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Background and Purpose:The purpose of this study was to expand on the limited psychometric testing of the NPI-Q, and extend testing to include hospitalized older adults.Method:This was a descriptive study using data from 318 dyads in an ongoing cluster randomized clinical trial. Rasch analysis and hypothesis testing were done.Results:The majority of the participants were female (62%), non-Hispanic (98%), and black (50%) with a mean age of 81.62 (SD= 8.43). There was evidence of internal consistency and invariance across race and gender. The items fit with each subscale. Hypothesis testing was supported with a significant association between the NPI-Q and dementia and caregiver distress.Conclusions:The NPI-Q is short, easy to complete, and reliable and valid when used with hospitalized older adults.

Background and PurposeThe purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis.MethodsThis study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial.ResultsA total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions.ConclusionsFuture use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.

Background and PurposeLimited literature exists regarding the psychometric properties of the Patient-Reported Outcome Measurement Information System (PROMIS) Fatigue Short Form 8a. This study compared the psychometric properties of the 8a to the established PROMIS Fatigue Short Form 7a.MethodsThis was a cross-sectional study of 31 older adults with joint pain. Equivalent forms reliability and a Rasch analysis explored reliability (equivalent forms, internal consistency), validity (unidimensionality, item INFIT/OUTFIT), and additional psychometrics (item mapping).ResultsThe measures were equivalent in measuring fatigue (r = 0.75, p < .001) with good internal consistency (α = .87−.92). Both were unidimensional. Even though the 8a had better fitting items, neither measure could differentiate low levels of fatigue.ConclusionThe 8a has comparable psychometric properties to the 7a in this population. Future work is needed in larger, more diverse samples.

Background and PurposeThe Preparedness for Caregiving Scale (PCS) is a widely used instrument to measure caregiver preparedness. The purpose was to evaluate the PCS in African American and White caregivers of patients with dementia upon discharge from the hospital.MethodsFactor structure, measurement invariance, and predictive validity of the PCS were assessed in a sample of 292 family caregivers/patient dyads.ResultsOne-factor structure of the PCS and measurement invariance by race was fully supported. Predicative validity revealed significant association between the PCS and anxiety (β = −.41, t = −7.61(287), p < .001), depression (β = −.44, t = −8.39(287), p < .001), and strain (β = −.48, t = −9.29(287), p < .001).ConclusionThe PCS is a valid and meaningful tool to measure preparedness in African American and White family caregivers of persons with dementia during post-hospitalization transition.

Background and PurposeThe Cohen-Mansfield Agitation Inventory (CMAI) is a widely used measure of agitation. The purpose of this study was to test the internal consistency, reliability, and validity of short-form CMAI in a sample of nursing home residents with cognitive impairment and examine if it is invariant across gender.MethodsThis study utilized baseline data from a randomized trial including 553 residents from 55 nursing homes. Data was analyzed using structural equation modeling.ResultsConfirmatory factory analysis supported the three-factor structure including aggressive (α = .794), physically nonaggressive (α = .617), and verbally agitated (α = .718) behaviors. Invariance testing confirmed that the shortened measure is invariant across gender.ConclusionsFindings provide validity evidence of short-form CMAI to assess agitation and gender differences in agitation in nursing home population.

Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.

Background and Purpose: The purpose of this pilot study was to test the reliability and validity of the MotionWatch 8 with older adults. Methods: Participants wore the MotionWatch 8 for 3 days, completed a diary of activities and the Borg Rating of Perceived Exertion (RPE) scale. Results: Evidence of reliability and validity was supported because there was no difference in daily level of activity and that recorded physical activity matched the activity counts. There was a significant difference in Borg RPE scale scores between the sedentary group (Borg RPE scale = 8.6,SD= 3.0) and those with some level of activity (Borg RPE scale = 9.9,SD= 2.3;F= 5.72,p= .02). Conclusion: The findings provide preliminary support for the reliability and validity of the MotionWatch 8 when used with older adults.

Background and Purpose: The purpose of this study is to test the reliability and validity of the 3-item Useful Depression Screening Tool (UDST) for use with older adults in congregate living settings. Methods: There were 176 residents of senior housing or assisted living who completed the UDST. Rasch analysis and test criterion relationships with pain, physical activity, and depression diagnosis were used to determine validity. Test-retest reliability was conducted with 29 senior housing residents. Results: Rasch analysis demonstrated good fit of all items to the concept of depression. Criterion validity was supported, F(5) = 14.17, p Keywords: depression; usefulness; assisted living; older adultsDepression remains a major public health problem for older adults, affecting approximately 5% of community-dwelling older adults (Akincigil et al., 2011; Blazer, 2003) and up to 26% of older adults residing in assisted living facilities or congregate senior housing (Kozar-Westman, Troutman-Jordan, & Nies, 2013; Robison et al., 2009; Watson et al., 2006). Rates of minor depression, which is defined as clinically significant depressive symptoms for 2 weeks or longer that do not meet criteria for major depressive disorder, have been reported to be even higher among older adults at approximately 30% (Meeks, Vahia, Lavretsky, Kulkarni, & Jeste, 2011). The impact of minor depression is similar to what has been noted for older adults with major depressive disorder. Specifically, this includes increased prevalence of illness and disability, decreased quality of life, escalated health care use and cost expenditure, and increased mortality (Lyness, Chapman, McGriff, Drayer, & Duberstein, 2009; Lyness et al., 2007; Meeks et al., 2011).Brief screening tools for depression (two to three questions) such as the Patient Health Questionnaire 2-item (PHQ-2) have been developed to help identify those older adults who maybe experiencing depression. These brief tools assess for sadness and anhedonia and are simple, quick to administer, and practical when used in community settings (Kroenke, Spitzer, & Williams, 2003). In a large community sample of older adults, the PHQ-2 had a sensitivity of 100% (Li, Friedman, Conwell, & Fiscella, 2007). However, the sensitivity of the PHQ-2 decreases to 80% when used with a sample of older adults in assisted living/ residential care settings (Watson, Zimmerman, Cohen, & Dominik, 2009). Therefore, there is a risk that individuals with depressive symptoms may be missed when using the PHQ-2 with older adults in assisted living setting. Revisions to the measure may increase the utility of the tool and the ability of this measure to comprehensively capture depressive symptoms and risk for depression among assisted living residents. Inquiring about feelings of usefulness may be an important way to address this shortfall among older adults in congregate living settings.BACKGROUND: FEELINGS OF USEFULNESSThe desire to feel useful and valued by others is an important component of successful aging and contributes to the mental and physical health of older adults (Gruenewald, Karlamangla, Greendale, Singer, & Seeman, 2007). Aging-related declines in physical and/or cognitive abilities can lead to a change or decrease in activities and social roles (Adams, Roberts, & Cole, 2011; Reker, 1997). If an older adult is unable to adapt to these changes, it puts him or her at risk for decreased feelings of usefulness. More important, a decline in feelings of usefulness to others who are close to them, such as friends and family, may erode an older adults' perception of their importance or value, sense of belonging, and feelings of self-worth. …

The Person-Centered Hospital Discharge Program (PCHDP) was offered by the Centers for Medicare and Medicaid Services as a way to improve care to Medicare and Medicaid beneficiaries in Maryland. The PCHDP used a care nurse/coordinator to facilitate the successful transition of patients at risk for becoming eligible for Medicaid. The purpose of this study was to examine the outcomes of the PCHDP pilot, explore factors that influenced hospital and long-term care admissions following hospital discharge, and obtain operational data to develop new programs with related objectives. Area Agencies on Aging were provided with a care coordinator who obtained patient data, developed an individualized care plan, and determined visit frequency and length of services. Multivariate analysis of variance was conducted to examine differences between those hospitalized or admitted to a skilled nursing facility during the follow-up period. The sample consisted of 359 at-risk patients, and the mean length of follow-up was approximately two months. Most patients did not go to the emergency room (N = 319, 88%) during the period of follow-up and were not admitted to an acute care setting (N = 301, 84%) or skilled nursing home (N = 322, 86%). Those who were rehospitalized were slightly younger and had more visits from the care coordinator. We anticipate that the care coordinators identified individuals at greatest need for follow-up and support. Future research should explore ways in which these care coordinators can intervene to prevent hospital readmission and long-term nursing home care.

Background and Purpose: This study examines the underlying factor structure of the Self-Efficacy for Functional Abilities (SEFA) scale among older adults in long-term care settings. Methods: A secondary analysis of SEFA data for 568 residents in 16 long-term care facilities was applied. The sample was randomly split into 2 subsamples. A 2-level exploratory and confirmatory factor analysis adjusting for clustering effect of facilities was used to identify and determine the factor structures respectively. Results: There were 1- and 2-factor models that were identified. Both models demonstrated acceptably mixed model fit. The 2-factor model had poor discriminant validity with high correlation between factors (r = .92, p Keywords: factor analysis; long-term care; Self-Efficacy for Functional Abilities (SEFA) scale; older adultsThe ability to perform activities of daily living (ADLs) is the most basic function for older adults in long-term care settings, and decreased functional abilities has significant impact on health (Hjaltadottir, Hallberg, Ekwall, & Nyberg, 2011). Older adults demonstrate functional decline in performing various ADLs over time after admission to long-term care facilities (Carpenter, Hastie, Morris, Fries, & Ankri, 2006; Gillen, Spore, Mor, & Freiberger, 1996; Hjaltadottir, Hallberg, Ekwall, & Nyberg, 2012) and that functional decline is frequently beyond what is anticipated with aging-related deteriorations and various comorbidities (Wang, Kane, Eberly, Virnig, & Chang, 2009). Long-term care residents may experience risk of greater functional decline because of various personal and institutional factors. These factors included caregivers' perception that residents are unable to actively perform functional activities with or without assistance (Galik, Resnick, & Pretzer-Aboff, 2009), custodial care practice that focuses on task completion, which reinforces excessive dependence (Bowers, Esmond, & Jacobson, 2000), and institutional policies that restrict activities for safety reasons (Galik et al., 2009). It is imperative to evaluate residents' current confidence and motivation in doing ADLs so as to reduce excessive dependence and enhance autonomy in performing functional activities at appropriate time (Resnick, 1998b, 2000). Increased independence and participation in these activities not only improves and maintains function but also enhances physical and emotional health and quality of life (Galik et al., 2008; Resnick, Galik, Gruber-Baldini, & Zimmerman, 2009; Resnick, Gruber-Baldini, et al., 2009).The Self-Efficacy for Functional Abilities (SEFA) scale assesses individuals' confidence in doing daily functional activities. Previous studies that have used the SEFA scale employed the total score by summing up the responses of 11 items, instead of using the score of any single item or a subgroup of items, with the underlying assumption that the 11 items cluster together (Pretzer-Aboff, Galik, & Resnick, 2011; Resnick, Galik, et al., 2009; Resnick, Galik, Gruber-Baldini, & Zimmerman, 2011; Resnick, Gruber-Baldini, et al., 2009). Prior research also pointed out the need of continued testing of the scale to ensure that the items have a direct relationship with the latent variable of self-efficacy for functional abilities, indicating the need of factor analysis (Resnick, 2003). The purpose of this study is to examine the underlying factor structure of the 11 SEFA items among older adults in long-term care using factor analysis modeling approaches. We conducted two-level exploratory factor analysis (EFA) to identify initial empirical factor structures in one randomly selected half of the sample and then two-level confirmatory factor analysis (CFA) to evaluate the identified factor structures in the other half of sample. …

The purpose of this study was to consider the longitudinal changes in self-efficacy and outcome expectations for exercise and the impact of these variables on maintaining regular exercise over a 4-year period in a group of older adults living in a continuing care retirement community. There were 78 individuals who completed all four surveys. The participants had at least a high school education, and the majority were Caucasian (99%), female (83%) and either widowed or never married (80%). The mean age of the participants was 84.4 ± 5.1 years. Based on repeated measure analysis of covariance, controlling for mental and physical health, there was not a statistically significant difference in self-efficacy expectations (F = 2.0, p > .05) or outcome expectations (F = 2.2, p > .05) over time. There was a statistically significant decrease in exercise over time (F = 9.9, p < .05). Using path analysis it was demonstrated that self-efficacy expectations, outcome expectations, and physical health directly and indirectly influenced maintenance of regular exercise. Age, gender, and mental health had a limited and inconsistent influence on maintenance of exercise. Future research and clinical work should focus on developing and testing interventions that strengthen both self-efficacy and positive outcome expectations in older adults to facilitate maintenance of exercise behavior over time.

Older African Americans and Latinos tend to exercise less than older Whites and are more likely to have chronic diseases that could benefit from exercise. Measurement of self-efficacy of exercise and exercise outcome expectations in this older population is required if exercise is to be monitored carefully and enhanced in this population. The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise Scale (SEE) and Outcome Expectations for Exercise Scale (OEE) in a sample of African American and Latino older adults. A total of 166 individuals, 32 males (19%) and 134 females (81%) with an average age of 72.8 ± 8.4 years participated in the study. The SEE and OEE scales were completed using face-to-face interviews. There was evidence of internal consistency for both scales with alphas of .89 and .90 for the SEE scale and .72 and .88 for the OEE scale. There was some evidence of validity for both scales based on confirmatory factor analysis and hypothesis testing, because factor loadings were greater than .50 in all but two items in the OEE, and there were significant relationships between self-efficacy and outcome expectations and exercise behavior at all testing time-points. The measurement models showed a fair fit of the data to the models. The study provided some evidence for the reliability and validity of the SEE and OEE when used with minority older adults, and it provides some guidelines for future scale revisions and use.

The SF-12 Short Form Health Survey was developed to describe mental and physical health status of adults, and to measure the outcomes of health care services. The purpose of this study was to test the reliability and validity of this measure in a sample of 185 older adults living in a continuing care retirement community. The mean age of the participants was 86 + 6.1 and the majority were female (82%), unmarried (82%), Caucasian (99%), and all had at least a high school education. Initial testing of the SF-12 measurement model as proposed by Ware, Kosinski, and Keller (1995) demonstrated that the model did not fit the data (chi-squared/