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Objective To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. Design Single-blind randomized clinical trial. Setting Eight post-acute care (PAC) facilities. Participants Community-dwelling older adults with dementia and delirium (N = 283). Intervention Research staff provided cognitively stimulating activities daily for up to 30 days. Measurements Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). Results Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6–70.1; control: 68.7%, 95% CI = 63.9–73.6; P = .37, Wilcoxon rank sum test) and delirium severity (range 0–39: intervention: 10.77, 95% CI = 10.10–11.45; control: 11.15, 95% CI = 10.50–11.80; difference 0.37, 95% CI = 0.56–1.31, P = .43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0–15): intervention: 6.58, 95% CI = 6.12–7.04; control: 5.89, 95% CI = 5.45–6.33; difference −0.69, 95% CI = 1.33 to −0.06, P = .03; constructional praxis (range 0–15): intervention: 8.84, 95% CI = 8.83–9.34; control: 7.53, 95% CI = 7.04–8.01; difference −1.31, 95% CI = 2.01 to −0.61, P < .001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P = .01, negative binomial regression). Conclusion Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.

Across midlife and into old age, older adults often report lower levels of negative affect and similar if not higher levels of positive affect than relatively younger adults. Researchers have offered a simple explanation for this result: Age is related to reductions in stressors and increases in pleasurable activities that result in higher levels of well-being. The current study examines subjective reports of emotional experience assessed across 8 days in a large sample of adults (N = 2,022) ranging from 35 to 84 years old. By modeling age differences before and after adjusting for daily positive uplifts and negative stressors, this article assesses the extent to which daily events account for age differences in positive and negative affect reports. Consistent with previous research, the authors found that older age is related to lower mean levels and shorter duration of a negative emotional experience in a model only adjusting for gender, education, and ethnicity. After adjusting for daily events, however, the linear age-related effects were no longer significant. For positive affect, adjusting for daily events did not alter age-related patterns of experiencing higher mean levels and longer positive experience duration, suggesting that other factors underlie age-related increases in positive affect. (PsycINFO Database Record

Despite the prominence of time in influential aging theories and the ubiquity of stress across the life span, research addressing how time perspective (TP) and adversity are associated with well-being across adulthood is rare. Examining the role of TP in coping with life events over the life span would be best accomplished after large-scale population-based exposure to a specific event, with repeated assessments to examine within- and between-person differences over time. A national sample aged 18-91 years (N = 722, M = 49.4 years) was followed for 3 years after the September 11, 2001 (9/11) terrorist attacks. Respondents completed assessments of 9/11-related television (TV) exposure 9-21 days after the attacks, temporal disintegration 2 months post-9/11, and TP, ongoing stress, and well-being at 12, 24, and 36 months post-9/11. Results provided support for measurement invariance of TP across time and across age. Early 9/11-related TV exposure was significantly associated with greater temporal disintegration. Temporal disintegration and ongoing stress, in turn, were associated with between- and within-person variation in past TP. This effect was qualified by an age interaction that indicated a stronger relationship between ongoing stress and past TP for younger compared with older adults. Past and future TP were significantly and independently related to individual differences and within-person variation in psychological well-being, regardless of age. Future work should incorporate adversity as an important correlate of TP across adulthood. (PsycINFO Database Record

Objective Older adults often appraise and remember events less negatively than younger adults. These tendencies may influence reports that rely more on nonexperiential, reconstructive processes. As such, the current study examined whether age differences may be more pronounced for reports of emotions that span across increasingly longer temporal epochs compared to reports of more proximal emotional experiences. Method Participants (aged 25-74 during Burst 1) from the Midlife in the United States Survey and the National Study of Daily Experiences reported the negative affect they experienced across a month, a week, and throughout the day at two measurement bursts 10 years apart. Results Across all negative affect measures, older age was related to lower levels of negative affect. The effect of age, however, varied across the three temporal epochs, such that age differences were smallest when people reported their daily negative affect and greatest when they reported their monthly negative affect. Discussion Taking into account how emotion reports differ based on method provides a more realistic picture of emotional experience in adulthood. Findings suggest that age differences in emotional experiences vary based on whether questions ask about short versus longer time periods. Age advantages are most pronounced when people recall emotions across increasingly longer periods of time.

Background: Individual perception of memory performance (i.e., subjective memory) is assessed using a variety of approaches. This article focuses on 2 such approaches: (1) self-comparison assessments that attempt to capture changes in memory ability over a period of time and (2) age-anchored comparisons that assess how an individual perceives their memory in relation to others their age. These different types of assessment may relate to psychological well-being differently due to the underlying mechanisms of assessment. Objective: The purpose of these analyses is to examine 2 measures of subjective memory (i.e., a self-comparison measure and an age-anchored comparison measure) as predictors of psychological well-being among adults in mid- and late life. Methods: Participants (n = 3,434) in the Midlife in the United States Study completed measures of subjective memory, depressive affect, and life satisfaction. Structural equation modeling was used to examine whether the self-comparison and age-anchored comparison measures had differential predictive utility regarding psychological well-being. Results: Higher age-anchored comparison ratings were related to higher life satisfaction scores. There was a significant interaction between the 2 items such that individuals with lower ratings on both subjective memory measures had the poorest outcomes. Additionally, age-anchored comparisons interacted with age: older adults had the poorest outcomes when they reported poorer age-anchored comparisons. Conclusion: These findings highlight the importance of precise measurement in the consideration of subjective memory. How an individual was asked to rate his or her perception of memory influenced the relationships between subjective memory and psychological well-being. This study contributes valuable insight into the importance of the assessment models of subjective memory.

OBJECTIVE The purpose of this study was to investigate the reciprocal relationship between sedentary behavior (SB) and momentary affect in the context of daily experiences. METHODS Community-dwelling midlife women (N = 121; age 40-60 y) were recruited for a 15-day daily diary study. The women rated their positive and negative affect when prompted on a personal digital assistant device four times per day and wore an accelerometer for objective assessment of SB. Multilevel models were estimated to test concurrent and lagged associations between momentary estimates of SB and affect. RESULTS In models that controlled for day of week, number of hot flashes, and total minutes of accelerometer wear time, greater concurrent positive affect was associated with fewer minutes spent being sedentary (β = -31, P

Mobile technologies are increasingly used to measure cognitive function outside of traditional clinic and laboratory settings. Although ambulatory assessments of cognitive function conducted in people’s natural environments offer potential advantages over traditional assessment approaches, the psychometrics of cognitive assessment procedures have been understudied. We evaluated the reliability and construct validity of ambulatory assessments of working memory and perceptual speed administered via smartphones as part of an ecological momentary assessment protocol in a diverse adult sample ( N = 219). Results indicated excellent between-person reliability (≥0.97) for average scores, and evidence of reliable within-person variability across measurement occasions (0.41-0.53). The ambulatory tasks also exhibited construct validity, as evidence by their loadings on working memory and perceptual speed factors defined by the in-lab assessments. Our findings demonstrate that averaging across brief cognitive assessments made in uncontrolled naturalistic settings provide measurements that are comparable in reliability to assessments made in controlled laboratory environments.

Based on the stress process model of family caregiving, this study examined subjective stress appraisals and perceived schedule control among men employed in the long-term care industry (workplace-only caregivers) who concurrently occupied unpaid family caregiving roles for children (double-duty child caregivers), older adults (double-duty elder caregivers), and both children and older adults (triple-duty caregivers). Survey responses from 123 men working in nursing home facilities in the United States were analyzed using multiple linear regression models. Results indicated that workplace-only and double- and triple-duty caregivers’ appraised primary stress similarly. However, several differences emerged with respect to secondary role strains, specifically work–family conflict, emotional exhaustion, and turnover intentions. Schedule control also constituted a stress buffer for double- and triple-duty caregivers, particularly among double-duty elder caregivers. These findings contribute to the scarce literature on double- and triple-duty caregiving men and have practical implications for recruitment and retention strategies in the health care industry.

Background: Participation in activities is associated with a range of positive outcomes in adulthood. Research has shown that pain and physical symptoms are associated with less activity in older adults, whereas higher self-efficacy is associated with more activity. Such research tends to examine cross-sectional or long-term between-person change, limiting the opportunity to explore dynamic within-person processes that unfold over shorter time periods. Objectives: This study aimed to (1) replicate previous between-person associations of self-efficacy with engagement in activity and (2) examine whether daily variation in pain, physical symptoms, and self-efficacy corresponded with daily within-person variation in different types of activity. We predicted that participants would engage in less activity on days when they experienced more pain or physical symptoms than their average (a negative within-person association) and that participants would engage in more activity on days when self-efficacy was higher than average (a positive within-person association). Methods: This study used an online diary study to assess self- reported daily pain, physical symptoms, self-efficacy, and engagement in activity among 185 adults aged 51-84 years for up to 7 days. Multilevel modelling was used to examine whether between-person (average) and daily within-person variability in pain, physical symptoms, and self-efficacy were associated with social, physical, and mental activity. Results: In line with previous research, between-person self-efficacy was positively associated with social and physical activity. Supporting the hypotheses, within-person self-efficacy was also positively associated with social and physical activity. The results for pain and physical symptoms were less consistent. Between-person pain was positively associated with social activity. Age interactions indicated that within-person pain was negatively associated with social activity and positively associated with physical activity among older adults. Within-person physical symptoms were positively related to social and mental activity. Conclusion: Stable individual differences as well as short-term within-person variation in physical and psychological functioning are associated with day-to-day variation in activity. Between-person associations did not always reflect within-person associations (e.g., for pain). These complex associations may be influenced by a range of factors including the type of activity and how it is defined (e.g., specific activities and their difficulty), the type of physical symptoms experienced, and age.

Agazarian’s (1997, 2001) systems-centered therapy and training (SCT)1 extends Foulkes’ (1964) concept of inseparable, interacting personal and group matrices to a three-level hierarchical matrix. SCT presents the group member nesting in a subgroup, in turn nesting in the group-as-a-whole. The SCT group member works by joining other members exploring a similar experience in the here-and-now, thus forming a ‘functional subgroup’ of the group-as-a-whole. In this study, two large groups (ns=76 and 91) used functional subgrouping during experiential SCT training. As hypothesized, more functional subgrouping predicts better member mood, more learning, and more goal achievement post-training. To our knowledge this is the first empirical demonstration of factors predicting outcome in large training groups.

Internet-based assessments became a part of research methodology in the 1990s as the Internet moved into mainstream use. Originally met with skepticism, there is evidence that data collected with this methodology are valid, and these methods are now used to collect data in a variety of studies. The advantages of Internet-based assessments include reduced burden for both participants and researchers, greater disclosure from individuals, and better access to hard-to-reach populations including isolated older adults. As technology advances, these types of assessments are evolving beyond personal computers to deployment using mobile devices. Keywords: assessment; Internet; technology

Objectives. The current study examined emotional and cognitive reactions to daily stress. We examined the psychometric properties of a short cognitive interference measure and how cognitive interference was associated with measures of daily stress and negative affect (NA) between persons and within persons over time. Methods. A sample of 87 older adults (Mage = 83, range = 70–97, 28% male) completed measures of daily stress, cognitive interference, and NA on 6 days within a 14-day period. Results. The measure yielded a single-factor solution with good reliability both between and within persons. At the between-person level, NA accounted for the effects of daily stress on individual differences in cognitive interference. At the within-person level, NA and daily stress were unique predictors of cognitive interference. Furthermore, the withinperson effect of daily stress on cognitive interference decreased significantly with age. Discussion. These results support theoretical work regarding associations among stress, NA, and cognitive interference, both across persons and within persons over time.

Behavioral and Psychological Symptoms of Dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home residents living with dementia. BPSD result in negative health outcomes decline in physical functioning and high cost of care. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. We developed a real world practical solution to assuring that staff provide behavioral interventions for BPSD while optimizing function, preventing adverse events and improving quality of life of residents. The implementation process is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well-suited to the complexity and variability found in the nursing home environment. EIT is a readily applied framework that brings together evidence informed person-centered approaches for management of BPSD and facility stakeholders. To optimally address behavior change among staff in nursing home settings additional theoretical support for the intervention, EIT-4-BPSD, includes the Social Ecological Model and Social Cognitive Theory. To test the implementation process measurement of outcomes needs to be practical, effective, and address the facility, staff and residents. This symposium will describe EIT-4-BPSD and several of the measures used to address the implementation process and establish the effectiveness of the EIT-4-BPSD approach. Specifically we describe the psychometric testing of a quality of life measure, a measure of the care plans developed in the settings and a measure of the environment and policies within these settings.

Negative age-based stereotypes are pervasive in society. Younger adults (YA) are most likely to endorse negative age-based stereotypes. Thus, it is imperative to reach YA through innovative means in order to challenge negative stereotypes. The purpose of this study was to measure and describe YA experiences with and perceptions of a cross-generational, multi-media artistic installation. Changes were examined in YA (n=35; mean:19.37 years old; 94% female; 82% Caucasian) attitudes toward aging and older adults pre-viewing, post-viewing, and one-month post-viewing the installation. Data collected included measures on attitudes toward older adults and aging, analyzed using mixed modeling. Semi-structured interviews focused on participants’ subjective experiences were examined via thematic analysis. Both quantitative and qualitative results suggested that the installation improved YA attitudes toward older adults immediately post-viewing and one-month post-viewing. Thematic analysis revealed this improvement might be due to changes in attitudes and anticipated behaviors, reinforcement of positive views of older adults, and transformation of negative views of older adults to more positive views. YA attitudes toward aging did not improve post-viewing or one-month post-viewing. Qualitative results suggest this might be due to pre-existing positive impressions of aging, increased self-awareness of eventual aging, and the affirmation of aging-related fears. Future research is needed to establish whether the installation supports sustained changes in attitudes beyond a one-month time period. This study is an essential step in better understanding the potential for innovative and accessible approaches to address YA attitudes toward older adults with the goal of promoting positive changes in intent and behavior.

Understanding how older adults interpret and respond to questions about cognition is critical to identifying response biases that may limit the accuracy of cognitive self-reports in identifying risk for cognitive decline. In this study, we used cognitive interviewing to identify features of cognitive self-report item content and structure that contribute to: 1) differing interpretations among respondents, and 2) older adults’ decisional processes when responding. Older adults without dementia (n=49; Mage = 74.5 years; 36.7% male) completed an audio-recorded cognitive interview during which common cognitive self-report items were evaluated; the Question Appraisal System was used to analyze the resultant transcripts. The most common sources of response bias were vague item wording leading to multiple interpretations of meaning, incorrect assumptions regarding consistency of problems across situations, and provocation of an emotional reaction that influenced responses. Findings from this study identify modifiable sources of response bias to inform refinement of cognitive self-report measures.

Increasingly research in heart failure (HF) and related areas on other complex, chronic conditions (e.g., diabetes) includes informal caregivers whether for observational purposes to understand how informal caregivers support the patient in self-care or for interventional purposes to directly involve the informal caregiver in symptom management. However, dyadic participation in research studies requires additional effort from the researcher to recruit, enroll, and obtain the data required for eventual analysis. Missing data due to poor caregiver compliance remains an issue and identifying predictors of caregiver participation would improve recruitment efforts. The current project examined likelihood of caregiver completion in two projects as predicted by dyadic self-care type, a measure of whether patients and caregivers work together to manage the patients’ HF symptoms. In study one, patients (N=68, Mage=73.0, 63% Male) were only recruited if a caregiver was immediately present at the appointment (restricted condition). In study two, patients (N=178, Mage=81.1, 50% Male) were recruited and a caregiver was contacted only after the patient was enrolled (unrestricted condition). In the restricted condition, caregivers were more likely to participate when their dyadic self-care approach was collaborative, though this was not true in the unrestricted condition. In the unrestricted condition, caregiver participation was highest when patients indicated their caregiver took care of most of their HF management. We will discuss the utility of using a dyadic assessment early in recruitment and screening processes to determine the effort that will be needed to engage caregivers in research participation.

Metallothionein (MT) is a small molecular weight protein possessing metal binding and free radical scavenging properties. We hypothesized that MT-1/MT-2 null (MT−/−) mice would display exacerbated soleus muscle atrophy, oxidative injury, and contractile dysfunction compared with the response of wild-type (WT) mice following acute spinal cord transection (SCT). Four groups of mice were studied: WT laminectomy, WT transection, MT−/−laminectomy (MT−/−lami), and MT−/−transection (MT−/−trans). Laminectomy animals served as surgical controls. Mice in SCT groups experienced similar percent body mass (BM) losses at 7 days postinjury. Soleus muscle mass (MM) and MM-to-BM ratio were lower at 7 days postinjury in SCT vs. laminectomy mice, with no differences observed between strains. However, soleus muscles from MT−/−trans mice showed reduced maximal specific tension compared with MT−/−lami animals. Mean cross-sectional area (μm2) of type I and type IIa fibers decreased similarly in SCT groups compared with laminectomy controls, and no difference in fiber distribution was observed. Lipid peroxidation (4-hydroxynoneal) was greater in MT−/−trans vs. MT−/−lami mice, but protein oxidation (protein carbonyls) was not altered by MT deficiency or SCT. Expression of key antioxidant proteins (catalase, manganese, and copper-zinc superoxide dismutase) was similar between the groups. In summary, MT deficiency did not impact soleus MM loss, but resulted in contractile dysfunction and increased lipid peroxidation following acute SCT. These findings suggest a role of MT in mediating protective adaptations in skeletal muscle following disuse mediated by spinal cord injury.

Working memory capacity (WMC) has received attention across many areas of psychology, in part because of its relationship with intelligence. The mechanism underlying the relationship is unknown, but the nature of typical WMC tasks has led to two hypothesized mechanisms: secondary-memory processes (e.g., search and retrieval) and the maintenance of information in the face of distraction. In the present study, participants ( N = 383) completed a battery of cognitive tasks assessing processing speed, primary memory, working memory, secondary memory, and fluid intelligence. Secondary memory was the strongest predictor of fluid intelligence and added unique predictive value in models that accounted for working memory. In contrast, after accounting for the variance in fluid intelligence associated with the secondary-memory construct, the working memory construct did not significantly predict variability in fluid intelligence. Therefore, the secondary-memory requirements shared by many memory tasks may be responsible for the relationship between WMC and fluid intelligence, making the relationship less unique than is often supposed.

Objectives We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure. Design In this secondary analysis we used control group data from an ongoing randomized clinical trial. Setting/Participants Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (±6.83) years; 67.6% were women; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele. Measures We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; the Confusion Assessment Method; and the Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale. Results Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition. Conclusions For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function, and greater length of stay during rehabilitation.

Delirium is common in post-acute care (PAC) patients with dementia; its treatment is not established. We hypothesized that cognitive activities would reduce the duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. This was an NIH-funded single-blind randomized clinical trial conducted in eight PAC facilities. Participants were 283 community-dwelling older adults with dementia and delirium randomized to intervention or control. The intervention group received cognitive activities daily for up to 30 days. The control group received usual care. Primary outcomes were delirium duration (Confusion Assessment Method), and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment and CLOX) and physical function (Barthel Index). There were no differences between the groups for mean percentage of delirium-free days or delirium severity. Significant differences for secondary outcomes favoring intervention were found: executive function: 6.58 (95% CI: 6.12–7.04) vs. 5.89 (95% CI: 5.45–6.33), a difference of -0.69 (95% CI: 1.33- -0.06, p=0.03); and constructional praxis: 8.84 (95% CI: 8.83–9.34) vs. 7.53 (95% CI: 7.04–8.01), a difference of - 1.31 (95% CI: 2.01- -0.61, p=0.0003). After adjusting for baseline constructional praxis the group comparison was no longer significant. Average length of stay was shorter in intervention (36.09 days vs. 53.13 days, SE = 0.15, p = 0.01, negative binomial regression. Cognitive activities did not improve delirium but did improve executive function and reduced length of stay. Resolution of delirium may require more intense non-pharmacological management when the patient has dementia.

Purpose of the study This study examined how certified nursing assistants (CNAs) with unpaid family caregiving roles for children ("double-duty-child caregivers"), older adults ("double-duty-elder caregivers"), and both children and older adults ("triple-duty caregivers") differed from their nonfamily caregiving counterparts ("workplace-only caregivers") on four work strain indicators (emotional exhaustion, job satisfaction, turnover intentions, and work climate for family sacrifices). The moderating effects of perceived family time adequacy were also evaluated. Design and methods Regression analyses were conducted on survey data from 972 CNAs working in U.S.-based nursing homes. Results Compared with workplace-only caregivers, double-and-triple-duty caregivers reported more emotional exhaustion and pressure to make family sacrifices for the sake of work. Triple-duty caregivers also reported less job satisfaction. Perceived family time adequacy buffered double-duty-child and triple-duty caregivers' emotional exhaustion and turnover intentions, as well as reversed triple-duty caregivers' negative perceptions of the work climate. Implications Perceived family time adequacy constitutes a salient psychological resource for double-duty-child and triple-duty caregivers' family time squeezes. Amid an unprecedented demand for long-term care and severe direct-care workforce shortages, future research on workplace factors that increase double-and-triple-duty caregiving CNAs' perceived family time adequacy is warranted to inform long-term care organizations' development of targeted recruitment, retention, and engagement strategies.

Experiencing positive and negative emotions together (i.e., co-occurrence) has been described as a marker of positive adaptation during stress and a strength of socioemotional aging. Using data from daily diary (N = 2,022; ages 33-84) and ecological momentary assessment (N = 190; ages 20-80) studies, we evaluate the utility of a common operationalization of co-occurrence, the within-person correlation between positive affect (PA) and negative affect (NA). Then we test competing predictions regarding when co-occurrence will be observed and whether age differences will be present. Results indicate that the correlation is not an informative indicator of co-occurrence. Although correlations were stronger and more negative when stressors occurred (typically interpreted as lower co-occurrence), objective counts of emotion reports indicated that positive and negative emotions were 3 to 4 times more likely to co-occur when stressors were reported. This suggests that co-occurrence reflects the extent to which negative emotions intrude on typically positive emotional states, rather than the extent to which people maintain positive emotions during stress. The variances of both PA and NA increased at stressor reports, indicating that individuals reported a broader not narrower range of emotion during stress. Finally, older age was associated with less variability in NA and a lower likelihood of co-occurring positive and negative emotions. In sum, these findings cast doubt on the utility of the PA-NA correlation as an index of emotional co-occurrence, and question notion that greater emotional co-occurrence represents either a typical or adaptive emotional state in adults.

Skilled nursing facilities (SNFs) are major sites of postacute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are suboptimal because of poor-quality treatment, including the failure to provide needed care. Pain is frequently unrecognized and untreated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined.Secondary analysis of data from an on-going randomized clinical trial.Eight SNFs located in central and northeast Pennsylvania.A total of 103 SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were women (66%) and white (98%).Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge.On days when participants experienced greater than their average level of pain, they also experienced more delirium symptoms (P .001) and lower physical function (P .001). Participants with higher levels of average daily pain were more likely to die (odds ratio [OR] 6.306, 95% confidence interval [CI] 1.914-20.771, P = .003) or be placed in a nursing home (OR 4.77, 95% CI 1.7-13.2, P = .003) compared with returning to the community at 3-month follow-up.Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs.

Neighborly cohesiveness has documented benefits for health. Furthermore, high perceived neighborhood cohesion offsets the adverse health effects of neighborhood socioeconomic adversity. One potential way neighborhood cohesion influences health is through daily stress processes. The current study uses participants (n=2022, age 30-84 years) from The Midlife in the United States II and the National Study of Daily Experiences II, collected between 2004 and 2006, to examine this hypothesis using a within-person, daily diary design. We predicted that people who perceive high neighborhood cohesion are exposed to fewer daily stressors, such as interpersonal arguments, lower daily physical symptoms and negative affect, and higher daily positive affect. We also hypothesized that perceptions of neighborhood cohesion buffer declinein affective and physical well-being on days when daily stressors do occur. Results indicate that higher perceived neighborhood cohesion predicts fewer self-reported daily stressors, higher positive affect, lower negative affect, and fewer physical health symptoms. High perceived neighborhood cohesion also buffers the effects of daily stressors on negative affect, even after adjusting for other sources of social support. Results from the present study suggest interventions focusing on neighborhood cohesion may result in improved well-being and may minimize the adverse effect of daily stressors.

The current study applied a model of pain communication [10] to examine the distinction between verbal and nonverbal pain expression in their prediction of punishing, empathic, and solicitous spouse responses to patient pain. It was hypothesized that on days when patients engaged in more nonverbal expression spouses would respond more positively (i.e., with less punishing, and more solicitous and empathic behavior). The same pattern was predicted for verbal expression. In addition, it was expected that associations between patient nonverbal pain expression and positive spouse responses would be strengthened, and that the association with punishing responses would be weakened, on days when levels of verbal pain expression were higher than usual, regardless of daily pain severity. In a 22-day diary study, 144 individuals with knee osteoarthritis and their spouses completed daily measures of pain expression, spouse responses, health, and affect. The predicted positive main effect of nonverbal expression on empathic and solicitous responses was supported by the data, as was the positive main effect for verbal pain expression. Results from moderation analyses partially supported our hypothesis in that a) patients’ nonverbal pain expression was even more strongly related to empathic and solicitous spouse responses on days of high verbal pain expression, and b) patients were buffered from spouse punishing responses on days when both nonverbal and verbal expression were high. These findings suggest that pain expression in both verbal and nonverbal modes of communication is important for positive and negative spousal responses.

Daily stressors, such as an argument with a spouse or an impending deadline, are associated with short-term changes in physical health symptoms. Whether these minor hassles have long-term physical health ramifications, however, is largely unknown.The current study examined whether exposure and reactivity to daily stressors is associated with long-term risk of reporting a chronic physical health condition.Participants (N = 435) from the National Study of Daily Experiences completed a series of daily diary interviews between 1995 and 1996 and again 10 years later.Greater affective (i.e., emotional) reactivity to daily stressors at time 1 was associated with an increased risk of reporting a chronic physical health condition at time 2.Results indicate that how people respond to the daily stressors in their lives is predictive of future chronic health conditions.

Physical activity is critical for the management of knee osteoarthritis, and the spouse may play a role in encouraging or discouraging physical activity.The purpose of this study was to examine four types of spousal influence-spouses' daily activity, autonomy support, pressure, and persuasion-on the daily physical activity of adults living with knee osteoarthritis.A total of 141 couples reported their daily experiences for 22 days using a handheld computer and wore an accelerometer to measure moderate activity and steps.Spouses' autonomy support for patient physical activity, as well as their own level of activity, was concurrently associated with patients' greater daily moderate activity and steps. In addition, on days when male patients perceived that spouses exerted more pressure to be active, they spent less time in moderate activity.Couple-oriented interventions for knee osteoarthritis should target physical activity in both partners and spousal strategies for helping patients stay active.

The current study examined individual differences in exposure to daily stressors and self-reported changes in memory among older adults. A sample of 87 older adults completed measures of daily stressful experiences, negative affect, cognitive interference, and rated their memory compared to six months ago. Results indicated that more frequent exposure to daily stressors was associated with rating one’s memory to be worse compared to six months prior. Furthermore, cognitive interference, but not negative affect partially mediated this association. The findings highlight cognitive interference as a psychological pathway for understanding the links between daily stress and perceptions of memory and cognition in old age.

Purpose Lipoic acid (LA) shows promise as a beneficial micronutrient in improving health, particularly in the elderly. Clinical and in vitro reports show that LA induces endogenous antioxidants and acts as an anti-inflammatory agent. LA also increases nerve conductance, improves diabetes-induced polyneuropathies, and remediates the age-associated cognitive decline in canines. Furthermore, LA significantly improves hypertriglyceridemia and glucose handling. From our preclinical research we have found that LA primarily influences three areas of health: cognition, stress response, and lipids. This study examines the effects of LA on human subjects in components of each of the three aforementioned areas of health.

Patients having co-occurring borderline personality disorder and alcohol use disorders represent a common, but particularly severe and refractory subgroup. An individual, time-limited treatment, dynamic deconstructive psychotherapy (DDP), has been shown to be effective for this subgroup, but long-term outcomes are not known. Participants were recruited from a sample of 30 patients enrolled in a 12-month randomized controlled trial of DDP versus optimized community care (OCC). Outcomes were assessed after an additional 18 months of naturalistic follow-up. DDP participants received an equivalent amount of individual treatment and less group therapy than those receiving OCC, but demonstrated large, sustained treatment effects over a broad range of outcomes and achieved significantly greater improvement in core BPD symptoms, depression, parasuicide, and recreational drug use over the 30-month study. These results suggest that DDP is a cost-effective treatment that can lead to broad and sustained improvement for the dually diagnosed subgroup.

Methods. ICU patients with >1 of the following were included: Metastatic malignancy, hospitalization >9 days prior to the ICU admission, ICU LOS >13d, ventilation >6d, age >79 with >1 comorbidity, cardiac arrest, cerebral hemorrhage requiring ventilation, or admission from an LTAC. Patients listed for transplant were excluded. Outcomes were family member surveys and abstracted chart data. Results. 99 subjects were included in the preintervention cohort, mean age 60.4y (SD 16.5), median ICU LOS 5d (IQR 2-12), and median LOS 13d (IQR 627); 35% died in hospital. Common inclusion criteria included: longer mechanical ventilation (23%); age >79 (21%); cardiac arrest (21%). 60% (n1⁄459) of family member surveys were returned. A higher level of satisfaction with ICU care (mean 84.4 (1-100), SD 12.8) than with ICU decision-making (mean 82.6, SD 16.3) was seen. For those who died in the ICU, respondents rated the quality of their loved ones death highly (mean 8.8 (1-10), SD 1.2). Family meetings occurred for 39% of all subjects though only in 20% of ICU survivors. In a multivariate regression adjusting for age, sex, race, ICU LOS, and mortality, documentation of a family meeting was associated with higher family satisfaction with decision-making in the ICU (s 1⁄413.7, 95% confidence interval 1.5-30, p1⁄40.029). Conclusions. 1. Families rate the quality of their loved ones’ care in the ICU higher than the quality of decision-making. 2. A family meeting is strongly associated with satisfaction with decision-making. 3. Family meetings are uncommon. 4. Interventions that increase the occurrence and documentation of ICU family meetings and their effects should be studied.

303 1 SCT® and Systems-Centered® are registered trademarks of Dr. Yvonne M. Agazarian and the Systems-Centered Training and Research Institute Inc., a nonprofit organization. The authors would like to acknowledge the contributions of Emma N. Cleary and Corinne N. Stockmal to the preparation of this manuscript. 2 Professor, Institute for Decision Excellence and Leadership, Department of Psychiatry, State University of New York. Correspondence should be addressed to Richard M. O’Neill, PhD, ABPP, CGP, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210. E-mail: oneillr@ upstate.edu. 3 Assistant Professor, College of Nursing, Penn State University. Large experiential groups are common at association conferences and are presented as positive experiences with positive outcomes. However, empirical investigation of effects is lacking. Systems-Centered therapy (SCT) methods are designed to improve the process and outcome of groups whatever their size. In this project, large-group members (n = 264) were trained to use SCT’s cardinal method of “functional subgrouping” while discussing professional roles. Preto postgroup, members on average reported no change in mood, but members scoring higher on the SCT Functional Subgrouping Questionnaire (FSQ) reported significantly more positive change in mood and greater connection to the association. Also, members with higher FSQ scores reported feeling more heard during the group and greater satisfaction with learning. Suggestions are made for future research that may further substantiate these findings.