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We are an interdisciplinary group of colleagues dedicated to partner engagement and team science. This influences our academic work, informs our research mentorship and capacity-building initiatives with junior scholars, conditions how we communicate with individuals outside of our disciplines, and makes lifelong learning a priority for ourselves and our trainees. Using the analogy of a seven-layer cake, this paper describes our capacity-building approach to develop, engage, and sustain research teams in a manner that aligns with health and risk communication principles. While preparing for a pandemic and engaging in team-based academic research may seem like apples and oranges, they both require the same key component throughout the process that we must encourage in our mentorship practices – effective communication. We provide concrete examples from our experiences on research teams that span decades and institutions. [ABSTRACT FROM AUTHOR]

Due to COVID-19, many schools switched to remote instruction, creating an urgency to address the technology needs of many families, including grandparent-headed families. Many grandparent-headed families (i.e., custodial grandparents) have limited access to digital devices and stable internet. Moreover, many of these grandparents lack the skills and confidence to use technology, which may affect both their grandchildren's ability to attend school as well as their academic performance. This study investigates both the associations of grandfamilies' access to technology and custodial grandparents' comfort level with technology with their grandchildren's academic attendance and performance during COVID-19. We analyzed cross-sectional survey data collected from grandparents raising grandchildren between March 2021 and February 2022 in the United States. Ordered logistic regression analyses were conducted using STATA. The key results suggested that grandfamilies' more stable access to technology (OR = 1.54, p = 0.048) and grandparents' high comfort level with technology (OR = 2.18, p = 0.003) during grandchildren's remote learning were significantly associated with higher odds of grandchildren's better school attendance. Similarly, more stable access to technology (OR = 1.53, p = 0.048) and higher comfort level with technology (OR = 1.67, p = 0.030) were significantly associated with higher odds of grandchildren's better academic performance. The results imply the need to provide stable internet and digital devices to grandfamilies without access to these services or devices, as well as technical assistance and technical-related education workshops to custodial grandparents who are not tech-savvy. [ABSTRACT FROM AUTHOR]

This study aims to examine the (a) prevalence of adverse childhood experiences (ACEs) among children in kinship care; (b) relationships between the number and type of ACEs and children's internalizing and externalizing problems; and (c) moderating role of kinship caregivers' mental health on the relationships between ACEs and children's internalizing and externalizing problems. A sample of children in kinship care (N = 224) obtained from the National Survey of Child and Adolescent Well-Being II was used. Ordinary least squares regression models were conducted. Results indicated that neglect followed by parental substance abuse were found to be the most prevalent of the ACEs. Child neglect, sexual and emotional abuse, and parental substance abuse were significantly associated with child internalizing problems, whereas sexual and emotional abuse were significantly associated with child externalizing problems. The total number of ACEs and experiencing three or more ACEs were significantly associated with child externalizing problems. Kinship caregivers' mental health significantly moderated the relationships between neglect, sexual abuse, and child internalizing problems. Caregiver's mental health also moderated the relationships between emotional and sexual abuse, neglect, and children's externalizing problems. Findings suggest the importance of addressing ACEs and the need for mental health services to both kinship caregivers and children in kinship care. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is associated with an increased maternal risk for the development of type 2 diabetes (T2DM). We previously demonstrated in a randomized trial that a web-based postpartum lifestyle intervention program, Balance After Baby, increased weight loss among postpartum women with recent pregnancies complicated by GDM. The aim of this analysis is to identify the impact of the intervention on study participants as assessed by exit interviews after completion of the 12 month study. We conducted structured exit interviews created with a concurrent-contextual design with subjects randomized to the intervention group at the conclusion of their participation (∼12 months) in the Balance After Baby study, with the objectives of 1) understanding the impact of the intervention on participants and their family members, 2) identifying which program components were most and least helpful, and 3) identifying the perceived best timing for diabetes prevention interventions in postpartum women with recent GDM. Seventy-nine percent (26/33) of eligible intervention participants participated in interviews. Participants noted changes in diet and physical activity as a result of the intervention. Several components of the intervention, particularly the online modules and support from the lifestyle coach, were perceived by intervention participants to have had a positive effect on personal and familial lifestyle change, while other components were less utilized, including the community forum, YMCA memberships, and pedometers. Nearly all participants felt that the timing in the intervention study, beginning about 6 weeks postpartum, was ideal. Results of this study identify the importance of individualized coaching, impact on family members, and demonstrate that postpartum women feel ready to make changes by 6 weeks postpartum. Findings from this study will help inform the development of future technologically-based lifestyle interventions for postpartum women with recent GDM. [ABSTRACT FROM AUTHOR]

The article illustrates a variety of strategies utilized by two research teams to recognize, detect and prevent survey bots which present as threats to online surveys. Topics covered include strategies that researchers can use to help further detect and isolate bot responses from valid human responses, case studies that have specific implications for researchers, and suggestions for researchers and institutional review boards (IRB) regarding what to include in IRB protocols.

This paper presents reflections on mentorship from scientists and mentors of the National Institute on Aging (NIA)-funded Carolina Center on Alzheimer's Disease and Minority Research (CCADMR). Using a network approach to mentoring, this program aims to increase the pipeline of underrepresented minority (URM) scientists studying Alzheimer's disease (AD) disparities. Six mentors and five scientists participated in interviews. Thematic analysis identified recurring themes; transcripts of mentors and scientists were compared. Most common thematic categories identified by mentors included experience interacting with scientists, goals as a mentor, recruitment of underrepresented minorities, scientists' challenges, and programmatic qualities. The most mentioned categories by scientists were challenges, seminars, working with mentors, career development, and project experience. The CCADMR will use findings to enhance the experience and training methods for future grant years. Results can benefit other training programs focused on aging and AD. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine the reliability and validity of the ADRQL instrument among older adults with cognitive impairment in mainland China. Three hundred older adults with cognitive impairment and their primary family caregivers from Wuhan participated in structured interviews. Cronbach's α and Kuder–Richardson Formula 20 were used to examine internal consistency reliability. Confirmatory factor analysis, Heterotrait-Monotrait ratios, and ordinary least square regression were used to assess the factorial validity, discriminant validity, and criterion validity. The ADRQL had acceptable reliability and validity, which can be used to assess overall quality of life for this population. [ABSTRACT FROM AUTHOR]

Grandparent kinship caregivers may experience increased parenting stress and mental distress during the COVID-19 pandemic. It may lead to risky parenting behaviors, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren. This study aims to examine (1) the relationships between parenting stress, mental health, and grandparent kinship caregivers' risky parenting practices, such as psychological aggression, corporal punishment, and neglectful behaviors towards their grandchildren during the COVID-19 pandemic, and (2) whether grandparent kinship caregivers' mental health is a potential mediator between parenting stress and caregivers' psychological aggression, corporal punishment, and neglectful behaviors. A cross-sectional survey among grandparent kinship caregivers (N = 362) was conducted in June 2020 in the United States. Descriptive analyses, negative binomial regression analyses, and mediation analyses were conducted using STATA 15.0. We found that (1) grandparent kinship caregivers' high parenting stress and low mental health were associated with more psychological aggression, corporal punishment, and neglectful parenting behaviors during COVID-19; and (2) grandparent kinship caregivers' mental health partially mediated the relationships between parenting stress and their psychological aggression, corporal punishment, and neglectful behaviors. Results suggest that decreasing grandparent kinship caregivers' parenting stress and improving their mental health are important for reducing child maltreatment risk during COVID-19. [ABSTRACT FROM AUTHOR]

COVID‐19 and its related policy measures have increased the psychological distress of individuals, including grandparent kinship caregivers. Guided by the Resilience Model of Family Stress, Adjustment, and Adaptation, this study examines relationships between material hardship, parenting stress, social support, resilience and psychological distress of grandparent kinship caregivers during the COVID‐19 pandemic, as well as the moderating role of kinship license status on these relationships. Kinship care licensing is a prerequisite to receiving financial assistance and other supporting services from the government. We administered a cross‐sectional survey of grandparent kinship caregivers (N = 362) in the United States. Logistic regression results indicated that material hardship was associated with higher odds of experiencing psychological distress, whereas resilience and social support were associated with lower odds. Kinship license status moderated the relationships of social support and resilience with psychological distress. Results suggest that additional emergency funds and more tailored financial services should be provided to meet material needs, and interventions with a focus on resilience and social support are particularly needed. The moderating effects of license status indicate that some interventions should be specifically implemented among licensed kinship caregivers, whereas parallel services should be provided to kinship caregivers regardless of their license status. [ABSTRACT FROM AUTHOR]

Children in foster care face disproportionate rates of biopsychosocial challenges but social and extracurricular activities (SEAs) may support their healthy development. The Reasonable and Prudent Parenting Standard (RPPS), a 2014 federal policy, aims to increase access to these opportunities for children in foster care. Analyses of statutes from 50 US states and the District of Columbia (n = 51) revealed similarities and differences in state-level RPPS policy implementation. Building on these findings, researchers conducted semi-structured retrospective telephone interviews with foster parents across one southeastern state (n = 20) to identify local retrospective perspectives on RPPS implementation. Using thematic inductive coding two unique themes emerged about SEAs prior to RPPS: 1) negative social impacts and 2) complicated activity approval processes. Three unique themes emerged after RPPS: 1) empowerment, 2) implementation disparities and 3) resource recommendations. Policy implications include the need to support foster parents by increasing resources (funding, transportation, access), clarifying liability and clarifying motivation expectations. [ABSTRACT FROM AUTHOR]

Background and Objective Sexually transmitted diseases (STDs) are increasing among older adults concomitant with a rise in divorce after the age of 50 years. The objective of this study was to examine the effectiveness of a web-based human immunodeficiency virus (HIV)/STD risk reduction intervention for divorced and separated women aged more than 50 years. Research Design and Methods Two hundred nineteen divorced or separated women, aged 50 years and older, participated in 60-day randomized pre–post control group study. Recruitment occurred via health agencies in Boston and Columbia, SC, and Craigslist advertisements placed in Boston, Columbia, Charleston, New York City, Washington DC, Baltimore, Chicago, Atlanta, Orlando, and Miami. Results Intervention group reported greater intention to practice safe sex compared to the control group (B =.55, p =.03). Intention to practice safe sex differed by perceived stress (B =.15, p =.005), with no difference between control and intervention groups for those with low levels of stress. For high levels of stress, intervention group reported greater intention to practice safe sex compared to controls. Sexual risk was reduced by 6.10 points (SD : 1.10), and self-efficacy for sexual discussion was increased by 2.65 points (SD : 0.56) in the intervention group. Discussion and Implications A web-based intervention represents a promising tool to reduce HIV/STD risk among older women. Offering HIV/STD education in the context of other topics of interest to at-risk older women, such as divorce, may solve the problem of at-risk older women not seeking out prevention information due to lack of awareness of their heightened risk. [ABSTRACT FROM AUTHOR]

Background: To reduce cardiovascular disease (CVD) risk, we tested an online intervention to improve healthy lifestyle for women with recent preeclampsia. Materials and Methods: We conducted a randomized controlled 9-month clinical trial, Heart Health 4 Moms (HH4M), among 151 U.S. women with preeclampsia within 5 years. Sample size was planned to detect differences of 0.5 standard deviation units in primary outcomes between study arms. Preeclampsia history was validated by medical records; women with chronic hypertension were excluded. The intervention included online educational modules, a community forum, and communication with a lifestyle coach. The control group received internet links to CVD risk reduction information. Primary outcomes were self-efficacy to eat a healthy diet and increase physical activity; change in physical in/activity; adherence to the Dietary Approaches to Stop Hypertension (DASH) diet; and knowledge of and personal control over CVD risk. Secondary outcomes were weight and blood pressure. Results: In the intervention arm, 84% of participants accessed at least one online educational module; 89% completed at least three scheduled calls with the coach. At 9 months, intervention participants reported significantly greater knowledge of CVD risk factors (corrected p = 0.01), increased self-efficacy for healthy eating (p = 0.03), and less physical inactivity than controls (p = 0.0006). The groups did not differ in sense of personal control of CVD risk factors, adherence to the DASH diet, self-efficacy for physical activity, or reported physical activity. There were no differences in secondary outcomes between groups. Conclusions: The HH4M program improved CVD risk knowledge, self-efficacy to achieve a healthy diet, and reduced physical inactivity among women with recent preeclampsia. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy (ART) is the primary treatment for HIV, and adherence to it is crucial to addressing health disparities. Approximately half of individuals in the United States living with HIV are African Americans, and those over 45 years of age are more likely to die early from HIV/AIDS than their White counterparts. This mixedmethod pilot study evaluated the feasibility of a text-based mobile phone intervention designed to improve ART adherence among older African Americans with HIV. Feasibility was assessed via implementation, participant adherence, acceptability, and satisfaction, as well as short-term impact on medication adherence, adherence-related self-efficacy, and positive affect. The intervention utilized pill reminder, motivational, and health educational texts. Participants (N = 21) ranged in age from 50 to 68 years. Outcomes were evaluated via quantitative results from self-report measures and qualitative data from four focus groups. There was no attrition in participation. After 8 weeks, participants reported statistically significant improvements in medication adherence, but not in self-efficacy or affect scores. Qualitative findings highlight the psychologically supportive potential of the intervention, challenges to adherence, as well as suggestions for improvement. The study demonstrates that a text messaging intervention may be feasible for older African Americans with HIV, and helpful in supporting ART adherence. [ABSTRACT FROM AUTHOR]

Background: Screening older veterans in Veterans Affairs Medical Center (VAMC) primary care clinics for risky drinking facilitates early identification and referral to treatment.Objective: This study compared two behavioral health models, integrated care (a standardized brief alcohol intervention co-located in primary care clinics) and enhanced referral care (referral to specialty mental health or substance abuse clinics), for reducing risky drinking among older male VAMC primary care patients. VAMC variation was also examined.Method: A secondary analysis of longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study, a multisite randomized controlled trial, was conducted with a sample of older male veterans (n = 438) who screened positive for risky drinking and were randomly assigned to integrated or enhanced referral care at five VAMCs.Results: Generalized estimating equations revealed no differences in either behavioral health model for reducing risky drinking at a 6-month follow-up (AOR: 1.46; 95% CI: 0.42-5.07). Older veterans seen at a VAMC providing geriatric primary care and geriatric evaluation and management teams had lower odds of risky drinking (AOR: 0.24; 95% CI: 0.07-0.81) than those seen at a VAMC without geriatric primary care services.Conclusions: Both integrated and enhanced referral care reduced risky drinking among older male veterans. However, VAMCs providing integrated behavioral health and geriatric specialty care may be more effective in reducing risky drinking than those without these services. Integrating behavioral health into geriatric primary care may be an effective public health approach for reducing risky drinking among older veterans. [ABSTRACT FROM AUTHOR]

Community–academic partnerships have a long history of support from public health researchers and practitioners as an effective way to advance research and solutions to issues that are of concern to communities and their citizens. Data on the development and evaluation of partnerships focused on healthy aging and cognitive health were limited. The purpose of this article is to examine how community partners view the benefits and barriers of a community–academic partner group established to support activities of the South Carolina Healthy Brain Research Network (SC-HBRN). The SC-HBRN is part of the national Healthy Brain Research Network, a thematic research network funded by the Centers for Disease Control and Prevention (CDC). It is focused on improving the scientific and research translation agenda on cognitive health and healthy aging. Semistructured interviews, conducted at end of Year 2 of the 5-year partnership, were used to collect data from partners of the SC-HBRN. Reported benefits of the partnership were information sharing and networking, reaching a broader audience, and humanizing research. When asked to describe what they perceived as barriers to the collaborative, partners described some lack of clarity regarding goals of the network and opportunities to contribute to the partnership. Study results can guide and strengthen other public health-focused partnerships. [ABSTRACT FROM AUTHOR]

Objective: Women with prior preeclampsia are at increased risk of cardiovascular disease (CVD). This study investigated barriers and facilitators toward learning about this link and engaging in lifestyle modifications to reduce this risk.Methods: Four focus groups were held with 14 women within 6 months of a preeclamptic pregnancy.Results: Participants were unaware of the link between preeclampsia and CVD, suggested improvements to provider-patient communication, and discussed the benefits of social support and online tracking (weight, blood pressure) in making lifestyle modifications.Conclusions: Solutions offered may improve efforts to modify lifestyle and communication between providers and women about this link. [ABSTRACT FROM AUTHOR]

The article presents research on intervention development with Latina women with type 2 diabetes. The study used focus groups to elicit from participants receiving care at the Joslin Diabetes Center in Boston, Massachusetts their concept of ideal body aesthetics and how this affect their health decisions. It examines the implications of findings on the more likely preferred body image of these Latinas in the design of diabetes intervention that would be culturally sensitive.

Objective: Low perceived risk for type 2 diabetes (T2DM) may be a barrier to lifestyle change in women with recent gestational diabetes (GDM). We assessed perceived risk for T2DM at delivery and postpartum. Methods: We used a validated diabetes risk perception instrument to survey women with GDM at delivery and postpartum. We compared women with low perceived risk for T2DM at delivery to those with high perceived risk. Results: The majority ( N = 43 of 70, 61%) perceived high risk at delivery. Women who perceived low risk were younger (30.76.3 versus 35.04.5 years, p = 0.003) than women who perceived high risk. Although knowledge of risk factors for T2DM was poor (mean 6.01.9, of 11 points), 95% correctly identified GDM as a risk factor. Perceived risk was maintained in most ( N = 51 of 58, 88%) who returned for their postpartum visit. Low perceived risk was not associated with loss to follow up, however correct identification of GDM as a risk factor was protective (OR 0.05, 95% CI 0.005, 0.56). Conclusions: Risk perception is accurate in most women with GDM at delivery and postpartum. Further study is needed to translate perceived risk into preventive behaviors in women with recent GDM. [ABSTRACT FROM AUTHOR]

Background A history of preeclampsia is a risk factor for the future development of hypertension and cardiovascular disease (CVD). The objective of this study was to assess, in women with prior preeclampsia, the level of knowledge regarding the link between preeclampsia and CVD, motivators for and barriers to lifestyle change and interest in a lifestyle modification program to decrease CVD risk following a pregnancy complicated by preeclampsia. Methods Twenty women with a history of preeclampsia participated in 5 phone-based focus groups. Focus groups were recorded, transcribed, and analyzed. Qualitative content analysis was used to identify common themes across focus groups. Consensus was reached on a representative set of themes describing the data. Results Women with prior preeclampsia were in general unaware of the link between preeclampsia and future CVD but eager to learn about this link and motivated to achieve a healthy lifestyle. Major perceived barriers to lifestyle change were lack of time, cost of healthy foods and family responsibilities. Perceived facilitators included knowledge of the link between preeclampsia and CVD, a desire to stay healthy, and creating a healthy home for their children. Women with prior preeclampsia were interested in the idea of a web-based program focused on lifestyle strategies to decrease CVD risk in women. Conclusions Women with prior preeclampsia were eager to learn about the link between preeclampsia and CVD and to take steps to reduce CVD risk. A web-based program to help women with prior preeclampsia adopt a healthy lifestyle may be an appropriate strategy for this population. [ABSTRACT FROM AUTHOR]

Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population. Cross-sectional screening assessments during a multisite trial for the treatment of depression, anxiety, and at-risk drinking. Department of Veterans Affairs (VA)-based primary care clinics across the United States. Seventeen thousand two hundred five veterans aged 65 and older. Sociodemographic information, the General Health Questionnaire (GHQ-12), questions about death wishes and suicidal ideation, quantity and frequency of alcohol use, smoking, exposure to traumatic events, and PTSD symptom clusters. Twelve percent (2,041/17,205) of participants screened endorsed PTSD symptoms. Veterans with PTSD symptoms from some ( partial PTSD) or each ( PTSD all clusters) of the symptom clusters were significantly more likely to report poor general health, currently smoke, be divorced, report little or no social support, and have a higher prevalence of mental distress, death wishes, and suicidal ideation than those with no trauma history or those with trauma but no symptoms. Group differences were most pronounced for mental distress and least for at-risk drinking. Presence of PTSD all clusters was associated with poorer outcomes on all of the above-mentioned health characteristics than partial PTSD. PTSD symptoms are common in a substantial minority of older veterans in primary care, and careful inquiry about these symptoms is important for comprehensive assessment in geriatric populations. [ABSTRACT FROM AUTHOR]

Background: Women who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program. Methods: We used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews. Results: Of 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach. Conclusion: Time constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM. Trial Registration: ClinicalTrials.gov: NCT01102530 [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue including one about the provision of care for people with dementia and other severe illnesses in China, another on a study about Chinese women caring for older family members with dementia and living in the San Francisco Bay Area and one about dementia care in China.

OBJECTIVES: To determine whether patients who developed delirium after cardiac surgery were at risk of functional decline. DESIGN: Prospective cohort study. SETTING: Two academic hospitals and a Veterans Affairs Medical Center. PARTICIPANTS: One hundred ninety patients aged 60 and older undergoing elective or urgent cardiac surgery. MEASUREMENTS: Delirium was assessed daily and was diagnosed according to the Confusion Assessment Method. Before surgery and 1 and 12 months postoperatively, patients were assessed for function using the instrumental activities of daily living (IADL) scale. Functional decline was defined as a decrease in ability to perform one IADL at follow-up. RESULTS: Delirium occurred in 43.1% (n=82) of the patients (mean age 73.7±6.7). Functional decline occurred in 36.3% (n=65/179) at 1 month and in 14.6% (n=26/178) at 12 months. Delirium was associated with greater risk of functional decline at 1 month (relative risk (RR)=1.9, 95% confidence interval (CI)=1.3–2.8) and tended toward greater risk at 12 months (RR=1.9, 95% CI=0.9–3.8). After adjustment for age, cognition, comorbidity, and baseline function, delirium remained significantly associated with functional decline at 1 month (adjusted RR=1.8, 95% CI=1.2–2.6) but not at 12 months (adjusted RR=1.5, 95% CI=0.6–3.3). CONCLUSION: Delirium was independently associated with functional decline at 1 month and had a trend toward association at 12 months. These findings provide justification for intervention trials to evaluate whether delirium prevention or treatment strategies might improve postoperative functional recovery. [ABSTRACT FROM AUTHOR]

Native-born Chinese women’s experiences with medical help seeking in the U.S. is poorly understood, including how life phase affects it. Focus groups with middle-aged and older immigrant Chinese women explored: a) behaving assertively with doctors, b) strategies for assertiveness, c) characteristics of “ideal” doctors. Assertiveness was described as a reciprocal behavioral process between patient and doctor. Responsibility for initiating the process was seen as resting with doctors. Patient assertiveness goals included obtaining information and referrals. Strategies for achieving goals included not mentioning low-priority medical concerns in order to increase odds of obtaining referrals, and switching doctors when dissatisfied with communication. Older women reported refusing medical treatment due to language barriers. Cultural values, reported to be rooted in Confucianism, were identified by participants as shaping their help seeking. “Ideal” doctors were described as unhurried, and fully responsive to patient symptoms. Older women viewed “direct speaking” by doctors as always desirable around general information, and sometimes desirable around serious diagnoses. Older women perceived cultural differences with American-born Chinese providers. Findings are discussed in relation to continuity of care issues. [ABSTRACT FROM AUTHOR]

Anxiety and depression are common psychiatric disorders affecting older persons. To explore the relationships between these disorders and client characteristics, we examined data from the baseline phase of PRISM-E, a multisite randomized trial comparing two models of service delivery for older persons aged 65 and over identified in primary care settings with depression, anxiety, and/or at-risk drinking. Clinical characteristics, functioning and service use were compared across five diagnostic groups of study participants ( n = 1,763; mean age = 73.8 ± 6.3 years, 71% male) with (1) anxiety only ( n = 82), (2) minor/other depression ( n = 502), (3) major depression ( n = 700), (4) mixed minor/other depression and anxiety ( n = 121), and (5) mixed major depression and anxiety ( n = 358). Increasing functional problems and use of services were found across the five diagnostic subgroups, corresponding to a gradient of increasing severity for health status, number of medical disorders, SF-36 mental component score, suicidal or death ideation, and number of hospital stays, emergency room visits, and outpatient medical visits. Multivariate analyses controlling for site, demographic variables, and clinical characteristics confirmed the observed clinical severity gradient. Anxiety alone and anxiety comorbid with depression represent the two extremes of the severity gradient from the least to the most complicated and severe clinical presentations. Primary care clinicians identifying anxiety disorders in older persons should also screen for depression due to the relative infrequency of anxiety disorder alone and the significant clinical implications of co-occurring anxiety and depression. [ABSTRACT FROM AUTHOR]

Few studies have examined how medical professionals, i.e. “caregiving experts,” approach caregiving when called upon to provide it for someone in their own families. Expert strategies are sought in problem-solving research, and may be of similar benefit in the field of caregiving research. Thus, we report data from a focus group with middle-aged, registered nurses about their experiences providing care for an elderly, chronically-ill parent. Questions centered on: (i) key caregiving tasks performed by nurses for elderly parents (ii) obstacles to performing caregiving tasks, (iii) strategies used to overcome obstacles. Participants reported serving primarily as health educators and patient advocates for elderly parents. They advocated in an assertive manner, while simultaneously framing the need for patient assertiveness as an unfair burden placed on patients by the rushed managed care climate. This climate was viewed as placing elderly parents at risk, and interfering with good nursing practices. In serving as health educators for parents, participants linked the need to do so to inadequate health education provided by doctors and/or parents’ passivity in seeking health information. Health education provided to elderly parents centered on diabetes care, the seriousness of which participants believed diabetic parents did not grasp. Participants bemoaned passivity around health perceived in members of their parent’s generation, and encouraged parents to adopt a consumerist approach to medical help seeking. Key caregiver strategies for supporting elderly parents’ health included being impervious to doctor resistance when seeking medical help for parents; encouraging parents to act as healthcare consumers; and ensuring that elderly parents understood their own medical histories. Findings are discussed in terms of caregiving and eldercare program implications. [ABSTRACT FROM AUTHOR]

Few consumer health websites target low-literate and/or non-English speaking patient populations, despite the fact that these populations are most vulnerable to poor health outcomes. Latinos providing care to a family member with Alzheimer’s disease and related dementias (ADRD) fall within this vulnerable population in that they face numerous language, literacy, and cultural barriers to accessing and using health and social services. As a result, Latino family caregivers tend to suffer greater morbidity due to stress burden than ADRD caregivers in Anglo American, English-speaking families. Moreover, distance and other convenience barriers prevent family caregivers across ethnic groups from utilizing health and support services. The internet represents a promising tool for eliminating barriers to education and service use among family caregivers. In particular, using the internet to reach Latino caregivers, who are most at-risk for stress-related morbidity, could represent a breakthrough means for reducing health disparities in this group. In this paper, we report our efforts to develop a “plain language” bilingual website to educate and support Latino family caregivers. We review our website design process, preliminary evaluation study findings, and future directions for web-based education for under-served Latino family caregivers. [ABSTRACT FROM AUTHOR]

Background. Delirium has been hypothesized to be a central nervous system response to systemic inflammation during a state of blood--brain barrier compromise. The purpose of this study was to compare postoperative changes in groups of inflammatory markers in persons who developed delirium following cardiac surgery and matched controls without delirium. Methods. Serum samples were drawn from 42 patients undergoing cardiac surgery preoperatively and postoperatively at 6 hours and postoperative day 4. The serum concentrations of 28 inflammatory markers were determined with a microsphere flow cytometer. A priori, inflammatory markers were assigned to five classes of cytokines. A class z score was calculated by averaging the standardized, normalized levels of the markers in each class. Beginning on postoperative day 2, patients underwent a daily delirium assessment. Results. Twelve patients with delirium were matched by surgical duration, age, and baseline cognition to 12 patients without delirium. At the 6-hour time point, patients who went on to develop delirium had higher increases of chemokines compared to matched controls (class z score 0.3 ± 1.0, p < .05). Among the five classes of cytokines, there were no other significant differences between patients with or without delirium at either the 6 hour or postoperative day 4 assessments. Conclusion. After cardiac surgery, chemokine levels were elevated in patients who developed delirium in the early postoperative period. Because chemokines are capable of disrupting blood-brain barrier integrity in vitro, future studies are needed to define the relationship of these inflammatory mediators to delirium pathogenesis. [ABSTRACT FROM AUTHOR]

Objectives This study focuses on examining the relations of religious participation and affiliation to mental health status among older primary care patients, and to the use and clinical outcomes of mental health services. Methods A sample of older adults participating in a clinical study (PRISM-E) to treat their depression with or without co-morbid anxiety (n = 1610) were queried about their religious affiliation and the frequency of their participation in religious activities. The diagnoses of depressive and anxiety disorders were made based on the MINI-International Neuropsychiatric Interview. Severity of depressive disorders was assessed by emotional distress using the CES-D. Results Those attending religious activities on a weekly, monthly, or occasional basis were significantly less likely to have suicidal ideation (p < 0.02) and emotional distress (p < 0.0001) than those who never participated or participated on a less frequent basis. Frequency of religious participation was not associated with mental health service utilization (p = 0.16), but it was predictive of a lower CES-D score at the end of the study intervention (p < 0.001). Conclusions Religious participation is positively associated with older adults' mental health status and treatment effects, but results regarding mental health service utilization were inconclusive. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article focuses on a study entitled Primary Care Research in Substance Abuse and Mental Health for the Elderly, which examined six-month outcomes for older primary care patients with depression who had undergone different models of treatment. Clinical outcomes were compared among patients who were randomly assigned to enhanced specialty referral (ESR). The reduction in symptom severity was superior for those randomly assigned to the ESR group in the subgroup with major depression.

OBJECTIVES: To determine the extent to which preoperative performance on tests of executive function and memory was associated with delirium after coronary artery bypass graft (CABG) surgery. DESIGN: Prospective observational cohort study. SETTING: Two academic medical centers and one Department of Veterans Affairs medical center in Massachusetts. PARTICIPANTS: Eighty subjects without preoperative delirium undergoing CABG or CABG-valve surgery completed baseline neuropsychological assessments with validated measures of memory and executive function. MEASUREMENTS: Beginning on postoperative Day 2, a battery to diagnose delirium was administered daily. Confirmatory factor analysis (CFA) was used to define two cognitive domain composites (memory and executive function). The loading pattern of neuropsychological measures onto the latent cognitive domains was determined a priori. Poisson regression was used to model the association between neuropsychological performance and cognitive domain composite scores and risk of postoperative delirium. The association was expressed as the difference between impaired (0.5 standard deviations (SDs) below mean) and nonimpaired (0.5 SDs above mean) performers. RESULTS: Forty subjects (50%) developed delirium. Measures of memory function were not significantly related to delirium. Of the executive function measures, verbal fluency, category fluency, Hopkins Verbal Learning Test learning, and backward recounting of days and months were significantly related to delirium. Preoperative mental status was a strong predictor of postoperative delirium. After controlling for age, sex, education, medical comorbidity, mental status, and the other cognitive domain, CFA cognitive domain composites suggest that risk for delirium is specific for executive functioning impairment (relative risk (RR) = 2.77, 95% confidence interval (CI) = 1.12–6.87) but not for memory impairment (RR = 0.49, 95% CI = 0.19–1.25). CONCLUSION: Worse preoperative performance in executive function was independently associated with greater risk of developing delirium after CABG. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges of ageism in the minority populations in the United States. It is estimated that by 2050, one in four people of 65 and more age will be of minority descent in the country. It reflects that the recent rapid growth rates of the older minority population demands research on the issue of ageism in this population. It informs about the under-explored phenomenon of the dangers related to the growing older populations of minority descent. They face greater disadvantages in socioeconomic status, health status and life expectancy compared to those who are younger and white and compared to those people who are in the same age group but white. The article also reflects on the relationship between ageism and the health-related disparities that exist for older minority populations as compared to older non-minority populations. It reviews how older minorities overcome some common stereotypes that potentially limit their access to a better quality of life.

Understanding variability in conceptions of dementia in multiethnic populations is important to improve care and guide research. The objectives of this study were to describe caregiver conceptions of dementia using a previously developed typology and to examine the correlates of conceptions of dementia in a multiethnic sample. This is a cross-sectional study conducted in Boston and the San Francisco Bay area. Participants were a convenience sample of 92 family dementia caregivers from four ethnic/racial groups: African-American, Anglo European-American, Asian-American, and Latino. In-depth, qualitative interviews explored the caregivers' ideas about the nature and cause of dementia (i.e., explanatory models). Explanatory models of caregivers were categorized as biomedical, folk, or mixed (folk/biomedical). Quantitative analyses examined the association between ethnicity and other caregiver characteristics, and explanatory model type. Overall, 54% of caregivers, including 41% of Anglo European Americans, held explanatory models that combined folk and biomedical elements (i.e., mixed models). For example, many families attributed Alzheimer's disease and related dementias to psychosocial stress or normal aging. Ethnicity, lower education, and sex were associated with explanatory model type in bivariate analyses. In multiple logistic regression analysis, minority caregivers ( P<.02) and those with less formal education ( P<.02) were more likely to hold mixed or folk models of dementia. Although minority and nonminority caregivers often incorporated folk models into their understanding of dementia, this was more common in minority caregivers and those with less formal education. Further research on cross-ethnic differences in a larger, more-representative sample is needed. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to deter- mine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. Method: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N= 70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/sub- stance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1 ,023). Results: Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Conclusions: Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown that integrated behavioral health services for older adults in primary care improves health outcomes. No study, however, has asked the opinions of clinicians whose patients actually experienced integrated rather than enhanced referral care for depression and other conditions.Method: The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings across the United States. Primary care clinicians at each participating site were asked whether integrated or enhanced referral care was preferred across a variety of components of care. Managers also completed questionnaires related to the process of care at each site.Results: Almost all primary care clinicians (n = 127) stated that integrated care led to better communication between primary care clinicians and mental health specialists (93%), less stigma for patients (93%), and better coordination of mental and physical care (92%). Fewer thought that integrated care led to better management of depression (64%), anxiety (76%), or alcohol problems (66%). At sites in which the clinicians were rated as participating in mental health care, integrated care was highly rated as improving communication between specialists in mental health and primary care.Conclusions: Among primary care clinicians who cared for patients that received integrated care or enhanced referral care, integrated care was preferred for many aspects of mental health care. [ABSTRACT FROM AUTHOR]

Objective: To describe the design of the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study and baseline characteristics of the randomized primary care patients with mental health problems and at-risk alcohol use. Method: Adults aged 65 and older were screened at primary care clinics from 10 study sites throughout the United States. Those diagnosed for depression, anxiety, and/or at-risk alcohol consumption were randomized to either integrated or enhanced referral care. Results: Of the 23,828 participants, 14% had a positive assessment for depressive and/or anxiety disorders, and 6% had at-risk alcohol consumption diagnoses. Among patients with mental health diagnoses, there was a higher preponderance of younger ages, women, and ethnic minorities. Among patients with at-risk drinking, there was a higher preponderance of younger ages, Whites, and men. Discussion: These findings indicate the need for screening in primary care and for engaging older adults in treatment. [ABSTRACT FROM AUTHOR]

We present the evaluation of a pilot videotape training program for older African American women in constructive conflict resolution. The program was developed because research shows: (a) older African American women suffer disproportionately from hypertension, (b) hypertension is linked to anger inhibition, and (c) older African American women tend to inhibit their anger in interpersonal conflict. Community-dwelling and institutionalized older women participated in the training. Evaluation findings indicate that the training led to increased knowledge of health-promoting skills for handling conflict, and that providing a brief group intervention in a familiar, non-stigmatizing setting may be an effective means of mental health promotion for older African American women. [ABSTRACT FROM PUBLISHER]

Dementia is a major concern in serving the older population. Understanding it has become essential to the curriculum in geriatrics education in Japan. Given the untreatable nature of the disease, the goal of care is often to maximize independence of dementia-impaired elders in community-based long-term care settings by preventing disabilities caused by an excess of care that might exacerbate the symptoms of dementia. To prepare future front-line health professionals who will work in the allied health professions, we provided students from three associate degree colleges in Japan with a two-week summer institute at Harvard Medical School which trains them to become dementia specialists. The training experience increased participants' knowledge and interests in dementia care. Implications of these training efforts for future interdisciplinary care for dementia are discussed. [ABSTRACT FROM PUBLISHER]

Older African American women are at high risk for morbidity due to anger suppression and stress. Yet sources of everyday stress and conflict in the lives of older African American women have not been documented. Such information is essential for developing health promotion programs. A focus group study was conducted with older African American women on everyday stress and conflict. Everyday stress stemmed from worries about functional disability and about accessing transportation. Everyday conflicts occurred with adult children, teen-aged grandchildren, and older neighbors or peers. Conflicts with adult children centered on how the adult child was raising his/her children. Conflicts with grandchildren centered on social respect. Conflicts with neighbors/peers centered on perceived rudeness or past transgressions. Participant strategies for dealing with stress and conflict tended to be avoidant. A training program in constructive conflict strategies for older African American women is presented that draws on information gained in the focus groups. [ABSTRACT FROM AUTHOR]

With rapidly growing concerns about the high rates of dementing illness in Korea, this study presents findings from in-depth qualitative interviews with fifteen family caregivers and health professionals on: (1) perceptions of dementia among Korean family caregivers, (2) cultural influences on caregiving, and (3) status of the development and utilization of formal services for the older population with dementia in Korea. Practices of the traditional familism are demonstrated in the multigenerational family where both material support and respect for the aged are the social norm. Thus, providing informal care for a demented parent is expected in the context of fulfilling filial responsibilities. In assessing the current situation in Korea, there is a lack of social services established by the Korean government for the older individuals, which can be attributed to the norm of parental caregiving. This cultural influence poses significant challenges to Korean caregivers of dementia-impaired elders. [ABSTRACT FROM AUTHOR]