Search

Each year the GSA publications team sponsors a symposium to assist authors who wish to publish in GSA’s high impact and influential journals. The first part of the session will include five brief presentations from the editors of The Gerontologist, Innovation in Aging, and the Journals of Gerontology Series A and B plus journal managing editors. We will integrate practical tips with principles of publication ethics and scholarly integrity. The topics will be as follows: (1) Preparing your manuscript: strong and ethical scholarly writing for multidisciplinary audiences, (2) common problems that affect peer review, (3) addressing translational significance and fit to journal expectations, (4) transparency, documentation, and Open Science; and (5) working with Scholar One. Following these presentations, we will hold round table discussions with editors from the GSA journals portfolio. At these round tables, editors will answer questions related to the podium presentations and other questions specific to each journal. Intended audiences include emerging and international scholars, and authors interested in learning more about best practices and tips for getting their scholarly work published.

Social support serves as a protective factor against depression and other negative outcomes among older adults. Satisfaction with social support among long-term care residents has not received as much attention, and the experience of support among newly admitted long-term care residents has not been investigated. The current study examines what variables influence a long-term care resident’s satisfaction with their social support. This sample consists of 48 individuals newly admitted into long-term nursing home care. This study used the Social Support Questionnaire (SSQ6) to gather information on social support network size and overall satisfaction of perceived social support. Correlations were estimated between social support satisfaction, social support network size, and psychosocial factors including depression (PHQ-9), anxiety (RAID), religious involvement, cognitive status (BIMS), positive and negative affect (PANAS). Satisfaction with support was significantly correlated with social network size (r = .328, n = 48, p < .05) and positive affect (r = .437, n = 24, p < .05). In a regression model with support satisfaction as the dependent variable, both social network size and positive affect contributed significantly to model R2 F(2,21) = 2.441, p = .049 R2 = .250. Satisfaction with support depends upon the number of supporters available, but also on levels of positive affect.

Assisted living (AL) is now the largest residential provider of long-term care in the U.S., and the acuity of AL residents has been rising. However, AL is not a health care setting, and concern has grown about the medical and mental health care needs of AL residents. Because there is no guidance to inform this care, a Delphi consensus panel of 19 experts was convened, and their recommendations were compared to actual practice. Panelists rated 200 discrete items, 43 of which met standard recommendation cut points (rated as important by at least 75% of panelists) and reflected four critical components of AL: the tenets of AL, the role AL plays in providing long-term care for persons with dementia, the need for pragmatism in response to the diversity of AL, and workforce needs. Next steps regarding implementation of the recommendations will be discussed.

ImportanceAssisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care.ObjectiveTo identify consensus recommendations for medical and mental health care in AL and determine whether they are pragmatic.Evidence ReviewA Delphi consensus statement study was conducted in 2021; as a separate effort, the extent to which the recommendations are reflected in practice was examined in data obtained from 2016 to 2021 (prepandemic). In the separate effort, data were from a 7-state study (Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, Texas). The 19 Delphi panelists constituted nationally recognized experts in medical, nursing, and mental health needs of and care for older adults; dementia care; and AL and long-term care management, advocacy, regulation, and education. One invitee was unavailable and nominated an alternate. The primary outcome was identification of recommended practices based on consensus ratings of importance. Panelists rated 183 items regarding importance to care quality and feasibility.FindingsConsensus identified 43 recommendations in the areas of staff and staff training, nursing and related services, resident assessment and care planning, policies and practices, and medical and mental health clinicians and care. To determine the pragmatism of the recommendations, their prevalence was examined in the 7-state study and found that most were in practice. The items reflected the tenets of AL, the role of AL in providing dementia care, the need for pragmatism due to the diversity of AL, and workforce needs.Conclusions and RelevanceIn this consensus statement, 43 recommendations important to medical and mental health care in AL were delineated that are highly pragmatic as a guide for practice and policy.

OBJECTIVES: Evidence-based depression therapies are difficult to implement in nursing homes. We present data for BE-ACTIV, a 10-week depression treatment designed for implementation in nursing homes, to address questions of treatment fidelity (delivery, receipt, and enactment) in that context. METHOD: Participants were 41 patients from 13 nursing homes in the treatment arm of a clinical trial, treated by graduate student therapists. Therapists and their supervisor rated their audio-recorded sessions for adherence to treatment protocol and session quality. RESULTS: Delivery of core program elements averaged from 80–94% across all sessions; mean quality was 5.6 (SD 0.61) out of 6 points. Delivery of core components to nursing home activities staff who collaborated in the treatment was similarly high. Patients received an average of 7.32 sessions (SD 3.39); 17 completed 10 sessions. The theoretical basis of BE-ACTIV is behavioral activation; therapist-client dyads planned new pleasant events weekly, from a mean of 3.66 (SD 1.35) after the first session to a mean of between 5 and 6 activities a week across sessions 6–9, with a similar progression in percent activities completed. Activities enactment was significantly related to the likelihood of remission at post-treatment, and of maintaining improvement at 3-month follow-up. Treatment receipt and enactment were also related to improved mood from baseline to 3 months. CONCLUSION: Results demonstrate delivery, receipt, and successful enactment of BE-ACTIV core components in diverse nursing homes and patients, and support the theoretical premise of the intervention. These findings support further implementation work for the BE-ACTIV intervention.

Objectives: Although late adulthood may be a time of greater well-being, optimal aging still characterizes a minority of older adults. Understanding how individuals achieve well-being across adulthood is important for intervention and social policy. We focused on how attending live theatre might enhance the well-being of a sample of 53 season ticket holders aged 60 and older. Based on a previously tested conceptual framework, we hypothesized that post-performance reports of social-cognitive experience while at the play would predict post-performance positive affect, which in turn would predict well-being.Method: The sample was a subset of volunteers from a large survey study of theatre ticket purchasers. They completed baseline and two-year follow-up measures of well-being, and questionnaires immediately after attending seven plays across two seasons: measures of social engagement, belonging, flow, positive affect, and their reactions to the plays.Results: We found that sense of belonging, social engagement, and flow were associated with positive affect after performances, as hypothesized. We also found that the cumulative positive affect experienced after plays in the two seasons predicted change in well-being between baseline and follow-up.Conclusion: Our findings suggest that attending performances is a combined social, cognitive, and affective experience that transcends entertainment. Future research might investigate whether the psychological benefit model we assessed will generalize to other leisure activities that create similar engagement. The findings have implications for individuals seeking to promote their own well-being, and, possibly more importantly, for policies that support enriching cultural opportunities, particularly in the arts.

A recent study of single-ticket buyers and subscribers at a major regional theatre – Actors Theatre of Louisville, Kentucky – focused on measuring quantitatively the psychological benefits of engaging with theatre and gathering qualitatively observations by focus groups. Both confirmed the hypothesis that regular attendance promotes flourishing and meaningful social interaction, psychological stimulation, and positive emotions. The study also affirms that attending theatre contributes to a shared sense of community, this at a time when such community appears starkly diminished in the United States. In addition, focus groups wished that audiences better reflected the demographic diversity outside the auditorium. Evident disparities include urban vs. rural, prosperous vs. not, more education vs. less, black vs. white – reflecting those that splinter national politics. One microcosm of one theatre's audience provokes suggestions to foster a more democratic audience and plural istic culture that endeavours to cross rather than ignore the divides. Russell Vandenbroucke is Professor of Theatre at the University of Louisville and Director of its Peace, Justice & Con flict Transformation programme. He was previously Artistic Director of Chicago's Northlight Theatre. Suzanne Meeks is Professor and Chair of the Psychological and Brain Sciences Department, University of Louisville. Her research focuses on mental health in later life.

To assess mental health providers' experience with LGBT older adults in long-term care (LTC) settings and perceived barriers to quality care.Providers (N = 57) completed an online survey on demographics and practice characteristics. They were also asked about: number of LGBT residents they've worked with, relevance of LGBT issues to their practice, preparedness, willingness to learn, hours of formal/informal training, and barriers to providing care to LGBT patients.Respondents were 63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses, most of whom practiced in LTC consulting roles. Most providers felt working with LGBT issues was relevant to their practice and felt well-prepared and willing to learn, though they were unaware of evidence based practices (EBTs), especially for LTC settings. They had little coursework on LGBT issues, and identified lack of training, stigma, and residents concealing their identity as the greatest barriers to quality care.Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care.LGBT-specific training and EBTs are needed. Facilities need to address stigma with residents and providers.

To examine whether exposure to a message to avoid antipsychotic medications and a salient sense of managerial oversight influenced nurses' treatment intentions.158 nurses from 28 long-term care facilities were randomized to one of four conditions within a 2 × 2 between-participants design. The nurses responded to a case study depicting a resident with dementia-related behavioral problems with their intent to initiate an antipsychotic or a psychosocial intervention. Self-efficacy, descriptive norms, and attitudes were measured via self-report.Perceived local antipsychotic prevalence was related to the nurses' treatment intentions. There were no main or interactive effects of the avoid antipsychotic or manager oversight conditions on the nurses' treatment intentions. However, there was a significant interaction of actual facility antipsychotic prevalence and the avoid antipsychotics message on intentions to initiate an antipsychotic.Nurses' perceptions of local antipsychotic prevalence were positively associated with intentions to initiate an antipsychotic and negatively associated with intentions to initiate a psychosocial intervention. However, a salient message to avoid antipsychotics had limited influence on nurses' treatment intentions and was associated with increased intentions to initiate antipsychotics in facilities with higher rates of antipsychotic use. The oversight condition did not demonstrate adequate internal validity, which may have caused its lack of effect on treatment intentions.Nurses' perceptions of the local prevalence of antipsychotic use is associated with their treatment intentions. However, increasing the visibility of a message discouraging antipsychotic use may have limited utility in influencing nurses' intentions to initiate an antipsychotic or psychosocial intervention.

Background and Objectives Depressed older adults are more likely to be seen in primary care than in specialty mental health settings, but research shows that physicians may not routinely screen for depression. Other clinical disciplines are also in a position to screen for depression, but have not been studied. This study examined barriers to screening older adults for depression, and disciplinary differences in clinical trainees’ likelihood of screening. Research Design and Methods We used a cross-sectional, online survey with experimental manipulation of vignettes. A four-way mixed analysis of variance explored the effects of clinical discipline (between subjects) and time pressure, patient difficulty, and level of symptoms (within subjects) on trainees’ likelihood of screening. Results Participants were 229 trainees in medicine (83), psychology (51), nursing (49), and social work (46). Lower time pressure and greater symptom severity increased likelihood of screening. There was a significant three-way interaction among discipline, patient difficulty, and symptom level that was driven by social work graduate trainees’ greater likelihood of screening for depression when there were more symptoms present, which was diminished if the patient was being difficult. There was a two-way interaction between patient difficulty and level of symptoms: more symptoms resulted in increased likelihood of screening, an effect that diminished with greater patient difficulty. Discussion and Implications The study holds implications for identifying and addressing gaps in education on depression screening to minimize the effects of barriers. Interventions could address education about older adults and depression, including practice-based screening, time management, and behavior management skills.

Person-centered care constructs such as fulfilled preferences, sense of control, and life satisfaction might contribute to loneliness among nursing home residents, but these relationships have not been thoroughly explored. The aim of this study was to examine the relationship between fulfilled preferences and loneliness in nursing home residents with perceived control and life satisfaction as potential mediators.The study utilized a cross-sectional design, examining the targeted variables with a questionnaire administered by trained research staff. A convenience sample of 65 residents (median age = 71) of eight nursing homes were interviewed. Linear regression analysis was utilized to examine the mediation hypotheses.The relationships between fulfilled preferences and loneliness (β = -.377, p = .002), fulfilled preferences and perceived control (β = -.577, p.001), and perceived control and loneliness (β = .606, p.001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.040, p = .744) became non-significant when perceived control was included in the model. The relationships between fulfilled preferences and life satisfaction (β = .420, p.001) and life satisfaction and loneliness (β = -.598, p.001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.152, p = .174) became non-significant when life satisfaction was included in the model.The findings suggest an important association between person-centered care, particularly fulfilling personal care and recreation preferences, and social-affective needs of long-term care residents. Fulfilling preferences may be an appropriate intervention target for loneliness.

Residence in a long-term care (LTC) facility poses numerous challenges to psychological well-being and rates of depression are high. Sense of belonging (SoB) has been linked with measures of well-being in all age groups and interventions focused on improving SoB have been successful with college-age adults. It is unclear if SoB improves in LTC residents as they adjust to living in this environment or what factors predict poor SoB in this population. As part of a larger study of care preferences in LTC residents, participants (n= 76) completed measures of SoB, well-being, religious activity, and demographic information. SoB did not vary significantly based on duration of stay, age, gender, ethnicity, marital status, number of children, education, facility, cognitive functioning, or physical health. SoB was found to be significantly and positively correlated with participation in religious activities (r= .388, N=76, p=.001), private religious practices (r= .275, N=71, p=.020), and spirituality (r= .263, N=70, p=.028). There was also a significant positive correlation between SoB and positive affect (r= .450, N=74, p

This presentation will emphasize the importance of plain, good writing. Editors of high impact journals read 10 or more manuscripts per week, and are under pressure to reject 80-90% of them. Regardless of scholarly quality, if the point and contribution are not clear in a quick scan of the paper, it likely will not be reviewed favorably. I will provide tips for strong scientific writing that are commonly violated in manuscript submissions, and provide references for additional writing support. I will also discuss some common publication ethics issues that arise during the review process, including author contributions and embedding your scholarship in the context of prior work.

My first clinical exposure to older adults was in a psychiatric hospital, to people with life-long severe mental illnesses; I was drawn to their perseverance. The older people we see clinically interact with care environments that may or may not effectively use patients’ personal histories. I have studied the affective experiences of older people in care environments--the mental health system and long-term care--to improve mental health care and well-being. Solutions seem obvious, and difficult. Theory and abundant empirical research tell us that environments can support adaptation through nurturing strengths, offering compensatory tools, and acknowledging losses. My work on depression is a simple example of how this can work in psychotherapy. Yet implementing simple solutions means overcoming barriers of training, resources, and institutional inertia. The promise is understanding age as the dynamic representation of a life span; the challenge is making this understanding work for older people.

The GSA publications team sponsors this annual symposium to assist prospective authors to successfully publish their gerontological scholarship in GSA’s high impact and influential journals. The first part of the session will include five brief presentations from the Editors-in-chief of Journals of Gerontology-Series B, Social and Psychological Sciences, The Gerontologist, and Innovation in Aging, plus one of GSA’s managing editors. We will integrate practical tips with principles of publication ethics and scholarly integrity. The topics will be as follows: (1) preparing your manuscript, including how to choose the right journal; (2) strong and ethical scholarly writing for multidisciplinary audiences; (3) transparency, documentation, and Open Science; (4) successfully responding to reviews; and (5) working with Scholar One. Following these presentations, we will hold round table discussions with editors from the GSA journals portfolio. At these roundtables, editors will answer questions related to the podium presentations and other questions specific to each journal. Intended audiences include emerging and international scholars, and authors interested in learning more about best practices and tips for getting their scholarly work published.

Late adulthood can offer greater life satisfaction, lower stress, and fewer mental disorders than earlier decades, but optimal aging still characterizes only a minority of older adults. Understanding how older adults achieve well-being can illuminate targets for increasing optimal aging. This study examined how attending live theatre relates to well-being for some older adults. Fifty-five regular theatre patrons 60 and over (mean age 66.13, SD=4.61) reported their experience after each play attended across two seasons. Using a previously tested conceptual framework, we hypothesized that patrons reporting belonging, social interaction, enjoyment, or experiencing flow during the performances would report higher positive affect, and that positive affect, flow experiences, social interaction, and sense of belonging would predict well-being across the two years of the study. We tested the first hypothesis with repeated measures mixed effects models. Initial individual differences in affect, sense of belonging, flow, and social engagement significantly predicted concurrent positive affect after performances. In prospective regression analyses, positive affect reported after performances and summed over two seasons significantly predicted change in the Ryff Scales of Psychological Well-being, between baseline and the end of the second season (about 20 months later), R2 change= .07, F(1,35) = 14.592, p = .001, despite the fact that well-being was very stable. The results suggest that psychological benefits from arts engagement may include sense of belonging, flow, and social engagement. These benefits may increase well-being by increasing opportunities for promoting positive affect.

Providers (N=57) completed an online survey on practice characteristics. They were asked about: number of LGBT residents they’ve worked with, relevance of LGBT issues to their practice, preparedness, willingness to learn, hours of formal/informal training, and barriers to providing care to LGBT patients. Respondents were 63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses, most of whom practiced in LTC consulting roles. Most providers felt working with LGBT issues was relevant to their practice and felt willing to learn, though they were unaware of evidence based practices (EBTs), especially for LTC settings. They had little coursework on LGBT issues, and identified lack of training, stigma, and residents concealing their identity as the greatest barriers to care. Mental health providers in LTC facilities would benefit from training in LGBT-specific mental health problems and EBTs, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care.

In this section of the symposium, I will talk about manuscript preparation for maximizing the likelihood that your work will be sent for review. I will talk about common author errors that usually guarantee an immediate reject decision such as not reading and following the Instructions to Authors. I will emphasize the importance of plain, good writing. Editors of high impact journals receive 10 or more new manuscripts per week, and due to limited page space, have to reject 80-90% of them. Regardless of scholarly quality, if the point and contribution are not clear in a quick scan of the paper, it likely will not be reviewed favorably. I will provide tips for strong scientific writing that are commonly violated in manuscript submissions, and provide references for additional writing support.

Racial microaggressions are a common form of racial discrimination consisting of subtle or interpersonal slights. Racial microaggressions are linked to various kinds of psychological distress in younger adults, but have not been studied across the lifespan. We examined the relationship of racial microaggressions with psychological distress and anger rumination among younger and older adults identified as racial or ethnic minorities. We hypothesized that age would moderate the relationship between racial microaggressions and psychological distress and anger rumination, that is, the relationship would be weaker for older than for younger adults. Participants were recruited from Amazon Mechanical Turk and were compensated $1 for their participation. Preliminary tests of the hypotheses (N=220), using multiple regression analyses to test for moderation, failed to support the hypothesis that age would mitigate the impact of microaggressions on symptom severity. Both age and microaggressions were related to psychological distress and anger rumination, but contrary to prediction, older adults showed more exacerbation of distress in the face of microaggressions than younger adults. The results also differed by gender and ethnic groups, suggesting the importance of examining intersectional experiences of race, gender, and age in response to discrimination. These cross-sectional findings lend support to the importance of considering both subtle and overt discriminatory experiences in understanding the mental health challenges for minority groups in the U.S., but more work is needed to examine the intersection of ethnicity with other demographic variables, and to understand how the lifelong experiences of discrimination may shape older adults’ vulnerability, well-being, and resilience.

This paper presents preliminary baseline data from a prospective study of nursing home adaptation that attempts to capture the complexity of residents' adaptive resources by examining psychological, social, and biological variables from a longitudinal conceptual framework. Our emphasis was on validating an index of allostasis.In a sample of 26 long-term care patients, we measured 6 hormone and protein biomarkers to capture the concept of allostasis as an index of physiological resilience, related to other baseline resources, including frailty, hope and optimism, social support, and mental health history, collected via interview with the resident and collaterals. We also examined the performance of self-report measures reflecting psychosocial and well-being constructs, given the prevalence of cognitive impairment in nursing homes.Our results supported both the psychometric stability of our self-report measures, and the preliminary validity of our index of allostasis. Each biomarker was associated with at least one other resilience resource, suggesting that our choice of biomarkers was appropriate. As a group, the biomarkers showed good correspondence with the majority of other resource variables, and our standardized summation score was also associated with physical, social, and psychological resilience resources, including those reflecting physical and mental health vulnerability as well as positive resources of social support, optimism, and hope.Although these results are based on a small sample, the effect sizes were large enough to confer some confidence in the value of pursuing further research relating biomarkers of allostasis to psychological and physical resources and well-being.

This article describes how research, practice, and education were integrated in a National Institutes of Mental Health-funded clinical trial for treating depression in nursing homes. Involving undergraduate and doctoral students in this clinical trial supported the development of key competencies, expanded the professional pipeline, and provided an avenue for disseminating the treatment to other settings. The clinical trial served as a teaching laboratory for sixteen undergraduate and six doctoral students to (1) observe the culture of older adults in nursing homes, (2) develop and adapt clinical skills to a challenging patient population, (3) refine skills for collaborating in multidisciplinary teams, and (4) appreciate the relationship between science and practice. Dissemination of the intervention to nonresearch settings was served when the students took their skills to the settings where they launched their careers. Involvement of trainees in clinical trial research expands and enriches the capacity of the health care workforce in evidence-based practice and practice-informed research.

Falls pose a significant health risk for nursing home residents and are associated with depression and medical treatments for depression. Data on falls as an adverse event to psychosocial treatments are lacking. We examined risk of falls as an adverse event in a clinical trial of a behavioral treatment for depression. Participants were 82 depressed nursing home residents. Adverse events were recorded at each research contact. We used the rate ratio based on the respective incidence densities in the treatment and control groups to measure association between fall rate and treatment. The treatment group had almost six times higher risk of falls than the control group, a statistically significant association. Findings suggest that it may be of value to include statistical analysis of falls as adverse events in trials of behavioral interventions for depression.

This study examined the validity of a psychological model for understanding nursing home providers' treatment choices when managing challenging dementia-related behaviors. Ninety-nine nurses from 26 long-term care facilities responded to a case study with their intentions to initiate an antipsychotic or psychosocial intervention and completed self-report measures of their attitudes, descriptive norms, self-efficacy, and outcome expectancies. The multi-level modeling results demonstrated that nurses with more positive outcome expectancies for the effect of an antipsychotic on resident behavior, and those with more positive attitudes towards antipsychotics, had greater intentions to initiate an antipsychotic. Intentions to initiate a psychosocial intervention were greater when nurses perceived a lower prevalence of antipsychotics and in facilities with nurses who collectively had higher self-efficacy to implement such interventions. The findings offer partial support for the proposed model and possible intervention targets to improve psychosocial intervention use and antipsychotic prescribing.

Although estimates place the prevalence of dementia in nursing home residents at approximately 50%, the longitudinal course of cognition and cognitive impairment in nursing home residents are not well understood. Using data from 33 long-term care residents, patterns of performance on the Mini-Mental State Examination across multiple quarterly administrations were examined. Results show that four distinct patterns were evident: declining, stable, improving, and inconsistent performance. Although a number of residents exhibited declines in performance across multiple administrations, the performance of the majority of residents either remained stable or improved. Few clinical correlates of patterns of performance were observed in this cohort. These results have implications for providers working in nursing homes and raise important questions for future research.

Ryff’s Psychological Well-being Scales (PWS) were developed with 120 items and have been used in versions with 84, 54, 42, 24, and 18 items, all divided into the same six dimensions of eudaimonic well-being: self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. The use of different combinations of the original 120 items, in different countries and with sociodemographic variability, makes analysis of the reliability and validity of the PWS a complex task. The longer scales have better internal consistency, while the shorter scales have better factorial validity. There is no consensus on the optimal version of the PWS, or on which populations it can be used. We examined scale reliability and factor loadings for the 42-item version in a multi-generational sample from a study of well-being associated with theatre audience involvement (N=581). Participants had similar demographic characteristics to the Ryff development sample. We found comparable internal consistency (α) between older and middle-aged groups, with slightly poorer reliability in the youngest (and smallest) group; average alphas were .71, .78, and .77, respectively, for the three groups. The scales performed with reasonable, but not ideal, factorial validity for the 6-factor model; NFI= .777, CFI= .836, RMSE= .063, PClose= .000, CMIN/DF= 3.089. A single factor hierarchical model did not improve fit. Results suggest that the Ryff scales are reliable across age groups but that there may be factor solutions that are superior to the original Ryff six factors.

Research on end-of-life care in nursing homes comes largely from the viewpoint of staff or family members. We examined patient perspectives on end-of-life care, preferences for care, and quality of life in long-term care settings. We hypothesized that fulfillment of the Self Determination Theory (SDT) needs of autonomy, competence, and relatedness would be related to better well-being and that the degree to which end-of-life care preferences are seen as possible in the setting would be related to SDT need fulfillment and well-being. Preliminary data, collected from older individuals at the end of life (over 55, presence of significant chronic disease, in long term care setting) (n= 72), demonstrated that autonomy, competence, and relatedness measures were moderately and significantly correlated with well-being as measured by life satisfaction, higher positive affect, lower negative affect, and overall quality of life measures The degree to which residents believed that their end-of-life care preferences could be honored in the setting was also significantly correlated with autonomy, competence, relatedness, positive affect, and psychological quality of life. These results are consistent with SDT and suggest that if long term care settings can promote autonomy, connection, and competence in making end of life decisions, possibly by discovering and fulfilling preferences for end of life care, individuals who end their lives on those settings have potential for greater satisfaction and happiness. These results suggest that SDT is a useful framework for ongoing research on how to improve the end of life experiences of older adults in long term care.

Dispositional optimism may be an important resource for well-being across the lifespan. However, the relationship between optimism and quality of life in recent nursing home residents with and without cognitive impairment has not been examined. The aim of this study is to fill this gap in a sample of 66 older adults with a mean age of 74.59 years old (SD=10.37) who were admitted to a nursing home within the previous 30 days. Sixty older adults completed measures of cognition, quality of life, and optimism, and thus were included in analysis for the current study. Participants were split into groups based on the presence or absence of cognitive impairment, and linear regressions were conducted to examine the relationship between optimism and quality of life. In recent nursing home residents without cognitive impairment (n=30), optimism did not predict quality of life and accounted for a very small amount of variance (R2=.042, p=.280). However, in recent nursing home residents with cognitive impairment (n=32), optimism accounted for 20.9% of the variance in quality of life (R2=.209, p=.009). Higher levels of optimism were associated with better quality of life. Future research should explore why a stable trait like dispositional optimism is a stronger predictor of quality of life in recent nursing home residents with cognitive impairment compared to those without cognitive impairment. This line of research would be synergistic with emerging research on the identification and encouragement of strengths in older adults with cognitive impairment.

Aging long-term care residents utilize a variety of coping strategies to manage stressors. While many older adults report religious faith is important in the coping process, it is unclear how religious coping appraisals and religious coping styles fit within a broader coping framework. This poster explores relationships between religious coping and general coping strategies in a convenience sample of older nursing home and assisted living residents (median age = 71.5). In this cross-sectional study, we interviewed residents (N = 102) from long-term care facilities (N = 11) in the Louisville metropolitan area and southern Indiana. Participants responded to questions about religious practices, religious coping, general coping, stress, life satisfaction, psychological distress, and health. The present analyses examined correlations between religious coping appraisals/styles and general coping strategies. We found: 1) small to moderate associations between theoretically adaptive religious coping appraisals/styles (e.g., positive appraisals, collaborative/deferring styles) and theoretically adaptive general coping strategies (e.g., positive reframing, instrumental support), and 2) small to moderate associations between theoretically maladaptive religious coping appraisals/styles (e.g., negative appraisals, self-directing styles) and theoretically maladaptive general coping strategies (e.g., denial, behavioral disengagement). Our results identify interesting conceptual relationships suggesting residents who report positive religious coping appraisals and less independent religious coping styles use adaptive coping strategies more frequently. These constructs may be explored in future research through examining their theoretical uniqueness and whether they independently account for variance in clinically-relevant outcomes. Further study of religious coping in these settings may help promote resilience and optimal aging for long-term care residents.

Background and objectives Activities that provide positive emotions, meaningful social interaction, and psychological stimulation can bolster well-being throughout life. We tested a model of psychological benefit from, and age differences in, adult ticket buyers' involvement with a large regional theatre. Research design and methods We sent online surveys to Actors Theatre of Louisville ticketbuyers, measuring involvement with the theatre, satisfaction/enjoyment, social engagement, flow, and sense of belonging while attending, and well-being. Structural models (N = 496) tested a model of well-being and age differences; focus groups of older subscribers (N = 20) elaborated quantitative findings. Results As hypothesized, theatre involvement was indirectly related to satisfaction and enjoyment of the theatre, hedonic well-being, and social functioning, through the psychosocial benefits of flow, social engagement, and belonging. Age moderated the model relationships: involvement was more strongly related to benefits for younger than older participants, but there were no age differences in the relationship between benefits and well-being. Focus group participants articulated how theatre contributes to a sense of community and pride of place, connecting individual well-being to community well-being. Discussion and implications Involvement in performing arts organizations may have lifelong benefits. The relationship between involvement and psychosocial benefit may be particularly strong for younger audience members despite the fact that older adults have more involvement. Older adults with long-term involvement appear to benefit even when they reduce their involvement. Our qualitative findings underscore the great richness of experience that younger generations might lose as a result of lower participation.

Background: Third-party hearing loss-related quality of life (HLQoL) reports measure the third-party disability as a result of communicating regularly with someone with hearing loss. Scales with known psychometric characteristics validated on a diverse subject population are needed in order to describe the activity limitations and participation restrictions experienced by spouses as a result of living with an individual with hearing loss. Purpose: The purpose of the present study was to develop a scale to measure third-party HLQoL in spouses of people with hearing loss with acceptable psychometric characteristics. This scale is known as the Hearing Impairment Impact–Significant Other Profile (HII-SOP). Research Design: In Study 1, the initial test items were developed and evaluated with a factor analysis for adequate construct validity. In Study 2, the internal consistency reliability, the validity, and the test-retest reliability of the revised test were evaluated. Study Sample: In Study 1, 120 people between 34 and 87 yr of age participated and in Study 2, 164 people between 23 and 88 yr of age participated. Data Collection and Analysis: In Study 1, a 41-item questionnaire was developed based on five content areas: physical adjustment, social activities, emotional reaction, intimate relationship, and change in roles. The scale was submitted to a factor analysis to analyze interrelationships among items, determine the underlying dimensions, and select items for the final scale. In Study 2, the internal consistency reliability, construct validity, and test-retest reliability were evaluated in the revised 20-item questionnaire. The internal-consistency reliability was measured using Cronbach's alpha. Validity was assessed by observing the correlations of the new scale with well-established scales measuring related constructs: overall health-related quality of life, marital communication, HLQoL, and negative affect, in both the person with hearing loss and the spouse. Test-retest reliability was measured in a subset of the spouses who completed the HII-SOP between 2 and 4 wk after the initial scale was completed. Results: The HII-SOP is a 20-item scale with three subscales which measure: (1) the emotions that arise when having a spouse with hearing loss as well as the impact of the hearing loss on the marital relationship, (2) the impact of the hearing loss on the social life of the spouse, and (3) the communication strategies used by the spouse. The scale and its subscales have adequate internal-consistency reliability suggesting that the 20 items do measure a single construct and the subscales do measure distinct subconstructs. The HII-SOP scale was significantly correlated with measures expected to relate to the construct of third-party disability associated with hearing loss. Finally, the HII-SOP scale has adequate test-retest reliability (r = 0.90) and the 95% critical differences is 19.7 points. Conclusions: The HII-SOP is a scale to measure third-party HLQoL in spouses of individuals with hearing loss. Scores of 20–39 reflect mild third-party disability, scores of 40–59 reflect moderate third-party disability, and scores >60 reflect severe third-party disability associated with hearing loss.

There is a gap between what we know about evidence-based depression care and what is available in nursing homes. Closing the gap will require understanding context-specific implementation issues specific to nursing homes. We present implementation fidelity data from the treatment arm of a randomized control trial of BE-ACTIV, a 10-week depression treatment designed for implementation in nursing homes. 40 patients in 15 nursing homes were treated by graduate student therapists. Audio-recorded sessions were rated by the therapists and their Ph.D. supervisor for adherence to treatment protocol and session quality. There was moderate agreement on adherence and quality that exceeded chance (mean ICC for adherence =.81 and session quality =.53). Average adherence to core program features ranged from 80–94%; mean quality was 5.6 (SD 0.61) out of 6 points. Patients completed an average of 7.05 sessions (SD 3.67) and 26 completed 10 sessions. The theoretical basis of BE-ACTIV is behavioral activation; the therapist and client increasingly planned new pleasant events across sessions 1–5, from a mean of 3.7 (SD 1.34) after the first session to about 6 activities a week across sessions 6–9, with a similar progression in percent activities completed, ending with about 80% completed. Number of sessions and number and percent of activities completed were significantly related to the likelihood of remission at post-treatment, and of maintaining improvement at 3-month follow-up. Results demonstrate the feasibility and fidelity of BE-ACTIV in diverse nursing homes with diverse patients, and support the theoretical premise of the intervention.

Research suggests that social networks decrease in size as individuals grow older and that older adults perceive more positivity and less negativity associated with their social relationships (English & Carstensen, 2014). In the context of a larger study of well-being associated with theatre audience involvement, we hypothesized that theatre patrons age 60 and above would report attending the theatre with fewer companion types than younger patrons, but would also report greater social engagement, positive relations, and sense of belonging. Data were from an online survey of 841 theater patrons of a nationally-recognized repertory company. We determined that individuals aged 60 and over attended performances with significantly fewer companion types (M=1.23, SD=.71) than did younger individuals (M=1.45, SD=.84), t(664)= -3.59, p

The study describes results of survey data on providers’ competency, training, and barriers encountered in delivering mental health care to LGBT older adults in nursing homes. Fifty-seven providers completed the survey: 47% psychologists, 12% social workers, 11% psychiatrists, and 4% nurses. Providers had practiced in nursing homes for about 12.5 years. 39% of providers reported they provided no care to LGBT residents the past year, while most of the 61% of providers who did reported working with 1–6 LGBT residents. 62% of providers reported the services they provided were focused on LGBT issues, while 38% reported that the focus was not at all related. For training, 86% of providers reported no formal coursework in LGBT issues or left the item blank; 81% reported no continuing education hours and 70% of providers reported no self-study hours. Providers reported that LGBT issues were relevant to their practice (83%), that they felt somewhat or well prepared to work with this population (76%), and were also somewhat or very willing to learn more (90%). Reported barriers included lack of training in LGBT issues, (85%) lack of familiarity with or availability of evidence-based treatments (76% and 79% respectively), resident unwilling to identify as LGBT (94%), and stigma (91% definitely or probably). Only 21% reported that their personal comfort could be a barrier. Results from this sample indicate facilities need more training, more evidence-based treatments, and less stigma to provide mental health care for the LGBT population.

The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement.This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response.The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome.There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8-45 weeks, five minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity, however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression.