Age and health bias in practicing clinical psychologists

Effects of Alzheimer's Diagnosis and Gender on Ageist Attitudes, Aging Anxiety, and Emotional Reactions to Older Adults

BACKGROUND AND OBJECTIVES

We investigated whether ageist attitudes, aging anxiety, and emotional reactions to older adults differ based on Alzheimer's disease (AD) diagnosis, older adult gender, and participant gender, as well as their interactions.

RESEARCH DESIGN AND METHODS

Using an experimental design, 291 participants (176 men, 115 women; 19-55 years) were randomly assigned to read 1 of 4 descriptions of an older adult that varied cognitive health and gender. Measures of ageist attitudes, aging anxiety, and emotional reactions to the older adult were completed online.

RESULTS

Relative to a cognitively intact older adult, an older adult with AD evoked less ageist attitudes, less aging anxiety, more compassion, and less emotional distance. A significant interaction between older adult gender and participant gender indicated women felt greater emotional distance from an older adult man than an older adult woman, while men showed no significant difference.

DISCUSSION AND IMPLICATIONS

The more positive emotions and less ageist responses to an older adult with AD could present as paternalistic and diminish older adults' agency. Women may prioritize shared gender identity over age, which has implications for caregivers and health professionals working with older adults.

[Clinical Judgement and Relational Competence in the Psychotherapy of Older Patients]

The negative attitude of psychotherapists towards the treatment of older patients in the past has weakened in the recent past. Nevertheless, the question remains as to how therapists perceive older patients in comparison to younger patients, what clinical judgements they arrive at and how they perceive the relationship with them. In the present study, which was conducted as part of the ÄPP study (Older Patients in Psychotherapy), therapists were asked to assess a self-selected younger (<40 years) or an older patient (>65) with regard to various variables. A total of 527 completed questionnaires were available. Two-factor analyses of variance were used to show, among other things, that younger therapists (compared to their older colleagues) rate older patients more negatively in terms of suitability for psychotherapy, the patient's ability to establish a therapeutic working relationship and other parameters. In comparison with their older colleagues, younger therapists perceive themselves as less competent in their relationships with older patients. There are only slight differences with younger patients.

Originalbeiträge (Originals). Unterscheidet sich der therapeutische Stil in altershomogenen und altersheterogenen therapeutischen Dyaden?

Does the therapeutic style differ in age-homogeneous and age-heterogeneous therapeutic dyads?

BACKGROUND AND AIMS

Differences between age-homogeneous and age-heterogeneous therapeutic dyads have rarely been the subject of research.The present study aimed to investigate differences in therapeutic style (Healing and Stressful Involvement).

METHOD

A sample of 527 questionnaires completed by therapists of different ages was available. Therapy style was compared between two patient groups (under 40 and over 65 years old) and three therapist groups (25-39, 40-59, ≥ 60).

RESULTS

The results show in particular more stress experienced by younger therapists in the treatment of older patients, while older therapists report less stress.There were no or fewer differences in the treatment of younger patients.The regression-analytical results show that the experience of stress in the therapy of older people is associated with a greater fear of old age.

CONCLUSION

Finally, some conclusions are discussed with regard to training and supervision of therapists in the treatment of older people.

Psychotherapy with older adults: Ageism and the therapeutic process

Objective This study explores how ageism in therapists is manifested in psychotherapy with older adults and how therapists deal with its impact on their therapeutic work. Method: Semi-structured interviews were conducted with 14 therapists and analyzed using grounded theory methodology. Results: Findings clustered around two themes: (i) maintaining openness to change while acknowledging limitations; (ii) dealing with manifestations of ageism inside therapy by going beyond relating to older patients only in terms of their chronological age. Conclusions: Our findings indicate that while therapists maintain an optimistic view regarding the possibility of therapeutic change, the therapeutic encounter with older patients triggers certain ageist therapeutic biases and behaviors in therapists, even in experienced therapists who have competency in working with older adults. Our findings also indicate that dealing with therapists' ageism in psychotherapy with older patients requires therapists not only to be aware in advance of their ageist attitudes but also to continuously engage in the management of the manifestations of ageism inside treatment. We use the conceptual framework of countertransference to suggest an understanding of the relationship between therapists' ageism and the therapeutic process. Implications for training and practice are discussed.

Posttraumatic stress disorder symptom severity and functional impairment in the education domain

To comprehensively understand and treat Posttraumatic Stress Disorder (PTSD), we need to accurately assess how PTSD symptoms affect people's daily functioning (e.g., in work, study, and relationships). However, the predominant use of self-report functional impairment measures-which are not validated against observable behavior-limits our understanding of this issue. To address this gap, we examined the relationship between posttraumatic stress (PTS) symptoms (including symptom clusters) and subjective and objective measures of functional impairment in the education domain. University students completed online self-report measures of educational impairment, PTS symptoms, intelligence and childhood trauma. We accessed participants' average grades at the end of the semester in which they participated. After controlling for IQ and childhood trauma, increased PTS symptoms were associated with both higher subjective educational impairment and lower Grade Point Average; this relationship was strongest for subjective global ratings of educational impairment, compared to educational impairment assessed according to specific examples. Our results suggest conceptual overlap between symptoms and impairment, and point to the benefit of using both objective and subjective modes of assessing impairment.

Evaluating the Working with Older Adults Scale with Clinical Psychology Doctoral Students

Background and Objectives

The ongoing workforce shortage in geropsychology requires continued efforts to understand the factors that influence whether or not students choose to enter this field. The current study builds on prior research by replicating the Working with Older Adults Scale (WOAS) model. Further, the scale was expanded to add professional attitudes, adultist concerns, and number of known professionals in the field of aging.

Research Design and Methods

Graduate students in clinical psychology (n = 117) completed the WOAS and new items as part of a larger survey of graduate students in an APA-accredited doctoral program. Structural equation modeling was used to first replicate the existing WOAS model and then expanded to include new antecedents in a second model.

Results

Results were largely similar to past research validating the WOAS, with the exception that Perceived Behavioral Control was not a significant predictor of Intention in this population. In the expanded model, new items improved the overall model fit and exhibited significant indirect paths to predict intention to work with older adults.

Discussion and Implications

These findings further validate use of the WOAS and expand scholarly understanding of the factors influencing the choice of a career in aging. Individuals positioned to encourage careers in aging may wish to address adultist concerns, explore attitudes about such careers, challenge unhelpful assumptions, and provide greater exposure and access to mentors in the field as part of recruitment efforts.

Health Bias in Clinical Work with Older Adult Clients: The Relation with Ageism and Aging Anxiety

OBJECTIVES

This experimental study examined health bias in mental health trainees' ratings of work with an older adult client and whether differences based on health were moderated by aging anxiety and ageist attitudes.

METHODS

Graduate-level mental health trainees (N = 488) were randomly assigned to read a vignette of an older adult client in good health or poor health, after which they rated aspects of clinical work with this client and completed measures of aging anxiety and ageist attitudes.

RESULTS

Trainees rated clinical work with the unhealthy older adult client more negatively than with the healthy older adult client. Health-based differences were larger at average and higher levels of ageist attitudes when considering the appropriateness of the client for therapy and at average and higher levels of aging anxiety for perceived competence to treat and comfort in treating the presenting complaint.

CONCLUSIONS

Trainees' health bias toward older adults may be magnified by higher aging anxiety and ageist attitudes. Training programs' intervention on these variables may improve geropsychological competencies of future mental health professionals.

CLINICAL IMPLICATIONS

Quality of mental health care for older adult clients may be compromised when biases about older adults, particularly those in poor health, are not addressed.

Scoping Review on Ageism against Younger Populations

Systematic efforts have been carried out to study ageism against older populations. Less is known about ageism against younger populations, including how it is defined, how it manifests, its effects, and how it can be addressed. A scoping review was conducted aimed at identifying available evidence on these topics. A comprehensive search strategy was used across thirteen databases, including PubMed, EMBASE, and CINAHL. Records were screened by two independent reviewers. Data extraction was done by one rater and independently reviewed by a second rater. Of the 9270 records identified, 263 were eligible for inclusion. Most of the evidence focused on the manifestation of ageism (86%), followed by a focus on the determinants of ageism (17%), available interventions to address ageism (9%), and the effects of ageism (5%). This study points to the inconsistent terminology used to describe ageism against younger populations and the relatively limited theoretical rationale that guides existing studies. It also highlights key research gaps and points to the strengths of existing research.

Working with Older Adults Scale: Application of the Theory of Planned Behavior

BACKGROUND AND OBJECTIVES

The expanding population of older adults in the United States, coupled with provider hesitance to work with this population, is expected to result in a large service gap, particularly in the health care field. Research on provider hesitancy has largely focused on the impact of attitudes toward older adults and professional competency, with some recent explorations of social influences. There is currently no comprehensive measure that includes all of these areas.

RESEARCH DESIGN AND METHODS

The present study outlines the development of the Working with Older Adults Scale (WOAS), which is grounded in the theory of planned behavior as applied to working with older adults. The WOAS is composed of 20 items, rated on a 7-point Likert scale, that make up four subscales: (i) Attitude, (ii) Subjective Norm, (iii) Perceived Behavioral Control, and (iv) Intention.

RESULTS

Results indicated that, for the young adult college student sample it was developed with, the measure has an excellent factor structure and good internal reliability and construct validity. Consistent with the theory of planned behavior model, intention to work with older adults was significantly predicted by attitudes, subjective norm, and perceived behavioral control. Subjective norm accounted for the greatest amount of variance. Further analyses revealed differential effects of age, gender, and experience on the WOAS subscales.

DISCUSSION AND IMPLICATIONS

The WOAS, and underlying theory, offers new insights and ideas for future exploration of the service gap between older adults' needs and professional availability across health service fields.

Depressed Older Patients with Death Wishes: Experimental Evidence for Psychotherapists' Age and Health Bias

Objectives: When psychotherapists encounter an older patient with depression and death wishes, especially when burdened by physical illness, they may be subject to judgmental biases. This study investigates how this group of patients with highest suicide risk may experience discrimination both on age and health status. Methods: Using a 2 × 2 [chronological age x physical health status] vignette design, psychotherapists (N = 147) were randomly presented with one of the four variants of a case describing a patient with depression and death wishes (i.e., 78 years old + poor physical health; 78 years old + normal physical health; 48 years old + poor physical health; 48 years old + normal physical health). Afterward, participants' attitudes toward the case were assessed. Results: In case of the hypothetical patient's old age and poor health status, participants did not underestimate the pathological significance of his death wishes, but nevertheless showed less optimistic treatment attitudes and less confidence in psychotherapeutic treatment. Conclusions: Psychotherapists' age bias and health bias may serve as two potentially fatal factors influencing the provision of mental health services. Clinical Implications: Psychotherapists may contribute to better mental health-care provision of older adults with depression and the prevention of late-life suicide by increasing awareness of their age and health bias.

Do Treatment Attitudes and Decisions of Psychotherapists-in-Training Depend on a Patient's Age?

OBJECTIVE

The objective of this study was to analyze how psychotherapists' treatment attitudes and decisions depend on a patient's age.

METHODS

A sample of psychotherapists-in-training (N = 97) responded to questions concerning a naturalistic case vignette of a female patient with symptoms of depression and anxiety. The patient was described as being either 79 or 47 years old.

RESULTS

Results revealed no evidence that psychotherapists-in-training had more negative treatment attitudes towards an older relative to a younger patient. However, the patient's age had an influence on participants' therapeutic approach. Specifically, psychotherapists-in-training recommended short- as opposed to long-term therapy, considered motivational clarification less important, and viewed clarifying techniques as less appropriate for an older patient.

CONCLUSIONS

The stereotype of the rigid and resigned old person appears to be an important and potentially problematic factor in psychotherapy. Interventions to help therapists to reflect on their individual representations of aging may increase the likelihood of successful psychotherapy.

Age cues in patients' descriptions influence treatment attitudes

Objectives: Ageism on the part of service providers has been widely cited as an important factor limiting access to and adequate quality of mental health services for old, especially very old adults. The objective of this study was to analyze how treatment attitudes depend on age cues in patients' descriptions.Method: A sample of psychotherapists-in-training (N = 114) responded to questions concerning a naturalistic case vignette of a male patient with symptoms of depression. Based on random assignment, participants either read the original (real-life) case description including very-old age cues ('very-old patient condition') or the manipulated case description ('middle-aged patient condition') which was identical with the exception that the most salient age cues were replaced by a younger chronological age of the patient (52 years) and age-neutral cues (e.g., "black hair" instead of "light grey hair"). All other aspects of the vignette including the patient's psychological symptoms and medical conditions were kept constant.Results: Participants showed less favorable attitudes towards the patient in the 'very-old patient condition' relative to the patient in the 'middle-aged patient condition', as indicated by more negative affect, less conviction in the treatability of the patient, a poorer prognosis, less interest in treatment provision as well as less subjective treatment competence.Conclusion: Mental health care providers' 'age bias' continues to be a problematic factor in psychotherapy with older adults. An "age-aware education" for psychotherapists is needed for better realizing the potentials of psychotherapy with older adults.

How medical professional students view older people with dementia: Implications for education and practice

Background

Healthcare professionals’ attitudes to older people, and especially those living with dementia, may contribute to unsatisfactory healthcare. Despite repeated calls to address increasing need, training an adequate geriatric workforce remains an international concern. Of particular concern are the attitudes and knowledge healthcare workers may hold about people living with dementia. Students’ knowledge of dementia has been found to be low at the beginning of their university education and has shown limited improvement throughout their coursework; greater understanding of students’ attitudes to ageing and dementia, upon entry and throughout their degrees, may help inform targeted educational interventions to improve the healthcare delivered to older people.

Methods

This study measured knowledge of and attitudes toward dementia and ageing in an Australian university student sample (n = 183), comparing students from medical professional versus non-medical professional related fields at both undergraduate and postgraduate levels. We examined diagnostic and prognostic biases through age manipulation of a vignette describing a hypothetical patient (aged 42 or 72 years), who was experiencing symptoms that were consistent with DSM-5 criteria for both dementia and depression. Based on information provided in the vignette, student participants were asked to select a primary disorder that they would assign to the patient.

Results

Showed that while medical professional students held significantly more positive attitudes toward ageing than 'other' students, average attitudinal scores indicated neutrality. Medical professional students indicated a diagnostic bias toward the older vignette patient, who was more likely to be diagnosed with dementia than depression. A history of geriatric-specific training did not predict dementia knowledge; however, having prior contact with people with dementia predicted both dementia knowledge and more positive prognoses.

Conclusions

Overall, findings indicated medical professional students held neutral attitudes towards older people and showed deficits in knowledge of dementia. Educational interventions that introduce students to people living with dementia may improve knowledge, skills, and attitudes. All university students would benefit from education about dementia and inclusivity to reduce stereotyping and stigma.

Ageism in informal care network members of older women

OBJECTIVES

Negative attitudes toward aging are common among formal healthcare providers, but have been infrequently assessed among informal caregivers providing assistance to older adults. The current study sought to identify factors associated with ageism toward older women.

DESIGN

Multivariate hierarchical linear regression model.

SETTING

Lower-income neighborhoods in an urban setting in the Midwestern USA.

PARTICIPANTS

144 care network members of White and African American women aged ≥ 65 years.

MEASUREMENTS

Age Group Evaluation and Description (AGED) Inventory assessed attitudes toward older women; CES-D scale measured depressive symptoms; Intergenerational Affectional Solidarity Scale assessed relationship closeness.

RESULTS

In bivariate analyses, African American caregivers endorsed more positive attitudes toward older women. In the multivariate regression model, attitudes toward older women were associated with care recipient health (β = 0.18, p < 0.05) and relationship closeness with the care recipient (β = 0.23, p < 0.05). However, these associations were fully mediated by care recipient-specific attitude ratings by the care network member. The association between person-specific attitudes and general attitudes was uniquely directional.

CONCLUSIONS

Findings from the present study are consistent with past research suggesting that 'ageism' may, at least in part, derive from bias against perceived poor health. Further, our findings of an association between attitude toward the care recipient and attitudes toward older women in general provide support for cognitive psychology theory which emphasizes the role of personal experience in stereotype formation through the availability heuristic. The current study underlines the necessity for development of interventions to address ageism in informal caregivers.

Can lncRNAs be indicators for the diagnosis of early onset or acute schizophrenia and distinguish major depressive disorder and generalized anxiety disorder?-A cross validation analysis

Depression and anxiety are apparent symptoms in the early onset or acute phase of schizophrenia (SZ), which complicate timely diagnosis and treatment. It is imperative to seek an indicator to distinguish schizophrenia from depressive and anxiety disorders. Using lncRNA microarray profiling and RT-PCR, three up-regulated lncRNAs in SZ, six down-regulated lncRNAs in major depressive disorder (MDD), and three up-regulated lncRNAs in generalized anxiety disorder (GAD) had been identified as potential biomarkers. All the lncRNAs were, then, cross-validated in 40 SZ patients, 40 MDD patients, 40 GAD patients, and 40 normal controls. Compared with controls, three up-regulated SZ lncRNAs had a significantly down-regulated expression in GAD, and no remarkable differences existed between MDD and the controls. Additionally, the six down-regulated MDD lncRNAs were expressed in an opposite fashion in SZ, and the expression of the three up-regulated GAD lncRNAs were significantly different between SZ and GAD. These results indicate that the expression patterns of the three up-regulated SZ lncRNAs could not be completely replicated in MDD and GAD, and vice versa. Thus, these three SZ lncRNAs seem to be established as potential indicators for diagnosis of schizophrenia and distinguishing it from MDD and GAD. © 2017 Wiley Periodicals, Inc.

Long noncoding RNA expression in peripheral blood mononuclear cells and suicide risk in Chinese patients with major depressive disorder

BACKGROUND

WHO stated that nearly one million people commit suicide every year worldly, and 40% of the suicide completer suffered from depression. The primary aim of this study was to explore the association between long noncoding RNAs (lncRNAs) expression in peripheral blood mononuclear cells (PBMCs) and suicide risk of patients with major depressive disorder (MDD).

METHODS

Using Human LncRNA 3.0 microarray profiling which includes 30,586 human lncRNAs and RT-PCR, six down-regulated lncRNAs were identified differentially expressed in MDD patients. According to suicidal ideation and suicidal attempt, the suicide risk of MDD patients was classified into suicidal ideation versus no suicidal ideation groups, and past attempt versus no past attempt groups, respectively. The expression of six lncRNAs in MDD patients and controls were examined by RT-PCR.

RESULTS

The expression of six lncRNAs had significant differences between no suicidal ideation, suicidal ideation, and controls; corresponding lncRNAs associated with suicidal attempt had remarkable differences between no past attempt, past attempt, and controls. Additionally, only the expression of lncRNAs in suicidal ideation group and past attempt group markedly declined compared with controls.

CONCLUSIONS

This study indicated that the expression of six down-regulated lncRNAs had a negative association with suicide risk in MDD patients, and the expression of lncRNAs in PBMCs could have the potential to help clinician judge the suicide risk of MDD patients to provide timely treatment and prevent suicide.

Long noncoding RNA as an indicator differentiating schizophrenia from major depressive disorder and generalized anxiety disorder in nonpsychiatric hospital

AIM

Depression and anxiety are common symptoms for schizophrenia (SZ) in the early onset. This study aimed to determine whether long noncoding RNAs (lncRNAs) can be indicators for diagnosing SZ in nonpsychiatric hospitals.

MATERIALS & METHODS

Three upregulated SZ lncRNAs, six downregulated major depressive disorder (MDD) lncRNAs and three upregulated generalized anxiety disorder (GAD) lncRNAs were cross-validated in 45 SZ patients, 48 MDD patients, 52 GAD patients and 40 controls by reverse transcription-PCR.

RESULTS

Three SZ lncRNAs were significantly downregulated in GAD patients. The expression of the six MDD lncRNAs showed an opposite trend in SZ patients, and the three GAD lncRNAs also showed significant differences between SZ and GAD patients.

CONCLUSION

The three upregulated SZ lncRNAs are not entirely replicated in MDD and GAD patients and could be potential indicators for distinguishing SZ from MDD and GAD in nonpsychiatric hospital.

In the End It All Makes Sense

This study explored psychological well-being in Australian adults with a particular focus on meaning in life. Older adults ( N = 57) reported lower levels of search for meaning and higher levels of presence of meaning than young adults ( N = 208) suggesting that both groups were able to distinguish between the two aspects of meaning. For older adults, higher presence was associated with better mental health and well-being outcomes, regardless of level of search. For the young adults, higher presence and lower search was associated with better outcomes. These results suggest that presence of meaning is an important aspect of well-being for older adults living in a high income English-speaking country and may be an important focus when working with depressed or anxious older adults, while both presence of, and search for meaning may be more meaningful therapeutic targets when working with depressed or anxious younger adults. Theoretical implications are discussed.

Images of Aging in the Psychotherapeutic Context

Both psychotherapists and their clients have mental representations of old age and the aging process. In this conceptual review, we draw on available research from gerontology, social and developmental psychology, and communication science to consider how these “images of aging” may affect the psychotherapeutic process with older clients. On the basis of selected empirical findings we hypothesize that such images may affect the pathways to psychotherapy in later life, therapist-client communication, client performance on diagnostic tests as well as how therapists select and apply a therapeutic method. We posit that interventions to help both older clients and therapists to reflect on their own images of aging may increase the likelihood of successful treatment. We conclude by making suggestions for future research.

Effect of Patient and Therapist Factors on Suicide Risk Assessment

The present study examined how patient risk factors and clinician demographics predict the assessment of suicide risk. Clinicians (N = 333) read two vignettes, one of which manipulated patient risk factors, then rated the patient's likelihood of suicide and need for hospitalization. Clinicians' assessments were heterogeneous. Results indicated that certain patient risk factors (access to excess medication) and clinician demographics (relationship status, religiosity) predicted perceived suicide risk; and, moreover, clinicians' suicide risk assessment did not always align with the decision to hospitalize the patient. The authors discuss methods for standardizing clinicians' judgment of risk and minimizing error through debiasing strategies (cognitive forcing strategy).

Ethical issues in the psychosocial assessment of bariatric surgery candidates

Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments.

Predicting counseling psychologists attitudes and clinical judgments with respect to older adults

The purpose of this study was to examine age, gender, training and experience in aging issues, fear of death, and multicultural competence in predicting counseling psychologists' global attitudes toward older adults and specific clinical judgments concerning a case vignette of an older client. A national sample of 364 practicing counseling psychologists participated in the study. Participants completed a demographic measure, Polizzi's refined version of the Aging Semantic Differential (Polizzi, 2003 ), a survey of professional bias based on a clinical vignette of a 70-year-old woman (James & Haley, 1995), the Collett-Lester Fear of Death Scale 3.0 (Lester, & Abdel-Khalek, 2003), the Multicultural Counseling Knowledge and Awareness Scale (MCKAS; Ponterotto, Gretchen, Utsey, Rieger, & Austin, 2002), and a Training and Experience Questionnaire. Hierarchical multiple regression analyses were used to investigate the extent to which the selected variables predicted more favorable attitudes toward older adults and less professional bias toward an older client beyond prediction by age and gender. Results revealed that older age and higher total scores on the MCKAS predicted less professional bias in clinical judgments. Gender was a significant predictor of global attitudes toward older adults. Findings suggest that multicultural knowledge, awareness, and skills are important in working with older adults.

Attributions of autonomy and competence of older and younger homeless mentally ill

This study investigated attributions of autonomy and competence. Respondents completed items following one of four vignettes in which a character was identified as an older male, younger male, older female, or younger female with a history of hallucinations, substance abuse, and living on the street. Respondents viewed the vignette character as suffering from malnutrition, alcoholism, depression, and likely to commit suicide. A General Linear Model revealed harsher perceptions toward the older vignette characters. When controlling for educational exposure to aging and psychopathology, there were significant differences in eight of 37 items (F = 116.270, df = 37, p < .001).

Pastoral care professionals in health and mental health care: recognizing classic and newer versions of ageism

Pastoral care professionals are cognizant of many forms of prejudice and discrimination in society and health care environments. Ageism is perhaps the least likely to be challenged as prejudice or discrimination. Ageist perception is suspicious of the health and cognitive ability of older persons; without consideration of emotional, spiritual, or social abilities. While positive and negative ageist attributions are culturally abundant, new and subtle versions of ageism offer convincing guidance about personal responsibility for health status and insist on personal social engagement. Older persons who are not free of disease or disability may be viewed as culpable for their failure to age well. Additionally, elders may be expected to maintain social involvement; especially through volunteerism. Elders who are unable or unwilling to engage in volunteerism may be viewed as selfish or irresponsible. If individuals are held responsible for their health as they age, then services and reimbursement for service may be limited to evidence-based medical interventions that result in complete recovery rather than life-quality improvement and only for "worthy" individuals. This paper seeks to heighten the awareness of pastoral care professionals to common ageist themes found in health and mental care service delivery.

Intrinsic and extrinsic barriers to mental health care among community-dwelling younger and older adults

This study examined intrinsic and extrinsic barriers to mental health care among younger (n = 76; M age = 23 years) and older adults (n = 88; M age = 71 years) using a new 56 item self-report measure, Barriers to Mental Health Services Scale (BMHSS). The BMHSS was developed to examine 10 barriers to the utilization of mental health services: help-seeking attitudes, stigma, knowledge and fear of psychotherapy, belief about inability to find a psychotherapist, belief that depressive symptoms are normal, insurance and payment concerns, ageism, concerns about psychotherapist's qualifications, physician referral, and transportation concerns. Results indicated that younger adults perceived fear of psychotherapy, belief about inability to find a psychotherapist, and insurance concerns to be greater barriers than older adults. Men perceived stigma to be a greater barrier than women whereas women perceived finding a psychotherapist to be a greater barrier than men. The rank order of the BMHSS subscales was strongly similar for younger and older adults (r = 0.90, p = 0.000). These results also provide further evidence that stigma about receiving mental health services is not a primary barrier among younger or older adults.

Enlightened or Delusional?

Psychological diagnosis faces unique challenges when used to differentiate nonpsychopathological religious/spiritual/transpersonal (R/S/T) experiences from those that might evidence psychopathology, particularly considering the diversity of such experiences and the value-laden assumptions inherent in most diagnostic practices. Theoretical and pragmatic problems related to the diagnostic category, Religious and Spiritual Problem, as contained in the Diagnostic and Statistical Manual of Mental Disorders are discussed. Attention is paid to identifying potential biases and errors in using, or failing to use, this diagnostic category, particularly as related to developing culturally sensitive diagnoses. Specific methods, including psychometric approaches, for evaluating R/S/T experiences that may range from healthy to psychopathological are reviewed and recommendations are presented for improving current diagnostic practices and furthering needed research.

When I'm 75 years old: perceptions of social work students

Bachelor of Social Work and Master of Social Work students (N=183) responded to items investigating their beliefs about what they would be like when they were age 75. From 27 items a principle component analysis identified seven factor variables that investigated perceptions of health concerns, health-related vulnerability, importance of spiritual/religious belief, social worth, cognitive capacity, fitness, and being old. Respondents believed that at age 75 they would have many health concerns, would be fit, have social worth, and would be somewhat religious/spiritual. Although most did not believe they would be as capable at 75 as they are now, most respondents did not believe that at 75 they would be vulnerable (a victim of crime, lonely, live in a nursing home, need assistance with bathing or dressing, or have Alzheimer's disease). The factor variables were entered in a standard multiple regression analysis with Perceptions of Health-Related Vulnerability as the dependent variable. The final model accounted for 54.6% of the adjusted variance using five predictor variables: (a) Perceptions of Health Concerns, (b) Perceptions of the Importance of Spiritual/Religious Beliefs, (c) Perceptions of Social Worth, (d) Perceptions of Cognitive Capacity, and (e) Perceptions of Being Old. Implications for research, practice, and education are discussed.

Black women and white women: do perceptions of childhood family environment differ?

INTRODUCTION

Few studies have examined racial differences in perceptions of childhood. Little is known about how Blacks perceive their own families, particularly the family environment that they experienced in childhood.

METHODS

A community sample of 290 women (55% White, 45% Black) from two-parent families, heterogeneous in age and social class, was examined using a self-administered questionnaire, including the Family Environment Scale (FES), followed by a focused interview. Siblings were used as collateral informants.

RESULTS

The psychometric properties of the FES showed remarkably little variation by race: The internal scale reliability, correlations between scales, and factor structures were quite similar. Although both White and Black women reported good childhood family environments, Black women when compared with White women rated their families of origin as more cohesive, organized, and expressive, and lower in conflict. Sibling responses corroborated these findings.

DISCUSSION

This study addresses a gap in the research literature and provides important evidence of strengths in Black family relationships as reported by a community sample of women. The psychometric properties of the FES, found to be strong for families of both races, lends support to our findings and those of other researchers who have used this measure.

Social work students' perceptions about incompetence in elders

Graduate and undergraduate social work students (N = 172) were surveyed to investigate their perceptions concerning memory impairment in elders. Approximately 70% of those surveyed did not strongly disagree with the perception that all elders are memory impaired. In further analysis, significant correlations were found to exist between this variable and several other variables, including perceptions of elders' behaviors (r = .602, p = .000) and perceptions of communicating with elders (r = .630, p = .000). In a standard multiple regression, three significant predictor variables accounted for 53.4% of the model's adjusted variance. These predictor variables included: (a) perceptions of elders' behaviors, (b) perceptions of communicating with elders, and (c) having taken courses in gerontology.

Applying the Transtheoretical Model to Physical Activity in Family Caregivers in Taiwan

OBJECTIVE

The objective of this study was to examine whether specific constructs from the Transtheoretical Model (TTM)(i.e., stages of change, self-efficacy, and perceived benefits and barriers) relative to regular physical activity are applicable to Taiwanese family caregivers.

DESIGN

A descriptive and cross-sectional design was used.

SAMPLE

A convenience sample included 108 primary family caregivers of mentally ill patients receiving home care from a psychiatric hospital in southern Taiwan.

MEASUREMENTS

After obtaining institutional review board approval and subject's consent, subjects' demographics, stages of change for regular physical activity, self-efficacy, and perceptions of the benefits of and barriers to regular physical activity were assessed through the questionnaire.

RESULTS

Subjects in the later stages of the TTM (action or maintenance) had significantly higher levels of self-efficacy than those in earlier stages (precontemplation or contemplation)(p<0.05). No significant difference was found in the level of perceived benefits and barriers across different TTM stages. This study provides partial support for the hypothesized relationships between constructs derived from the TTM.

CONCLUSIONS

Since this is the first TTM study in Taiwan, continued TTM testing is needed to adequately determine the applicability of the TTM and to identify the most effective theory-based physical activity interventions.

Effect of health-related stereotypes on physiological responses of hypertensive middle-aged and older men

This study examined the influence of health stereotypes on stress response among middle-aged and older men. It was hypothesized that anxiety and cardiovascular reactivity would increase when health stereotypes were activated among veterans seeking care in an outpatient setting. Among a sample of 122 veteran patients with hypertension, the level of stereotype activation varied by means of reference to either their health status (health stereotypes) or, conversely, some personally valued leisure activities (no stereotype activation). Predicted stereotype-related increases in anxiety, galvanized skin conductance, and blood pressure were evident. Potential explanations for these results are explored, including those relating to the negative health stereotypes associated with being a patient.

Psychiatric disability and clinical decision making: The impact of judgment error and bias

The psychiatric disability adjudicator is presented, with multiple types of evidence regarding claimants, and, utilizing primarily clinical judgment, must weigh and integrate this information before rendering a disability decision. The need to process large amounts of evidence in this fashion can result in the use of cognitive simplification strategies in the form of heuristics or specific types of decisional bias which can produce judgment error. The purpose of this review is to increase awareness regarding the role that bias can play in determining an individual's psychiatric disability status, using a large federal disability program for context purposes. Recommendations are also made regarding steps that can be taken to anticipate and reduce decision-making bias.

Development and utilization of vignettes in assessing medical students' support of older and younger patients' medical decisions

Currently no appropriate vignettes exist to examine issues of age-based care among students early in their medical careers. This paper addresses that issue in two parts. First, as the development of vignettes, widely used in medical research, is rarely described, suggestions for developing reliable and valid vignettes are presented. These suggestions are derived from the development of a series of vignettes assessing the support of older and younger patients' medical decisions among first year medical students. Second, the responses to the vignettes were analyzed quantitatively and qualitatively to assess potential age-based biases. Results indicate that students do not differ in their level of support for older and younger patients' medical decisions. However, students are more supportive of patients who desired aggressive treatments than of those who wished to end treatment. Many students did not focus on the age of the patient, but instead on the patient's quality of life.

Mutual biases underlying the problematic relationship between older adults and mental health providers: any solution in sight?

As the size and diversity of the older population increases, mental health providers will be called upon to deliver high-quality services to the elderly. However, many of these professionals hold negative attitudes toward the elderly; psychotherapy conducted with older adults by clinicians with such biases could represent a waste of time and energy, as well as money, for these clients. This article reviews studies conducted within the past three decades on the biases held by mental health professionals (primarily psychiatrists and psychologists) toward older patients and vice versa. It also discusses possible solutions to the conflicts within the elderly-mental health provider relationship, based on the contributions made by professionals from various health care disciplines on this topic. Moreover, this article takes into account various ethnicity-related issues that are often at play in the relationship in question, and provides research and clinical recommendations for the enhancement of the quality of this relationship. It is time to find successful and interdisciplinary ways to improve how older adults and mental health professionals deal with one another. These efforts should creatively enhance the quality of the mental health services offered to older patients, in addition to dispelling age-related myths and corresponding obstacles to the utilization of these needed services by older adults.

Psychometric characteristics of the Depressive Cognition Scale in African American women

Depression in African-American women frequently goes unnoticed and untreated since commonly used depression scales fail to focus on early symptom recognition, do not address contextual factors, and lack adequate psychometric testing in African-American women. This analysis of the Depressive Cognition Scale was conducted with 213 African-American female caregivers and noncaregivers. Alpha coefficients for both groups (alpha 's = .75 and .87) showed internal consistency. Correlations with resourcefulness, depression, and daily hassles scales in the expected directions demonstrated construct validity (R's = -.36, .26, and .31, respectively). Factor structures for caregivers and noncaregivers differed, suggesting certain depressive cognitions were strongly integrated into the caregiver role. As a reliable and valid measure of depressive cognitions, the DCS would be useful for early detection of depression in African-American women.

Evaluation of manual wheelchair skills: is objective testing necessary or would subjective estimates suffice?

OBJECTIVE

To test the hypothesis that subjective estimates of the ability to perform manual wheelchair skills, by wheelchair users and the therapists working with them, accurately reflect the results of objective testing.

DESIGN

Within-subject comparisons.

SETTING

Kinesiologic laboratory in a rehabilitation center.

PARTICIPANTS

Twenty-one wheelchair users and their therapists.

INTERVENTIONS

The wheelchair users and their therapists subjectively estimated how the wheelchair users would perform manual wheelchair skills, followed by an objective assessment.

MAIN OUTCOME MEASURES

Wheelchair Skills Test (WST, version 2.4), a set of 50 standardized skills.

RESULTS

The Spearman correlation coefficients between the total objective and subjective scores were.95 for the wheelchair users and.75 for the therapists. The mean difference between the total objective and subjective scores was statistically significant (P=.0002) for the wheelchair users (who overestimated their abilities by an average of 17.9%). The percentage concordance between subjective and objective scores for individual skills ranged from 57.1% to 100% for the wheelchair users and 50% to 100% for the therapists, with 25% and 35% of skills, respectively, for which there were no statistically significant associations (at a Bonferroni-adjusted alpha level of.001) between the objective and subjective scores. The skills that were misestimated by both were moving the armrests away, reaching a high object, transferring out of and into the wheelchair, folding the wheelchair, incline ascent, negotiation of gravel and irregular surfaces, and small curb ascent.

CONCLUSION

Although subjective ratings by wheelchair users and their therapists provide excellent and good estimates respectively of overall manual wheelchair abilities, objective testing should be performed when accurate assessments of many specific manual wheelchair skills are required.

A multifactorial study of age bias among rehabilitation professionals

OBJECTIVES

To assess different dimensions of age bias among rehabilitation professionals and to determine the effect of patient gender and behavior on these biases.

DESIGN

Between-subjects questionnaire study.

SETTING

Randomly selected institutions accredited with the Commission on the Accreditation of Rehabilitation Facilities (CARF).

PARTICIPANTS

Nine hundred seventy-four rehabilitation professionals from 9 disciplines at 23 CARF-accredited facilities.

INTERVENTIONS

Each professional received a vignette case history of an amputation patient who varied in age (36yr, 76yr), gender (male, female), and patient behavior (ideal, depressed, noncompliant). The vignette was followed by the Professional Bias Questionnaire (PBQ), which included 25 questions assessing the professionals' responses to the patient.

MAIN OUTCOME MEASURES

Main effects and interaction effects for age, gender, and behavior for the PBQ.

RESULTS

Factor analysis of the PBQ questionnaire yielded 4 reliable scales: the professional's judgment of the patient's psychologic neediness, postdischarge potential, worthiness for rehabilitation, and their personal reaction to working with the patient. Analyses of variance resulted in significant age by behavior interaction effects for 3 of the 4 scales. Older patients were viewed more negatively than equivalent younger patients when they were noncompliant. Professionals also had a more negative personal reaction to depressed older patients compared with equivalent younger patients. In contrast, gender bias was only found in 1 specific situation and did not interact with age bias.

CONCLUSION

Several forms of bias toward older adult patients were found among rehabilitation professionals, but they were present only when patient behavior was less than ideal. Age bias continues to be a critical issue in the equity of rehabilitation services and should be addressed with training and policy changes.

Clinician judgments of functional outcomes: how bias and perceived accuracy affect rating

OBJECTIVE

To evaluate the accuracy of clinician judgments of patient function, the susceptibility of judges to bias, and the relation between a judge's degree of belief in his/her accuracy of classification to observed accuracy when using the FIM instrument.

PARTICIPANTS

Fifty rehabilitation professionals.

SETTING

3 urban medical centers.

DESIGN

Four randomized experiments among subjects to examine the effect of potentially biasing information on FIM ratings of patient vignettes. Participants answered 60 true/false questions regarding patient function and FIM score and indicated confidence in the accuracy of their answers.

INTERVENTIONS

Manipulation of patient information.

MAIN OUTCOME MEASURES

The standard FIM 7-point scale, observed proportion of correct responses to the 60 true/false questions, and a 6-category confidence scale for each of the 60 questions were used as dependent measures.

RESULTS

FIM ratings assigned to others biased participants' FIM ratings of patient vignettes. Functional ability was overestimated when ratings in other domains were high and underestimated when they were low. Participants were overconfident in their ability to answer FIM questions accurately across all professional disciplines.

CONCLUSION

Bias and poor judgment of level accuracy play a significant role in clinician ratings of patient functioning. Blind ratings and training in debiasing are potential solutions to the problem.