Enhancing trauma-informed care for older veterans: clinician perspectives on trauma practices and curricular needs.

Trauma-informed care is mandated in long-term care settings in the United States; however, little is known about clinicians' perspectives on trauma-informed care educational needs. To address this gap, we gathered responses to closed- and open-ended questions from two samples who work with older adults: (1) hospice and palliative care staff ( = 279) completing a recurring bi-annual survey, and (2) clinicians from diverse settings ( = 242) responding to live polling during a Veterans Affairs (VA) national webinar. Results of qualitative and quantitative analysis revealed that both routinely screened for trauma history or posttraumatic stress disorder (PTSD).

Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility.

Background: Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs.

Methods: A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods.

Implementation of STAR-VA for behavioral symptoms of dementia in acute care: Lessons learned.

As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation.

Maximizing Veterans Health Affairs Community Hospice Collaborations: Review of Perceived Resource Needs to Support Veterans at End of Life.

Within the United States, approximately 330 000 military veterans die annually, but only 5% of deaths occur in Veterans Health Administration (VHA) facilities. To help provide end-of-life care for veterans, the VHA built community partnerships with community hospice and palliative care (HPC) organizations. Veterans experience unique psychosocial factors making it vital to ensure HPC organizations have access to veteran-specific knowledge and resources to reduce suffering.

Lived Experience: A Case-Based Review of Trauma-Informed Hospice and Palliative Care at a Veterans Affairs Medical Center.

Many individuals who present for hospice or palliative care might have experienced trauma during their lives, with some progressing to post-traumatic stress disorder. As these individuals face life-limiting illness, trauma might resurface. Consequently, physical and emotional health might suffer due to exacerbation of trauma-related symptoms, such as anxiety, irritability, or flashbacks.

A Citation Review of 83 Dissemination and Implementation Theories, Models, or Frameworks Utilized in U.S.-Based Aging Research.

Background And Objectives: Dissemination-implementation.org outlines 110 theories, models, and frameworks (TMFs): we conducted a citation analysis on 83 TMFs, searching Web of Science and PubMed databases.

Research Design And Methods: Search terms were broad and included "aging," "older," "elderly," and "geriatric.

Trauma re-engagement and PTSD in older medically ill veterans: implications for trauma-informed care.

Objectives: We characterize rates and correlates of PTSD and of trauma re-engagement without PTSD in medically ill older Veterans, as well as supportive strategies, with the goal of advancing trauma-informed care.

Methods: We interviewed medically ill older Veterans ( = 88, M age 75.13, SD = 6.

Trauma-Informed Care in Long-Term Care Settings: From Policy to Practice.

By older adulthood, nearly all older adults will have been exposed to at least one potentially traumatic event, and the majority (93%) of older veterans report exposure to at least one event. Some may have developed posttraumatic stress disorder (PTSD) during their lifetimes; however, most do not, as the prevalence of PTSD in later adulthood is low. Nevertheless, the long-lasting psychological effects of trauma may manifest in later life, exacerbated by the normative experiences of aging (e.

Supporting Veterans with dementia to remain in the community: strategies used in 12 Veterans Health Administration programs.

The Veterans Health Administration (VA) provides services to growing numbers of Veterans with dementIa, individuals at heightened risk for hospitalizations and nursing home placement. Beginning in 2010, the VA funded 12 innovative pilot programs to improve dementia care and help Veterans remain at home. We conducted a retrospective qualitative analysis of program materials and interviews with physicians, nurses, social workers, and other personnel (n = 33) to understand the strategies these programs adopted.

Advancing Trauma-Informed Care Education for Hospice and Palliative Staff: Development and Evaluation of Educational Videos.

Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit.

Validation of a Comprehensive Measure of the Family Caregiver Experience: The Caregiver Reaction Scale.

Objectives: The Caregiver Reaction Scale (CRS) is a multi-dimensional measure of the family caregiving experience that assesses role conflict, challenges, and positive aspects of caregiving. The CRS has been validated in a sample of older adult caregivers who sought counseling, but its validity and reliability in a broader population of caregivers had not been established. This study aimed to explore how well the CRS assesses the multiple dimensions of the caregiving experience in a sample of family caregivers who match the national profile of caregivers and to confirm the validity and structure of the subscales.

Application of treatment fidelity in tailored caregiver interventions.

Objectives: Demonstrations of the effectiveness of interventions requires evidence that the model can be implemented with fidelity. Caregiving interventions that are tailored to the individual or family require flexibility, which adds some challenges to the assessment of fidelity. This paper outlines the components necessary for examining treatment fidelity and common barriers to implementing fidelity studies, offers considerations for designing fidelity studies with tailored caregiver interventions, and aims to provide a set of procedures that can be used to guide future fidelity studies.

Preliminary Evidence for the Validity and Reliability of the Caregiver Reaction Scale.

Objective: Reliable and valid measures of caregiver experience are critical components of researching the caregiver experience and providing effective care to family caregivers. Assessments should be comprehensive, including positive aspects of caregiving as well as multiple dimensions of stress and burden (Family Caregiver Alliance, 2006). One such measure is the Caregiver Reaction Scale (CRS), a clinical tool adapted from research protocols in 1990.