Pre-loss group therapy for dementia family care partners at risk for complicated grief.

Introduction: Dementia family caregiving may span more than a decade and places many family care partners (CPs) at risk for poor bereavement outcomes; estimates of complicated grief in bereaved dementia family CPs range from 10% to 20%. We adapted our efficacious complicated grief group therapy intervention for bereaved dementia caregivers for soon-to-be bereaved dementia CPs at risk for complicated grief to facilitate healthy death preparedness and eventual bereavement-pre-loss group therapy (PLGT).

Methods: In this Stage IB pilot intervention study, we implemented and evaluated PLGT in three psychotherapy group cohorts with family CPs at-risk for complicated grief whose person living with dementia (PLWD) had a life expectancy of 6 months or less and resided in a nursing home.

If we knew then what we know now: The preparedness experience of pre-loss and post-loss dementia caregivers.

We evaluated the relationship between grief preparedness and grief experience in 106 family caregivers anticipating or who had experienced the death of a family member with dementia. Using a phenomenological lens to discern a process of meaning-making in narratives, we found preparation that included positive construction of memories, death as the end of suffering, relationship resolution, and shared construction of meaning were associated with positive grief. Those caregivers who experienced the family member's decline as traumatic, caregiver role loss, unavailable support, and difficulties creating a new life reported inadequate death preparation, and difficulty making meaning of the illness and death.

Resilience in Bereaved Caregivers of Persons With Dementia.

The purpose of the current study was to identify characteristics of resilience using surveys in 50 bereaved caregivers for persons with dementia who lost their care recipient in the past 6 months. Surveys were reviewed and sorted as demonstrating a resilient grieving process or a problematic grieving process. Resilience was defined as the ability to adapt in a positive direction, with adequate support resources in place despite destabilizing experiences.

State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health.

Interprofessional education (IPE) is essential to develop the healthcare workforce of the future. Geriatrics healthcare professionals have long championed innovations in IPE and patient care, but there is increased urgency to address challenges in aging, dementia, and geriatric mental health in America. In 2010, the Partnership for Health in Aging multidisciplinary competencies and a related position statement in the Journal of the American Geriatrics Society addressed interdisciplinary team (IDT) training in geriatrics.

Individual versus interprofessional team performance in formulating care transition plans: A randomised study of trainees from five professional groups.

Health professions trainees' performance in teams is rarely evaluated, but increasingly important as the healthcare delivery systems in which they will practice move towards team-based care. Effective management of care transitions is an important aspect of interprofessional teamwork. This mixed-methods study used a crossover design to randomise health professions trainees to work as individuals and as teams to formulate written care transition plans.

Supporting Caregivers of Rural Veterans Electronically (SCORE).

Background: The increasing prevalence of dementia, including among rural veterans, highlights the improved outcomes possible for caregivers who receive effective support. However, providing these complex interventions in rural areas presents challenges. Internet-based and telephone-based caregiver support can potentially expand access to effective support.

Complicated grief in older adults: a randomized controlled trial of complicated grief group therapy.

Purpose: This study compared the efficacy of complicated grief therapy (CGT; Shear, K. [2003]. Complicated grief: A guidebook for therapists [Liberty Version].

Predictors of attrition in older users of a home-based monitoring and health information delivery system.

Objective: This retrospective study evaluated predictors of attrition in data from veterans with chronic medical conditions who were enrolled in a Veterans Administration Care Coordination Home Telehealth program.

Subjects And Methods: Data were collected over a 4-year period. The enrolled sample was 73 veterans, 55.

Review of Veterans Health Administration telemedicine interventions.

The Veterans Health Administration (VHA) is a leader in developing and implementing innovative healthcare technology. We review 19 exemplary peer-reviewed articles published between 2000 and 2009 of controlled, VHA-supported telemedicine intervention trials that focused on health outcomes. These trials underscore the role of telemedicine in large managed healthcare organizations in support of (1) chronic disease management, (2) mental health service delivery through in-home monitoring and treatment, and (3) interdisciplinary team functioning through electronic medical record information interchange.

Reaching out to older veterans in need: the Elko clinic demonstration project.

Context: The challenge of providing meaningful health care services to veterans living in rural communities is a major public health concern that involves redefining the traditional facility-based model of care delivery employed in urban areas.

Purpose: This paper describes the steps of a demonstration project, the Elko Telehealth Outreach Clinic. The clinic, located in Elko, Nevada, was created to meet the health care needs of veterans who expressed a desire for greater access to VA services.

The Care Coordination Home Telehealth (CCHT) rural demonstration project: a symptom-based approach for serving older veterans in remote geographical settings.

Introduction: Innovative healthcare delivery strategies are needed to address the healthcare needs of the 3.5 million older veterans living in US rural areas who face unique healthcare delivery challenges, including transportation barriers, poverty, and limited access to health professions and community-based programs. The care coordination home telehealth (CCHT) rural demonstration project was developed to address the mismatch between the timely identification of patient needs and the care delivered by the traditional disease-oriented institutionally-based healthcare delivery system for older rural veterans.

Supporting the labor force participation of older adults: an international survey of policy options.

The unprecedented aging of the world's population challenges many institutions, including labor markets and public pension programs. This study was conducted to survey expert opinions regarding conditions and policies that affect employment of older adults. Eighty-nine respondents from 26 nations responded to an Internet survey regarding their own experiences with the aging labor force; factors that encouraged or discouraged labor force participation of older adults; and government responses to these issues.

The role of grief in dementia caregiving.

The literature examining issues of caregiver stress, burden,or depression has focused on the stress-process model of caregiving, which posits that there are characteristics inherent in dementia and in the course of caregiving for a person with dementia that can cause stress in the caregiver's life. A more recent literature has emerged that argues that issues of loss and grief play a significant role ina caregiver's ability to cope with the stressors of caregiving. This article reviews the caregiver stress and grief literatures,and proposes a conceptual model of dementia caregiving that outlines pathways of stress and grief in dementia caregiving.

Project ADAPT: a program to assess depression and provide proactive treatment in rural areas.

Purpose: We describe and evaluate a project designed to pilot test an evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. Project ADAPT-Assuring Depression Assessment and Proactive Treatment-utilized existing primary care resources to overcome barriers to sustainability experienced by similar projects.

Design And Methods: This multifaceted intervention, which was structured after the successful IMPACT (Improving Mood/Promoting Access to Collaborative Treatment) research intervention, used on-site geriatric depression specialists, clinic staff training, team collaboration, and depression practice guidelines to improve depression care for rural elders.

End-of-life care preferences of older adults and family members who care for them.

Using data from a series of in-depth semi-structured telephone interviews with family caregivers (N = 110), this study explored preferences for end-of-life care and the types of plans made. Caregivers provided rich descriptions of care receivers' perceived preferences for care at six weeks (post-patient discharge due to hip fracture or stroke), as well as their own preferences at one year and at five years. Three general themes characterizing care receivers' preferences for care emerged from the narrative responses: preferred setting for care, expectations for family care, and life-sustaining treatment preferences.

Social work and end-of-life care for older people: a historical perspective.

End-of-life issues became increasingly complicated during the 20th century as profound shifts occurred in who died, how they died, and when they died. This article reviews societal changes related to death in the United States and chronicles the developments in social work practice with and for dying people and their families in the 20th century, leading up to the 1993 policy statement of the National Association of Social Workers on end-of-life decision making, which reinforced that client self-determination, a fundamental principle of social work, should apply to people planning for their deaths or undergoing a dying process. After identifying limitations in policies and practices, suggestions are offered to promote competent social work practice and enhance end-of-life care, particularly with reference to the dying process of older people.