Abstract

Objective: To capture the profile of diversity among specialists certified by the American Board of Professional Psychology (ABPP) compared to a previous analysis in 2012.

Methods: A survey of ABPP specialists was conducted by posting a link on the ABPP website for a month in late 2016. The survey consisted of structured demographic questions, and two unstructured questions regarding board certification and specialists’ experience with diversity.

Results: ABPP specialists are diverse in certain aspects (especially regarding sex and age distribution). However, the majority racial background remains White, followed by only 3% Black, and 3% Latin representation. Over 11% are bilingual and 7% are physically challenged. Recognition as a specialist, job requirement, and professional expectations were the top three themes identified regarding reasons for board certification. The top three themes that were elicited regarding specialists’ experiences with diversity were 1) Need for active outreach and mentoring; 2) ABPP does a good job regarding diversity; and 3) Make it more affordable.

Conclusions: With the need for a competent and diverse workforce, ABPP continues to support diversity initiatives through diversity awards, scholarships for those in need, and working to promote diversity within each specialty. Additionally, ABPP will periodically  conduct  surveys to determine the progress that has been made in increasing the diversity of certified specialists. 

Abstract

The Philippines is a diverse country that will experience an increase in its aging population in the near  future. The aim of this paper is to provide an overview of the main issues surrounding population aging, as well as family caregiving and policies that are of concern to older adults in the Philippines. Policymakers and government leaders must plan for the expected growth in the numbers of older adults, which is likely to increase the demand for services and support for elders and their caregiving families. The Philippines’ unique history and rich culture shapes its citizens’ views on aging and bolsters expectations of informal caregiving for older family members. Research on aging in the Philippines and current policies must be enhanced to adequately address the needs of the country’s aging citizens.

Abstract

Objective: To examine differences between White and African American caregivers in strain, health, and service use in a 

population-based sample of informal caregivers for older adults. We also assessed whether relationship type (parent, other family, friend) and dementia care status (yes or no) were moderators of any racial differences.

Method: We examined 887 informal caregivers via covariate-adjusted 3 x 2 x 2 factorial ANOVAs

Results: After covariate adjustment, there were few significant racial differences in caregiving strain, health, and service use. Dementia caregivers reported greater strain, and there were three-way interactions among relationship type, dementia care status, and race for physical strain and emotional stress. 

Discussion: Previous findings suggesting substantial racial differences in caregiver strain, which have primarily come from convenience samples that combined care relationship types, were not replicated. Racial and ethnic differences in caregiving may be context-specific. Historical changes in caregiving should be examined in future research.

Abstract

Purpose: To examine the roles of both patient symptoms, and subjective appraisals of stress (self-efficacy, symptom barriers, symptom distress), in understanding well-being (anxiety, depression, cancer-specific quality of life, mental health quality of life, and physical health quality of life) in breast cancer patients.

Methods: We examined data from 104 female breast cancer patients. Using a stress process model, we hypothesized that while high levels of patient symptoms would be associated with poorer patient well-being, these effects would be mediated by subjective appraisals, including patient self-efficacy, perceived symptom barriers, and symptom distress.

Results: As expected, higher levels of patient symptoms were associated with poorer well-being on all five indicators. Subjective appraisals of stress added significantly to predictors of well-being, and were mediators of this relationship across all five outcomes.

Conclusions: While patient symptoms are important predictors of patient well-being, subjective appraisals of the stressfulness of symptoms, and of patients’self-efficacy in managing symptoms, are also key factors. The findings suggest the utility of a stress process model in understanding well-being in breast cancer patients, and point to the potential value of targeting patient appraisals as well as symptoms to improve psychological well-being and quality of life.

Abstract

Objectives: To determine whether employed family caregiver reports of caregiving to work conflict (CWC) are associated with emotional, physical, and financial strain, and whether organizational factors, including supervisor disclosure and caregiver-friendly workplace policies, attenuate these effects. 

Methods: We examined 369 full-time employed caregivers of adults ages 50 and above from the 2015 AARP and National Alliance for Caregiving population-based study, Caregiving in the United States, using ordinary least squares hierarchical regression and moderation analyses. 

Results: Regression analyses showed that caregiver reports of more CWC, in addition to disclosure of caregiving, were associated with greater emotional, physical, and financial strain after controlling for demographics and caregiving stressors, and workplace policies did not attenuate strain. Neither disclosure nor policies moderated the impact of CWC on caregiver strain. 

Discussion: Results suggest the importance of workplace strain in the caregiving stress process and suggest that disclosing caregiving responsibilities to supervisors should be closely examined. 

Abstract

Objectives: Compare care demands, strain, and health across 912 primary and secondary caregivers of parents, other family, and friends aged 50 and older. 

Methods: Data came from the nationally representative Caregiving in the U.S. 2015 data set. Two by three factorial ANOVAs and binary logistic regression examined the effects of primary caregiver status and relationship type on care demands and well-being. 

Results: Primary caregivers provided more hours of care for a longer duration and were more likely to report financial stress, and that caregiving made their health worse. Primary caregivers did not differ from secondary caregivers in emotional stress, and physical strain was comparable in primary and secondary caregivers of parents and other family. Caregivers of parents generally reported the highest levels of demands and stress/strain. Controlling for amount of care provided attenuated some of these differences. 

Conclusions: Secondary caregivers provide less care but report emotional stress comparable to primary caregivers. Primary caregivers of friends provide high levels of assistance that may increase their physical strain. 

Clinical Implications: Caregiver research and intervention should include greater attention to needs of secondary caregivers, and caregivers of friends, and ways to strengthen their potentially critical roles.

Abstract

Background and objectives: Studies comparing racial/ethnic differences on measures of psychological and physical well-being for dementia caregivers have reported differences between minority and white caregivers. Recruitment methods often differ for minority and white participants due to enrollment targets and may lead to biased comparisons, especially in convenience samples. We aimed to examine racial/ethnic differences in dementia caregiver outcomes and to determine whether differences vary between studies with population-based or convenience samples. 

Research design and methods: We systematically reviewed articles with primary data from PubMed, Google Scholar, and PsycINFO. We included studies comparing African American or Hispanic/Latino to white dementia caregivers on measures of psychological well-being or physical well-being. Reviewers screened titles and abstracts, reviewed full texts and conducted risk-of-bias assessments. Meta-analyses were conducted to assess effects by race/ethnicity and study bias. 

Results: A total of 159 effects were extracted from 38 studies, 2 of which were population based. Random-effects models revealed small but statistically significant effects with better psychological well-being in African American caregivers compared with white caregivers in both population-based (d = -0.22) and convenience sample studies (d = -0.21). Hispanics/Latino caregivers reported lower levels of physical well-being than white caregivers (d = 0.12), though these effects varied by level of rated study bias. 

Discussion and implications: Consistency across study methods raises confidence in the validity of previous reports of better psychological well-being in African American caregivers. Future studies should use population-based samples with subgroups of Hispanic/Latino, Asian American, and American Indian caregivers that are culturally distinct on factors such as country of origin and tribe. 

We used the PROSPERO Method [CRD42019121053]

Abstract

Objective: To examine differences in prevalence and risk factors of dementia by race/ethnicity and immigrant status using a nationally representative sample of Medicare beneficiaries. 

Methods: This was a cross-sectional study performed in the United States among non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and other Medicare beneficiaries from round 1 of the National Health and Aging Trends Study (N = 7,609). The authors used log-binomial regression analyses to investigate risk factors and interactions between race/ethnicity and immigrant status and dementia. Stratified log-binomial regression analyses by race/ethnicity were used to interpret the results of interaction effects of immigrant status found in these surveys. Analyses were conducted in three forms: probable dementia versus possible and no dementia, probable and possible dementia versus no dementia; and probable dementia versus no dementia. 

Results: Consistent with previous studies, U.S.-born NHBs have a higher prevalence of dementia than U.S.-born whites, Hispanics, and others. Immigrant status moderated the relationship between race/ethnicity and dementia. NHWs, Hispanics, and other immigrants had a higher prevalence of dementia compared with their U.S.-born counterparts. However, U.S.-born NHBs had a higher prevalence of dementia compared with NHB immigrants. Results were consistent across the three forms of analysis. Greater age predicted higher dementia across the four racial/ethnic groups. 

Conclusion: Immigrant status may have complex effects on dementia risk. Selection factors affecting immigration—varied health and educational systems in diverse countries of origin, acculturative stress, and validity of dementia assessment across diverse groups—deserve further attention.

Abstract

Cognitive dysfunction is a predictor of driving cessation in older adults and a common sequela of heart failure (HF). Although HF has been associated with an increased risk of driving cessation, the independent relationship between HF and driving cessation after cognitive function is considered remains to be established. The objective of these analyses is to examine HF as an independent predictor of driving cessation across three years among a cohort of older drivers in the United States. Analyses included 850 older adults who completed sensory, cognitive, and physical measures at baseline and mobility and health measures at a three-year follow-up. Cox regression was used to examine the effects of HF, stroke, vision, cognition, and physical function as predictors of incident driving cessation over three years. Participants with HF were over three times more likely to cease driving, HR = 3.19, 95% CI [1.27, 8.02], p = .014. However, HF was no longer a significant predictor of driving cessation when cognitive performance was considered, HR = 1.70, 95% CI [0.67, 4.30], p = .262. These findings suggest that the risk of driving cessation may be a consequence of the cognitive dysfunction associated with HF, rather than from HF itself. Cognitive training should be investigated among persons with HF to potentially prolong driving mobility.

Abstract

Purpose: To compare the Cognitive Self Report Questionnaire (CSRQ) hearing and cognitive subscale ratings among older 

adults with and without probable mild cognitive impairment (MCI) and examine whether self-report as measured by the CSRQ is associated with objective measures of hearing, auditory processing, and cognition.

Method: Data analyses included 97 older adults 61 to 91 years of age. Participants completed the CSRQ self-report measure as well as a battery of objective measures, including pure-tone audiometry, degraded speech understanding, temporal processing, and memory.

Results: Older adults with probable MCI rated their cognitive abilities more poorly than those without MCI, p=.002, but ratings of hearing and auditory abilities did not differ between the two groups, p=.912. Age and CSRQ hearing subscale ratings explained a significant proportion of variance in objective measures of hearing and degraded speech understanding, R2=.39, p<.001. Age, sex, mental status, and CSRQ cognition subscale ratings explained a significant proportion of variance in objective memory performance, R2 =.55, p<.001.

Conclusions: Taken together, these results suggest that the CSRQ is an appropriate self-report measure of hearing, cognition, and some aspects of auditory processing for older adults with and without probable MCI.

 Abstract

To encourage policymakers, business owners and the general public to recognize the profound consequences of an aging population, the University of South Florida's Policy Exchange Center on Aging (FPECA) and the School of Aging Studies have developed geo-coded county-level population maps displaying the percentage of residents who are 65 years of age or older in every Florida county from 2010 through 2040. Using United States Census Bureau medium population projections, these maps display Florida county-level aging in 5-year cohorts with filters that allow viewers to see projected population aging by sex (male and female) as well as by race and ethnicity (White, Black, and Hispanic).

Abstract

OBJECTIVES: To evaluate and contrast 25 content areas essential to the primary care of older adults by medical faculty, thus identifying faculty beliefs and areas of possible improvement. DESIGN: Using measures from the Healthcare Effectiveness Data and Information Set, the Consumer Assessment of Healthcare Providers and Systems, and Healthy People 2020, nine practicing clinical faculty identified 25 content areas essential to the primary care of older adults. 

SETTING: A large academic health center in southeastern United States. 

PARTICIPANTS: Eighty-two university medical faculty. 

MEASUREMENTS: Faculty rated importance, knowledge, and confidence in teaching the 25 content areas on a scale from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings for importance and confidence in teaching were calculated and assessed. The survey had high internal consistency within each of the three domains—Cronbach’s α > .94. 

RESULTS: The most important content areas were being able to explain details about patient’s condition and taking medication clearly, followed by taking age-appropriate history. The three largest gaps were: “evaluating sensory impairment,” “identifying and counseling at-risk drivers,” and “evaluating cognition.” The three smallest gaps were: “explaining prescribed medications,” “explaining health conditions in easy-to-understand language,” and “taking an age-appropriate patient history and performing a physical assessment.” 

CONCLUSION: Medical faculty were comfortable with topics reflecting primary care expertise but expressed less confidence with more specialized topics, such as sensory or cognitive impairment and driving. This may represent key areas for geriatrics training applicable to all those involved in education and training of future healthcare professionals. Integration of specialists (eg, neurologists, psychiatrists) may improve the geriatrics curricula.

Abstract

The number of Americans ages 65 and older is projected to more than double over the next four decades and to equal nearly one-fourth of the entire population by 2060. Recognizing that the health care workforce in the United States is not sufficiently prepared to meet the care needs of this growing population, the National Academy of Medicine has recommended curricular enhancements for health professional educational programs. To meet this challenge, the University of South Florida College of Nursing applied curriculum mapping principles and concepts to examine and align Family Nurse Practitioner and Adult-Gerontology Primary Care Nurse Practitioner program curricula for congruence with Partnership for Health in Aging multidisciplinary geriatric competencies. Through this process, we developed a geriatric-specific curriculum map and threaded geriatric-specific content, learning experiences, and learning assessment strategies to promote attainment of all 23 competencies. Given the growing role that nurse practitioners are projected to play in the delivery of primary care for older adults in the future, it is imperative that colleges and schools of nursing provide students with learning experiences to support attainment of the knowledge and skills graduates will need to care for older adults in practice. The techniques and strategies described here represent our approach. 

Abstract

As communities strive to create age-friendly accommodations that promote the health and wellbeing of a growing aging citizenry, the concomitant growth of caregivers requires additional planning considerations. Increasingly, persons providing care are managing their own aging and negotiating their community’s infrastructure for both themselves as well as on behalf of their aged loved ones.This study reports on the findings from a global age-friendly community effort that examined caregivers’ perception of the importance of community features across three clustered domains of community life: the built environment; the social environment; and, community and health supports. The study surveyed caregivers (n = 216) and non-caregivers (n = 135) age 50 and older in a Southeastern United States community in which more than half of the residents are age 50 and older and one-third are age 65 and older. Results indicate significant differences across multiple areas with the greatest differences noted in the areas of housing, community supports, and transportation. The findings suggest that caregivers consider their own prospective needs as well as more efficiently managing the needs of their care recipients. Planning to enhance the community features may subsequently benefit aging persons as well as caregivers. 

Abstract

Background: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environment. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.

Purpose: This research examines the extent of cross-jurisdictional resource sharing among LHDs, the programmatic areas and organizational functions for which LHDs share resources, and LHD characteristics associated with resource sharing.

Methods: Data from the National Association of County & City Health Officials' 2013 National Profile of LHDs were used. Descriptive statistics and multinomial logistic regression were performed for the 5 implementation-oriented outcome variables of interest, with 3 levels of implementation.

Results: More than 54% of LHDs shared resources such as funding, staff, or equipment with 1 or more other LHDs on a continuous, recurring basis. Results from the multinomial regression analysis indicate that economies of scale (population size and metropolitan status) had significant positive influences (at P ≤ .05) on resource sharing. Engagement in accreditation, community health assessment, community health improvement planning, quality improvement, and use of the Community Guide were associated with lower levels of engagement in resource sharing. Doctoral degree of the top executive and having 1 or more local boards of health carried a positive influence on resource sharing.

Conclusions: Cross-jurisdictional resource sharing is a viable and commonly used process to overcome the challenges of new and emerging public health problems within the constraints of restricted budgets. LHDs, particularly smaller LHDs with limited resources, should consider increased resource sharing to address emerging challenges.

***Collaborative Research Project (IRB H15420)