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Bowersox NW, Browne J, Grau PP, Merrill SL, Haderlein TP, Llorente MD, Washington DL. COVID-19 mortality among veterans with serious mental illness in the veterans health administration. J Psychiatr Res 2023; 163:222-229. [PMID: 37230006 PMCID: PMC10171776 DOI: 10.1016/j.jpsychires.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Persons with serious mental illness (SMI: schizophrenia-spectrum disorders, bipolar disorder) experience increased risk of mortality after contracting COVID-19 based on the results of several international evaluations. However, information about COVID-19 mortality risk among patients with SMI in the Veterans Health Administration (VHA) has been limited, precluding identification of protective factors. The current evaluation was conducted to assess COVID-19 mortality risk among VHA patients with SMI and to evaluate potential protective factors in mitigating mortality risk following a positive COVID-19 diagnosis. METHODS National VHA administrative data was used to identify all patients (N = 52,916) who received a positive COVID-19 test result between March 1, 2020, and September 30, 2020. Mortality risk was assessed by SMI status via bivariate comparisons and multivariate regression analyses. RESULTS In unadjusted analyses, VHA patients with SMI overall and patients with bipolar disorder in particular did not experience increased mortality risk in the 30 days following a positive COVID test, although patients with schizophrenia had increased risk. Within adjusted analyses, patients with schizophrenia remained at increased mortality risk (OR = 1.38), but at reduced levels relative to previous evaluations in other healthcare settings. CONCLUSIONS Within VHA, patients with schizophrenia, but not those with bipolar disorder, experience increased mortality risk in the 30 days following a positive COVID-19 test. Large integrated healthcare settings such as VHA may offer services which may protect against COVID-19 mortality for vulnerable groups such as persons with SMI. Additional work is needed to identify practices which may reduce the risk of COVID-19 mortality among persons with SMI.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter P Grau
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie L Merrill
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA
| | - Taona P Haderlein
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Maria D Llorente
- Patient Care Services, Department of Veterans Affairs, Washington DC, USA; Department of Psychiatry, Georgetown University School of Medicine, Washington DC, USA
| | - Donna L Washington
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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Haderlein TP, Wong MS, Yuan A, Llorente MD, Washington DL. Association of PTSD with COVID-19 testing and infection in the Veterans Health Administration. J Psychiatr Res 2021; 143:504-507. [PMID: 33261820 PMCID: PMC7682935 DOI: 10.1016/j.jpsychires.2020.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with coronavirus disease 2019 (COVID-19) risk factors, such as hypertension and obesity. Associations between PTSD and COVID-19 outcomes may affect Veterans Health Administration (VA) services, as PTSD occurs at higher rates among veterans than the general population. While previous research has identified the potential for increased PTSD prevalence resulting from COVID-19 as a public health concern, no known research examines the effect of pre-existing PTSD on COVID-19 test-seeking behavior or infection. This study aimed to evaluate pre-existing PTSD as a predictor of COVID-19 testing and test positivity. The sample consisted of 6,721,407 veterans who sought VA care between March 1, 2018 and February 29, 2020. Veterans with a previous PTSD clinical diagnosis were more likely to receive COVID-19 testing than veterans without PTSD. However, among those with available COVID-19 test results (n = 168,032), veterans with a previous PTSD clinical diagnosis were less likely to test positive than veterans without PTSD. Elevated COVID-19 testing rates among veterans with PTSD may reflect increased COVID-19 health concerns and/or hypervigilance. Lower rates of COVID-19 test positivity among veterans with PTSD may reflect increased social isolation, or overrepresentation in the tested population due to higher overall use of VA services. As the COVID-19 pandemic continues, the identification of patient-level psychiatric predictors of testing and test positivity can facilitate the targeted provision of medical and mental health services to individuals in need.
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Affiliation(s)
- Taona P. Haderlein
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michelle S. Wong
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anita Yuan
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Maria D. Llorente
- Department of Veterans Affairs, Patient Care Services, Washington, DC, USA,Georgetown University School of Medicine, Department of Psychiatry, Washington, DC, USA
| | - Donna L. Washington
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA,Corresponding author. 11301 Wilshire Blvd, 111G, Los Angeles, CA, 90073, USA
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Schultz SK, Llorente MD, Sanders AE, Tai WA, Bennett A, Shugarman S, Roca R. Quality improvement in dementia care. Neurology 2020; 94:210-216. [DOI: 10.1212/wnl.0000000000008678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022] Open
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Schultz SK, Llorente MD, Sanders AE, Tai WA, Bennett A, Shugarman S, Roca R. Quality Improvement in Dementia Care: Dementia Management Quality Measurement Set 2018 Implementation Update. Am J Psychiatry 2020; 177:175-181. [PMID: 32008398 DOI: 10.1176/appi.ajp.2019.19121290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Susan K Schultz
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Maria D Llorente
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Amy E Sanders
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Waimei A Tai
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Amy Bennett
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Samantha Shugarman
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Robert Roca
- From the James A. Haley Veterans Hospital (S.K.S.), University of Iowa Carver College of Medicine, Iowa City; Department of Psychiatry and Behavioral Sciences (S.K.S.), University of South Florida, Tampa; Department of Psychiatry (M.D.L.), VA Medical Center, Georgetown University School of Medicine, Wash., DC; Memory Care Center (A.E.S.), Ayer Neuroscience Institute, Hartford Healthcare Medical Group, Wethersfield, Conn.; Department of Neurology (W.A.T.), Christiana Care, Newark, Del.; American Academy of Neurology (A.B.), Minneapolis, Minn.; American Psychiatric Association (S.S.), Washington, DC; Sheppard Pratt Health System (R.R.), Towson, Md.; Department of Psychiatry (R.R.), University of Maryland School of Medicine; and Department of Psychiatry (R.R.), Johns Hopkins University School of Medicine, Baltimore, Md
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Chen P, Guarino PD, Dysken MW, Pallaki M, Asthana S, Llorente MD, Love S, Vertrees JE, Schellenberg GD, Sano M. Neuropsychiatric Symptoms and Caregiver Burden in Individuals With Alzheimer's Disease: The TEAM-AD VA Cooperative Study. J Geriatr Psychiatry Neurol 2018; 31:177-185. [PMID: 29966477 DOI: 10.1177/0891988718783897] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the prevalence of neuropsychiatric symptoms (NPS) in mild-to-moderate Alzheimer disease (AD) and their association with caregiver burden. METHODS Secondary analyses of baseline data from the Trial of Vitamin E and Memantine in Alzheimer's Disease (TEAM-AD) (N=613). Neuropsychiatric Inventory were used to measure severity of NPS and caregiver activity survey to measure caregiver burden. RESULTS A total of 87% of patients displayed at least 1 NPS; 70% displayed clinically meaningful NPS. The most common symptoms were apathy (47%), irritability (44%), agitation (42%), and depression (40%). Those with moderate AD had more severe NPS than those with mild AD ( P = .03). Neuropsychiatric symptoms were significantly associated with caregiver time after adjusting for age, education, cognitive function, and comorbidity ( P-value < .0001) with every point increase in NPS associated with a 10-minute increase in caregiver time. CONCLUSION Neuropsychiatric symptoms were prevalent in both mild and moderate AD, even in patients receiving treatment with an acetylcholinesterase inhibitors, and were more severe in moderate AD and associated with greater caregiver time.
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Affiliation(s)
- Peijun Chen
- 1 Department of Psychiatry, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 2 Department of Psychiatry, Geriatric Psychiatry Division, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peter D Guarino
- 3 Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- 4 Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Maurice W Dysken
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Muralidhar Pallaki
- 7 Department of Medicine, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 8 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sanjay Asthana
- 9 William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- 10 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maria D Llorente
- 11 Washington DC VA Medical Center, Washington, DC, USA
- 12 Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Susan Love
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Julia E Vertrees
- 13 VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Gerard D Schellenberg
- 14 Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mary Sano
- 15 Bronx Veterans Medical Research Center, New York, NY, USA
- 16 Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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6
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Kheirbek RE, Fokar A, Shara N, Bell-Wilson LK, Moore HJ, Olsen E, Blackman MR, Llorente MD. Characteristics and Incidence of Chronic Illness in Community-Dwelling Predominantly Male U.S. Veteran Centenarians. J Am Geriatr Soc 2017; 65:2100-2106. [PMID: 28422270 DOI: 10.1111/jgs.14900] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To assess the incidence of chronic illness and its effect on veteran centenarians. DESIGN Retrospective longitudinal cohort study. SETTING United States Veterans Affairs Corporate Data Warehouse (CDW). PARTICIPANTS Community-dwelling veterans born between 1910 and 1915 who survived to at least age 80 (N = 86,892; 31,121 octogenarians, 52,420 nonagenarians, 3,351 centenarians). MEASUREMENTS The Kaplan-Meier method was used to estimate cumulative incidence of chronic conditions according to age group. Incidence rates were compared using the log-rank test. Cox proportional hazards models were used to estimate unadjusted hazard ratios. RESULTS Ninety-seven percent of Centenarians were male, 88.0% were white, 31.8% were widowed, 87.5% served in World War II, and 63.9% did not have a service-related disability. The incidence rates of chronic illnesses were higher in octogenarians than centenarians (atrial fibrillation, 15.0% vs 0.6%, P < .001; heart failure, 19.3% vs 0.4%, P < .001; chronic obstructive pulmonary disease, 17.9% vs 0.6%, P < .001; hypertension, 29.6% vs 3.0%, P < .001; end-stage renal disease, 7.2% vs 0.1%, P < .001; malignancy, 14.1% vs 0.6%, P < .001; diabetes mellitus, 11.1% vs 0.4%, P < .001; stroke, 4.6% vs 0.4%, P < .001) and in nonagenarians than centenarians (atrial fibrillation, 13.2% vs 3.5%, P < .001; heart failure, 15.8% vs 3.3%, P < .001; chronic obstructive pulmonary disease, 11.8% vs 3.5%, P < .001; hypertension, 27.2% vs 12.8%, P < .001; end-stage renal disease, 11.9% vs 4.5%, P < .001; malignancy, 8.6% vs 2.3%, P < .001; diabetes mellitus, 7.5% vs 2.2%, P < .001; and stroke, 3.5% vs 1.3%, P < .001). CONCLUSION In a large cohort of predominantly male community-dwelling elderly veterans, centenarians had a lower incidence of chronic illness than those in their 80s and 90s, demonstrating similar compression of morbidity and extension of health span observed in other studies.
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Affiliation(s)
- Raya Elfadel Kheirbek
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia.,School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia.,School of Medicine, Georgetown University, Washington, District of Columbia
| | - Ali Fokar
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia
| | - Nawar Shara
- MedStar Health Research Institute, Hyattsville, Maryland.,Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, District of Columbia
| | | | - Hans J Moore
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia.,School of Medicine, Georgetown University, Washington, District of Columbia.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Edwin Olsen
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Marc R Blackman
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia.,School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia.,School of Medicine, Georgetown University, Washington, District of Columbia.,Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, District of Columbia
| | - Maria D Llorente
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia.,School of Medicine, Georgetown University, Washington, District of Columbia
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Guarino PD, Vertrees JE, Asthana S, Sano M, Llorente MD, Pallaki M, Love S, Schellenberg GD, Dysken MW. Measuring informed consent capacity in an Alzheimer's disease clinical trial. Alzheimers Dement (N Y) 2016; 2:258-266. [PMID: 29067313 PMCID: PMC5651363 DOI: 10.1016/j.trci.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Accurately and efficiently determining a participant's capacity to consent to research is critically important to protect the rights of patients with Alzheimer's disease (AD). METHODS Understanding of the informed consent document was assessed in 613 community-dwelling patients with mild-to-moderate AD enrolled in a randomized, placebo-controlled trial. Associations were examined between clinically determined capacity to consent and (1) patient demographics and clinical characteristics and (2) the Informed Consent Questionnaire (ICQ), an objective measurement of a participant's factual understanding and perceived understanding. RESULTS A total of 453 (74%) participants were determined to have capacity to consent by clinical judgment. ICQ perceived understanding, race, measures of cognitive function, and caregiver time were all significantly associated with the determination of capacity in multivariate analyses. DISCUSSION We found a significant association between capacity and disease severity level, caregiver time, race, and ICQ perceived understanding.
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Affiliation(s)
- Peter D Guarino
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Julia E Vertrees
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Sanjay Asthana
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary Sano
- Bronx Veterans Medical Research Center, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria D Llorente
- Washington DC VA Medical Center, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Muralidhar Pallaki
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Susan Love
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
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Swantek SS, Maixner SM, Llorente MD, Edgar L, Cheong JA, Thomas CR, Ahmed I. Response to: Canary in a Coal Mine: Geriatric Psychiatry in Crisis. Am J Geriatr Psychiatry 2016; 24:693. [PMID: 27569264 DOI: 10.1016/j.jagp.2016.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - Laura Edgar
- Accreditation Council for Graduate Medical Education
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Swantek SS, Maixner SM, Llorente MD, Cheong JA, Edgar L, Thomas CR, Ahmed I. The Road Ahead in Education: Milestones for Geriatric Psychiatry Subspecialty Training. Am J Geriatr Psychiatry 2016; 24:675-89. [PMID: 27396668 DOI: 10.1016/j.jagp.2016.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Accreditation Council of Graduate Medical Education (ACGME) Milestone Project is the next step in a series of changes revamping the system of graduate medical education. In 2013 the ACGME completed the general psychiatry milestones. The ACGME then pursued creation of milestones for accredited psychiatric subspecialty fellowships. This article documents the work of the geriatric psychiatry subspecialty milestones work group. It reports the history and rationale supporting the milestones, the milestone development process, and the implications for geriatric psychiatry fellowship training. METHODS In consultation with the American Association for Geriatric Psychiatry, the American Board of Psychiatry and Neurology, and the ACGME Psychiatry Residency Review Committee, the ACGME appointed a working group to create the geriatric psychiatry milestones using the general psychiatry milestones as a guide. CONCLUSION The geriatric psychiatry milestones are the result of an iterative process resulting in the definition of the characteristics vital to a fellowship-trained geriatric psychiatrist. It is premature to assess their effect on psychiatric training. The true impact of the milestones will be determined as each training director uses the milestones to re-evaluate their program curriculum and the educational and clinical learning environment. The ACGME is currently collecting the information about the milestone performance of residents and fellows to further refine and determine how the milestones can best be used to assist programs in improving training.
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Affiliation(s)
| | | | - Maria D Llorente
- VA Medical Center, Georgetown University School of Medicine, Washington, DC
| | - Josepha A Cheong
- Tennessee Valley Healthcare System, Nashville VAMC, Nashville, TN; University of Florida, Gainesville, FL
| | - Laura Edgar
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | | | - Iqbal Ahmed
- Tripler Army Medical Center, Uniformed Services University of Health Sciences, HI; University of Hawaii, HI
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Llorente MD, Morton K, Boughton S, Crawford P. A Real Welcome Home: Permanent Housing for Homeless Veterans. Fed Pract 2016; 33:26-31. [PMID: 30766175 PMCID: PMC6369036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ending homelessness in Washington, DC, involves the collaboration of government and community partners who can identify and address risk factors for homelessness.
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Affiliation(s)
- Maria D Llorente
- is a geriatric psychiatrist and associate chief of staff for mental health, is a social worker and coordinator of the Health Care for Homeless Veterans program, is a social worker and chief of social work services, and is a registered nurse and associate chief nurse for mental health, all at the Washington DC VAMC. Dr. Llorente is a professor of psychiatry at Georgetown University School of Medicine and Dr. Crawford is adjunct clinical professor of nursing at George Washington University, all in Washington, DC
| | - Kevin Morton
- is a geriatric psychiatrist and associate chief of staff for mental health, is a social worker and coordinator of the Health Care for Homeless Veterans program, is a social worker and chief of social work services, and is a registered nurse and associate chief nurse for mental health, all at the Washington DC VAMC. Dr. Llorente is a professor of psychiatry at Georgetown University School of Medicine and Dr. Crawford is adjunct clinical professor of nursing at George Washington University, all in Washington, DC
| | - Sevena Boughton
- is a geriatric psychiatrist and associate chief of staff for mental health, is a social worker and coordinator of the Health Care for Homeless Veterans program, is a social worker and chief of social work services, and is a registered nurse and associate chief nurse for mental health, all at the Washington DC VAMC. Dr. Llorente is a professor of psychiatry at Georgetown University School of Medicine and Dr. Crawford is adjunct clinical professor of nursing at George Washington University, all in Washington, DC
| | - Patricia Crawford
- is a geriatric psychiatrist and associate chief of staff for mental health, is a social worker and coordinator of the Health Care for Homeless Veterans program, is a social worker and chief of social work services, and is a registered nurse and associate chief nurse for mental health, all at the Washington DC VAMC. Dr. Llorente is a professor of psychiatry at Georgetown University School of Medicine and Dr. Crawford is adjunct clinical professor of nursing at George Washington University, all in Washington, DC
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Chopra MP, Zhang H, Pless Kaiser A, Moye JA, Llorente MD, Oslin DW, Spiro A. PTSD is a chronic, fluctuating disorder affecting the mental quality of life in older adults. Am J Geriatr Psychiatry 2014; 22:86-97. [PMID: 24314889 DOI: 10.1016/j.jagp.2013.01.064] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/24/2012] [Accepted: 06/27/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Examine the longitudinal course of posttraumatic stress disorder (PTSD) in older adults and its influence on mental health quality of life (MHQoL). DESIGN Evaluation performed at baseline, and 3 and 6 months postrandomization as part of a longitudinal trial. PARTICIPANTS AND SETTINGS A total of 1,185 participants, with a mean (±SD) age of 73.53 (±5.98) years, at seven primary care sites (including five Veterans Affairs clinics), were divided into four groups, namely, no trauma (n = 661), trauma only (n = 319), partial PTSD (n = 114), and PTSD (n = 81), based on reports of trauma and associated PTSD symptoms. MEASUREMENTS The prevalence of comorbid depression, anxiety, and alcohol use disorders, assessed using the Diagnostic and Statistical Manual, Fourth Edition, criteria and changes in MHQoL, as assessed by the Short Form-36 mental component score. RESULTS At baseline, the PTSD group had higher frequencies of comorbid depression and anxiety disorders and worse MHQoL than the other groups. Both chronic (participants diagnosed with PTSD at all three assessments) and fluctuating (participants moving to or from one of the other groups) trajectories of course were observed during the follow-up period, which appeared to be separate from that of the comorbid disorders. Even after accounting for those comorbid disorders, PTSD had an independent association with poorer MHQoL at multiple time points, especially in men, whereas trauma without PTSD symptoms (trauma only) had better MHQoL. CONCLUSIONS PTSD had chronic and fluctuating courses, with negative effects on MHQoL, while partial PTSD might represent a transitional state, underscoring the need to better identify and treat PTSD at any phase in later life.
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Affiliation(s)
- Mohit P Chopra
- Department of Psychiatry, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
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Durai UNB, Chopra MP, Coakley E, Llorente MD, Kirchner JE, Cook JM, Levkoff SE. Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: comorbid conditions and self-rated health status. J Am Geriatr Soc 2011; 59:1087-92. [PMID: 21649614 DOI: 10.1111/j.1532-5415.2011.03407.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population. DESIGN Cross-sectional screening assessments during a multisite trial for the treatment of depression, anxiety, and at-risk drinking. SETTING Department of Veterans Affairs (VA)-based primary care clinics across the United States. PARTICIPANTS Seventeen thousand two hundred five veterans aged 65 and older. MEASUREMENTS Sociodemographic information, the General Health Questionnaire (GHQ-12), questions about death wishes and suicidal ideation, quantity and frequency of alcohol use, smoking, exposure to traumatic events, and PTSD symptom clusters. RESULTS Twelve percent (2,041/17,205) of participants screened endorsed PTSD symptoms. Veterans with PTSD symptoms from some (partial PTSD) or each (PTSD all clusters) of the symptom clusters were significantly more likely to report poor general health, currently smoke, be divorced, report little or no social support, and have a higher prevalence of mental distress, death wishes, and suicidal ideation than those with no trauma history or those with trauma but no symptoms. Group differences were most pronounced for mental distress and least for at-risk drinking. Presence of PTSD all clusters was associated with poorer outcomes on all of the above-mentioned health characteristics than partial PTSD. CONCLUSION PTSD symptoms are common in a substantial minority of older veterans in primary care, and careful inquiry about these symptoms is important for comprehensive assessment in geriatric populations.
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Affiliation(s)
- U Nalla B Durai
- Department of Psychiatry, Jesse Brown VA Medical Center, School of Medicine, University of Illinois, Chicago, Illinois, USA
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Mavandadi S, Ten Have TR, Katz IR, Durai UNB, Krahn DD, Llorente MD, Kirchner JE, Olsen EJ, Van Stone WW, Cooley SL, Oslin DW. Effect of Depression Treatment on Depressive Symptoms in Older Adulthood: The Moderating Role of Pain. J Am Geriatr Soc 2007; 55:202-11. [PMID: 17302656 DOI: 10.1111/j.1532-5415.2007.01042.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether pain severity and interference with normal work activities moderate the effects of depression treatment on changes in depressive symptoms over time in older adults in primary care. DESIGN Patient-randomized, clinical trial. SETTING Multisite: three clinics located in Veterans Affairs Medical Centers. PARTICIPANTS Adults aged 60 and older (n=524) who screened positive for depression and participated in the Primary Care Research in Substance Abuse and Mental Health for the Elderly Study. INTERVENTION Integrated care versus enhanced specialty referral care. MEASUREMENTS Pain severity, the degree to which pain interferes with work inside and outside of the home, and depressive symptoms were examined at baseline and 3, 6, and 12 months. RESULTS Intention-to-treat analyses revealed that both treatment groups showed reduced depressive symptoms over time, although self-reported pain moderated reductions in depressive symptoms. At higher levels of pain severity and interference with work activities, improvements in depressive symptoms were blunted. Furthermore, pain interference appeared to have a greater effect on depressive symptoms than did pain severity; in individuals with major depression, pain interference fully accounted for the moderating effects of pain severity on changes in depressive symptoms over time. CONCLUSION Pain and its interference with functioning interfere with recovery from depression. Findings highlight the importance of addressing multiple domains of functioning (e.g., physical and social disability) and the degree to which pain and other forms of physical comorbidity may hinder or minimize treatment-related improvements in depressive symptoms.
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Affiliation(s)
- Shahrzad Mavandadi
- Section of Geriatric Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Kirchner JE, Zubritsky C, Cody M, Coakley E, Chen H, Ware JH, Oslin DW, Sanchez HA, Durai UNB, Miles KM, Llorente MD, Costantino G, Levkoff S. Alcohol consumption among older adults in primary care. J Gen Intern Med 2007; 22:92-7. [PMID: 17351846 PMCID: PMC1824716 DOI: 10.1007/s11606-006-0017-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients. OBJECTIVES To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. DESIGN Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers. PARTICIPANTS Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients. MEASUREMENTS Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety. RESULTS Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1-7 drinks/week), 4.1% were at-risk drinkers (8-14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables. CONCLUSIONS The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.
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Affiliation(s)
- JoAnn E Kirchner
- VA South Central Mental Illness Research Education and Clinic Center, Little Rock, AR, USA.
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Llorente MD, Burke M, Gregory GR, Bosworth HB, Grambow SC, Horner RD, Golden A, Olsen EJ. Prostate cancer: a significant risk factor for late-life suicide. Am J Geriatr Psychiatry 2005; 13:195-201. [PMID: 15728750 DOI: 10.1176/appi.ajgp.13.3.195] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to determine the incidence of suicide and its relevant correlates among men with prostate cancer. METHODS This was a population-based, retrospective cohort review of men age 65 and older, residing in South Florida between 1983 and 1993. Average annual suicide rate was calculated for prostate cancer-related suicides and contrasted with age and gender-specific rates in the same geographic area. RESULTS Of 667 completed suicides, 20 were prostate cancer-related (3% of the total male suicide sample). The average annual incidence of suicide for men was 55.32 per 100,000 persons, but for men with prostate cancer, the rate was 274.7 per 100,000. The risk of suicide in men with prostate cancer was 4.24 times that of an age- and gender-specific cohort. The clinical correlates included depression (70%), cancer diagnosis within 6 months of suicide (80%), physician visit within 1 month of suicide (60%), and being foreign-born (70%). CONCLUSION The incidence of suicide among older men with prostate cancer is higher than previously recognized. Depression, recent diagnosis, pain, and being foreign-born are important clinical correlates. Screens for depression and suicide in older men with prostate cancer should be done after diagnosis and redone during the first 6 months regularly, particularly in the primary-care setting. Public education is needed to decrease the stigma associated with having a cancer diagnosis.
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Affiliation(s)
- Maria D Llorente
- Miami Veterans' Affairs Medical Center, 1601 NW 12 Ave. #116A, Miami, FL 33125, USA.
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Bartels SJ, Coakley EH, Zubritsky C, Ware JH, Miles KM, Areán PA, Chen H, Oslin DW, Llorente MD, Costantino G, Quijano L, McIntyre JS, Linkins KW, Oxman TE, Maxwell J, Levkoff SE. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry 2004; 161:1455-62. [PMID: 15285973 DOI: 10.1176/appi.ajp.161.8.1455] [Citation(s) in RCA: 238] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. METHOD This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). RESULTS Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. CONCLUSIONS Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.
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Affiliation(s)
- Stephen J Bartels
- Department of Psychiatry, Dartmouth Medical School, Lebanon, NH, USA.
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Abstract
Benzodiazepines are disproportionately prescribed to older adults. Elderly adults with comorbid medical and psychiatric conditions, elderly adults taking multiple medications, and elderly women are the most likely adults to continuously use benzodiazepines. These are also the groups of elderly who are likely to experience adverse effects, including falls, accidents, and motor vehicle crashes. Despite recommendations for short-term treatment and the potential risks of long-term use, some patients continue to receive benefit for extended time periods, occasionally years. Future research needs to be directed at improved identification of which patients will benefit from intermittent versus continuous treatment while minimizing risk for adverse side effects. In order to advance the study of the risks and benefits of benzodiazepine use, we have proposed a set of definitions for classification of use. These definitions can be used to develop clinical guidelines based on empirically derived clinical research models.
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Affiliation(s)
- M D Llorente
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida, USA
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Llorente MD, Olsen EJ, Leyva O, Silverman MA, Lewis JE, Rivero J. Use of antipsychotic drugs in nursing homes: current compliance with OBRA regulations. J Am Geriatr Soc 1998; 46:198-201. [PMID: 9475449 DOI: 10.1111/j.1532-5415.1998.tb02539.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the degree and patterns of compliance with the Omnibus Budget Reconciliation Act (OBRA) regulations regarding the use of antipsychotic drugs in nursing homes. DESIGN Retrospective chart review of all resident records. PARTICIPANTS Eight nursing homes: five community, two county-owned, and one university-affiliated Veterans Administration facility. MEASUREMENTS A structured assessment instrument to track compliance with each aspect of the OBRA regulations regarding antipsychotic drug use. RESULTS A total of 1573 nursing home residents' pharmacy records were reviewed between August 1994 and March 1996. Two hundred seventy-nine residents were actively taking antipsychotic medications (prevalence = 17.7%). Mean compliance greater than 70% was found for (1) appropriate diagnostic indication (mean = 70.9%), (2) dosage within recommended limits (mean = 90.1%), and 3) documented appropriate target symptoms (mean = 90.4%). Dosages were more likely to exceed limits in those patients with histories of major mental illness, particularly schizophrenia. CONCLUSIONS Nursing homes were better able to comply with those guidelines that are most specific. Educational interventions now need to focus on behavioral interventions, monitoring of adverse effects, and efficacy. These data are useful in establishing threshold levels of performance and can be used by nursing homes for continuous quality improvement. OBRA continues to impact neuroleptic drug prescribing practices in nursing homes significantly.
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Affiliation(s)
- M D Llorente
- University of Miami School of Medicine, Florida, USA
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Llorente MD, Holland PJ. ECT in a geriatric depressed woman with bilateral frontal lobotomy. Convuls Ther 1996; 12:36-39. [PMID: 8777652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Llorente MD, Gorelick M, Silverman MA. Sertraline as the cause of inappropriate antidiuretic hormone secretion. J Clin Psychiatry 1994; 55:543-4. [PMID: 7814351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Llorente MD, Currier MB, Norman SE, Mellman TA. Night terrors in adults: phenomenology and relationship to psychopathology. J Clin Psychiatry 1992; 53:392-4. [PMID: 1459969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Night terrors have been classically described in children. Night terrors occurring in adults have been linked to psychopathology. Recent descriptions of sleep panic attacks have raised questions about their relationship to night terrors. METHOD Evaluations from a medically affiliated sleep disorders program were reviewed to identify adult patients presenting with events consistent with night terrors. Eleven patients were identified, 10 of whom had polysomnographic evaluation, and their records were reviewed for information relevant to night terrors and psychiatric symptoms. Six of these patients were available for further assessment which included inquiry regarding sleep events, a Structured Clinical Interview (SCID) for psychiatric disorders, and the Millon Clinical Multiaxial Inventory II (MCMI-II) for personality-related measurements. RESULTS In the original sample, night terror episodes featured confused behaviors, motor activity, and absent or fragmented recall. Polysomnography documented arousals from slow wave sleep in 9 of 10 patients. All of the original patients reported psychiatric symptoms. All 6 patients who received the subsequent structured evaluation met lifetime criteria for Axis I conditions (most commonly affective and substance use disorders) and had elevated scores on the personality scales of the MCMI-II. Night terrors were not limited to psychiatric episodes. CONCLUSION Night terrors occur in adults that are similar to episodes described in children. While distinct from sleep panic attacks, night terrors appear to occur in adults with histories of psychopathology.
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Affiliation(s)
- M D Llorente
- Department of Psychiatry, University of Miami School of Medicine, Fla
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