive for N. gonorrhea or C. trachomatis infection at enrollment, while none had recurrent STIs at the final visit. Use of both male and female condoms increased after the intervention.Conclusions: The KISS intervention was feasible to implement in the military setting and was acceptable to the active duty service members and other medical beneficiaries who participated in the pilot project. Further studies are needed to determine if the KISS intervention, or others, effectively decrease STI incidence in active duty personnel and would be appropriate for more widespread implementation.Trial Registration: Retrospectively registered as the pilot phase of clinicaltrials.gov NCT04547413 , "Prospective Cohort Trial to Assess Acceptability and Efficacy of an Adapted STI/HIV Intervention Behavioral Intervention Program in a Population of US Army Personnel and Their Medical Beneficiaries-Execution Phase." [ABSTRACT FROM AUTHOR]

Public stigma surrounds individuals who use medication for their recovery from a substance use disorder. However, we know little about subgroups of individuals with varying levels of perceived stigma and how these levels may be associated with physical and mental health-related quality of life (HRQOL) and social support. We used latent class analysis to define subgroups of people aged 50–72 years of age (N = 104) who were enrolled in eight medication for opioid use disorder (MOUD) programs to explore subgroupings and correlates of group membership. We found evidence for three distinct classes of individuals and named the classes 1) the high stigma class, 2) the embarrassed class, and 3) the low stigma class. We found that people in the high-stigma class reported more rejection, more abstinence-based support group involvement, and reduced mental HRQOL. Results suggest reducing stigma among people on MOUD may help to boost mental HRQOL and improve social support receipt. The results are consistent with iatrogenic effects of AA/NA support groups such that these treatment modalities may increase stigma due to their focus on abstinence-only treatment for substance use disorders. • We found three distinct latent classes based on stigma: high, embarrassed, and low. • Rejection and low mental health-related quality of life (HRQOL) were associated with being in the high-stigma class. • Being in the high-stigma class was associated with abstinence-based support group attendance. [ABSTRACT FROM AUTHOR]

While there is a growing interest in conducting qualitative research in military settings, there are few published studies which provide strategies for working with this unique population. [Our program] has conducted 437 focus groups (n=3,160) between 2008 and 2014. Through our extensive field experience with this population, we have observed how the culture of rank, transient nature of military life, "voluntold" atmosphere, military language, and cohesive environment can impact the planning and implementation of focus groups with Service members. The aim of this article is to provide a brief overview of these aspects of military culture, provide our insight about working with military populations, and discuss strategies that may help others better execute qualitative methodologies, particularly focus groups, in the military context. [ABSTRACT FROM AUTHOR]