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Meyerson JL, O'Malley KA, Obas CE, Hinrichs KLM. Lived Experience: A Case-Based Review of Trauma-Informed Hospice and Palliative Care at a Veterans Affairs Medical Center. Am J Hosp Palliat Care 2023; 40:329-336. [PMID: 35848682 DOI: 10.1177/10499091221116098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/15/2022] Open
Abstract
Many individuals who present for hospice or palliative care might have experienced trauma during their lives, with some progressing to post-traumatic stress disorder. As these individuals face life-limiting illness, trauma might resurface. Consequently, physical and emotional health might suffer due to exacerbation of trauma-related symptoms, such as anxiety, irritability, or flashbacks. Providing trauma-informed care can help mitigate the effects of trauma for those facing life-limiting illness who might not be able to tolerate formal trauma treatment due to limited prognosis, fatigue, or lack of willingness to engage in treatment. The goal of this narrative review is to describe how aging and the end-of-life experience can lead to a re-engagement with previous traumatic experiences and, using case-based examples, provide recommendations for all members of the interprofessional hospice or palliative care team on how to elicit and respond to a history of trauma to minimize the potential negative impact of trauma at end-of-life.
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Affiliation(s)
- Jordana L Meyerson
- Medical Service, Section of Palliative Care, 20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kelly A O'Malley
- Mental Health Service, RinggoldID:20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christelle E Obas
- Department of Nursing, 20026Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Kate L M Hinrichs
- Mental Health Service, RinggoldID:20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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2
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Correro AN, Hinrichs KLM, Krishnan MC, Cottingham ME, Trittschuh EH, Parmenter BA, Kang J, Stelmokas J. Neuropsychological assessment with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals: Practice, education, and training survey. Clin Neuropsychol 2022:1-43. [PMID: 36458596 DOI: 10.1080/13854046.2022.2148379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022]
Abstract
Objective: We sought to describe the LGBTQ + related education, training, and clinical practice of independently licensed neuropsychologists in the United States and to identify factors that predict affirmative neuropsychological practices. We hypothesized that LGBTQ + identity, female gender, more recent training, and extent of LGBTQ + education/training would predict use of LGBTQ + practice guidelines. Method: A workgroup of clinical psychologists with experience in LGBTQ + psychology and neuropsychology developed a survey to identify personal and professional factors that predict affirmative neuropsychological testing practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. Results: The majority of participants identified as heterosexual (70.3%) and cisgender (97.5%), and most (48-63%) received LGBTQ + training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ + specific education. Consistent with our hypotheses, factors predicting affirmative clinical practice behaviors were LGBTQ + education/training, and personal background (sexual minority status, female/feminine gender, and years since degree). Other significant factors included prior experience with LGBTQ + patients and primary patient population (child vs. adult). Qualitative responses indicated varying values, attitudes, and knowledge regarding collection of LGBTQ + information and modification of clinical practice. Conclusions: Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ + health information is available at their institutions, and adjusting evaluation and feedback approaches. We provide specific training and education recommendations to increase knowledge and skills and to address beliefs about LGBTQ + health that can serve to promote affirmative neuropsychological practice.
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Affiliation(s)
- Anthony N Correro
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Kate L M Hinrichs
- Mental Health Service, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Mira C Krishnan
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | | | - Emily H Trittschuh
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Healthcare System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brett A Parmenter
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Mental Health Service, American Lake Division, VA Puget Sound Healthcare System, Tacoma, Washington, USA
- Olympic Psychology Services, Tacoma, Washington, USA
| | - Jinkyung Kang
- Department of Internal Medicine-Geriatric and Palliative Medicine, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Julija Stelmokas
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
- Mental Health Service, Brooklyn Campus, VA New York Harbor Healthcare System, Brooklyn, New York, USA
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Abstract
Objectives: Group mental health interventions are difficult to implement into rehabilitation facilities, but no one has studied the specific barriers. This mixed-methods project systematically examined the implementation of a mental health (MH) group intervention in a VA community living center (CLC) for residents on subacute rehabilitation units, using the Promoting Action on Research Implementation in Health Services (PARIHS) implementation framework.Methods: We implemented a group MH intervention, tracking team referrals, attendance rates, and reasons for declining to participate. We conducted qualitative interviews with attendees.Results: Individual barriers to attendance included acute illness (n = 67, 20%), attitudes toward MH (n = 50; 15%), and perceived busyness (n = 19; 6%). Facility barriers included competing appointments (n = 69; 21%). Interviews demonstrated challenges to implementation, including stigma toward mental health (Theme: Challenges and Supports to Implementation). Attendees found the group relatable, and noted that both positive and negative group dynamics contributed to their experience (Themes: Content Relevance and Group Dynamics).Conclusions: The results provide insight into implementing a group MH treatment into the CLC setting, with implications for the MH care of older adults residing in CLCs.Clinical Implications: 1) Group leaders should consider matching attendees for ability levels (physical or cognitive). 2) At the facility level, leaders may take steps to address stigma toward MH by adopting approaches (e.g., music) or framing MH issues (e.g., use of language) in a way that is approachable. 3) Modifiable barriers at the individual and facility level could be addressed to encourage ease of implementation.
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Affiliation(s)
- Jessica V Strong
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,New England GRECC, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan Plys
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Internal Medicine, University of Colorado Denver- Anschutz Medical Campus
| | - Christine W Hartmann
- Edith Norse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kate L M Hinrichs
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McCullough
- Edith Norse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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4
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Anderson E, Eleazer JR, Kristensen Z, St Amand CM, Baker AM, Correro AN, Cottingham ME, Hinrichs KLM, Parmenter BA, Stelmokas J, Trittschuh EH. Affirmative neuropsychological practice with transgender and gender diverse individuals and communities. Clin Neuropsychol 2022:1-19. [PMID: 35642438 DOI: 10.1080/13854046.2022.2073915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
Objective: To provide guidance and resources on how to practice culturally safe and humble neuropsychology with transgender and gender diverse (TGD) individuals and communities. Methods: We gathered a multidisciplinary team of clinicians with relevant professional and/or lived experience to review pertinent literature, discuss important concepts, and identify key resources. From this process, we outline practical steps to advance gender affirmative neuropsychological practice. Results: Professional awareness and knowledge regarding how to gather context-relevant, gender identity information is critical. TGD individuals form a heterogenous group; a one-size-fits-all approach is not adequate. It is incumbent upon neuropsychologists to engage in clinical and research practices in a manner that does not perpetuate gender minority stress and trauma. Creating an open, safe environment of care requires intentionality and careful thinking to determine what information is relevant for a particular referral question. We provide recommendations and resources for neuropsychologists. Conclusion: When neuropsychologists are proactive, responsible, and intentional, they can better provide individualized, person-centered, and trauma-informed care to TGD individuals.
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Affiliation(s)
- Erica Anderson
- Anderson Health Strategies, LLC, President Former USPATH, Berkeley, CA, USA
| | | | | | - Colt M St Amand
- Department of Family Medicine, Mayo Clinic Rochester, Department of Psychology, University of Houston, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Abigail M Baker
- VA-Tennessee Valley Healthcare System
- Saint Mary's University of Minnesota
| | - Anthony N Correro
- VA Ann Arbor Healthcare System Michigan Medicine, University of Michigan
| | | | - Kate L M Hinrichs
- VA Boston Healthcare System, Mental Health Service, Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Brett A Parmenter
- Olympic Psychology Services, Tacoma, WA
- VA Puget Sound Health Care System, GRECC, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Julija Stelmokas
- VA Ann Arbor Healthcare System Michigan Medicine, University of Michigan
- New York Harbor Healthcare System Brooklyn Campus
| | - Emily H Trittschuh
- VA Puget Sound Health Care System, GRECC, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
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Strong JV, Plys E, Hinrichs KLM, Hartmann CW, McCullough M. Music for your mental health? The development and evaluation of a group mental health intervention in subacute rehabilitation. Aging Ment Health 2022; 26:950-957. [PMID: 34121525 DOI: 10.1080/13607863.2021.1935463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 10/21/2022]
Abstract
Objectives: Short-stay residents of nursing homes experience high rates of mental health (MH) distress compared to community dwelling counterparts, yet MH interventions are difficult to implement and sustain. We modified a music therapy framework to Effective Music in Psychotherapy. Using the modified model, we integrated music listening into MH group intervention and evaluated MH outcomes. This pilot study reports the development and evaluation of the Mental Health and Music Group for short-stay nursing homes residents.Method: The group was developed and refined to be non-sequential and non-cumulative, specific to the needs of short-stay nursing home residents. Pre-/post-session ratings examined affect, quality of life, and pain. Leaders monitored engagement across and between sessions. Qualitative interviews were conducted with a selection of attendees.Results: Findings indicated decreases in irritation and worry, and increases in mood, energy, and self-as-a-whole from pre- to post-session. There were no changes in pain, perception of physical health or life-as-a-whole, energetic, sad, or happy affect, or differences in engagement. Qualitative interviews demonstrated benefits of group modality and music to group cohesion and highlighted the relevance of music for mental health outcomes.Conclusion: The Mental Health and Music group was designed around a framework of Effective Music in Psychotherapy, for short-stay nursing home settings, and demonstrated promising results. Future research can solidify the interventions generalizeability to medical and rehabilitation settings addressing the specific population needs and preferences.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1935463 .
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Affiliation(s)
- Jessica V Strong
- VA Boston Healthcare System, Boston, MA, USA.,New England Geriatric Research Education and Clinical Center, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychology, Faculty of Arts, University of Prince Edward Island, Charlottetown, Canada
| | - Evan Plys
- VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kate L M Hinrichs
- VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System.,Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System.,Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
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Hinrichs KLM, Hiroto KE, Rodriguez RL. Unmasking Our Grief. Fed Pract 2022; 38:490-493. [PMID: 35136333 DOI: 10.12788/fp.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Health care systems have been calling for trainings on the topics of self-care and burnout to help staff cope with the impact of the COVID-19 pandemic. The geriatric care workforce in particular has been hard hit by the stresses of COVID-19 and social inequities for themselves and their patients. These stresses have led to trauma and grief among our colleagues and ourselves. Observations Self-care techniques in and of themselves are not an adequate salve for the massive, collective, and many times unrecognized grief that the geriatric care workforce has faced over the course of this pandemic. We must acknowledge, name, and make space for the grief that is exhausting the entire elder care workforce and we must do so at an organizational level. In this paper, we briefly discuss the distress affecting the geriatric care workforce, reflect on our efforts to cope as health care workers, and offer recommendations at individual and organization levels to help address our collective grief. Conclusions This pandemic has revealed our vulnerabilities as well as our strengths. These experiences also present us with opportunities to be better and do better as both professionals and people. We hope that teams and organizations will take advantage of these opportunities for self-reflection and continue unmasking our grief, healing our wounds, and honoring our shared humanity.
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Affiliation(s)
- Kate L M Hinrichs
- Veterans Affairs Boston Healthcare System, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kimberly E Hiroto
- Veterans Affairs Palo Alto Health Care System, California.,Stanford University School of Medicine, California
| | - Rachel L Rodriguez
- Home-Based Primary Care Program, Durham Veterans Affairs Health Care System, North Carolina
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Hinrichs KLM, Woolverton CB, Meyerson JL. Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness. Am J Hosp Palliat Care 2021; 39:250-257. [PMID: 33874784 DOI: 10.1177/10499091211010722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2023] Open
Abstract
Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses-Bipolar Disorders, Major Depressive Disorder, and Schizophrenia-are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.
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Affiliation(s)
- Kate L M Hinrichs
- Mental Health Service, 20026VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cindy B Woolverton
- Mental Health Service, 20026VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jordana L Meyerson
- Department of Medicine, 20026VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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8
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Hinrichs KLM, Steadman-Wood P, Meyerson JL. ACT Now: The Intersection of Acceptance and Commitment Therapy with Palliative Care in a Veteran with Chronic Suicidal Ideation. Clin Gerontol 2020; 43:126-131. [PMID: 31322060 DOI: 10.1080/07317115.2019.1642974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 10/26/2022]
Abstract
Suicide rates are increasing in the United States and groups at elevated risk include older adults, veterans, and those with life-limiting illnesses. However, the treatment of suicidality at end-of-life has been little studied. There is emerging evidence that palliative care itself may be protective against suicide and there is some support for the use of Acceptance and Commitment Therapy (ACT) at end-of-life. The overlapping mechanisms of palliative care and ACT are especially well-suited for individuals struggling with suicidality in the context of life-limiting illness.A case from a Veterans Affairs Home-Based Primary Care (HBPC) team is used to illustrate the challenges and opportunities when providing end-of-life care to an older veteran with chronic suicidal ideation. Prior mental health treatment had limited impact on his suicidality. However, with an integrated ACT and palliative care approach, the HBPC team was better able to focus on the veteran's goals. This approach was helpful in reducing suicidal ideation and engaging him in end-of-life decision-making discussions. This case highlights the valuable role of palliative care in suicide prevention and how the addition of ACT can aid in the effective treatment of chronic suicidal ideation at the end-of-life.
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Affiliation(s)
| | - Pamela Steadman-Wood
- Providence VA Medical Center, Providence, USA.,Alpert Medical School Brown University
| | - Jordana L Meyerson
- VA Boston Healthcare System, Boston, USA.,Harvard Medical School.,Boston University School of Medicine, Boston, USA
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9
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Gerolimatos LA, Page KS, Balestracci P, Hinrichs KLM. Interdisciplinary development and implementation of a dementia skills training program in a VA community living center: a pilot study. Geriatr Nurs 2018; 39:400-406. [PMID: 29336830 DOI: 10.1016/j.gerinurse.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
This pilot study investigates the usefulness of a dementia care training program developed by an interdisciplinary team to address problem behaviors associated with dementia. Staff members of a VA Community Living Center completed an 8-hour workshop covering fundamental knowledge about dementia and instruction in skills to use with patients through video, lecture, and role-plays. Measures on dementia knowledge and perceived self-efficacy were completed by staff members before and after the workshop. Results revealed increases in self-efficacy and knowledge, with particular gains in general knowledge of dementia and communicating with patients. Younger staff members scored higher on tests of knowledge at pre- and post-test, whereas staff members with more years of work experience rated their self-efficacy higher at post-test only. There was an associated decrease in assaultive behaviors by patients with dementia in the year this workshop was implemented. Results highlight the benefit of interdisciplinary collaboration in developing educational content and the value of providing staff training on managing dementia-related behaviors. Adjustments to this training program are discussed.
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Affiliation(s)
| | - Kyle S Page
- VA Central Iowa Healthcare System, Des Moines, IA
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10
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Abstract
OBJECTIVE This article evaluates the role healthcare providers play in balancing safety versus autonomy among elders when performing capacity evaluations. METHODS Presentation of a case study consisting of an 85-year-old, Caucasian, widowed, male, post-stroke veteran, residing in long-term care. He was assigned a permanent court-appointed joint guardian and conservator, but wanted to remove both of these as he felt he had the ability to manage his own affairs. This case study specifically addresses the issue of financial capacity. RESULTS After completion of the evaluation, a case was made for the least restrictive means balancing patient autonomy and protection, opting for a limited conservatorship. The court, using the evaluation as evidence, completely removed the guardianship and conservatorship. CONCLUSIONS This article outlines how providers can navigate multiple roles, team dynamics, and advocate for enhancing the capacity of an older adult.
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Affiliation(s)
- Kyle S Page
- a Cheyenne VA Medical Center , Cheyenne , Wyoming , USA
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Hinrichs KLM, Sharma S, Thurston J, Sivashanker K, Chang GH. Management of opioid use disorders among veterans in subacute rehab: Use of an interdisciplinary task force to address an emerging concern. Subst Abus 2015; 37:4-6. [PMID: 26672391 DOI: 10.1080/08897077.2015.1127871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/22/2022]
Abstract
There is both rapidly growing need, and limited evidence-based guidelines, for the management of opioid use disorders in subacute rehab and other nonaddiction medical settings. Following 2 unintentional opioid overdoses within the Community Living Center (CLC), a VA (Veterans Administration) subacute rehab setting, an interdisciplinary CLC Addictions Task Force was created to address a critical issue: how to best meet the combined neuropsychiatric and medical needs of the opiate use disorder patient through a multifaceted treatment approach. The goals of the task force were to develop and institute educational initiatives for providers; create patient care guidelines; increase safety on the unit; improve provider confidence when caring for this high-risk population; and mitigate the risk of unintentional overdose. The task force divided into 4 working groups to meet these aims. Process and outcomes are discussed. We found that in-services by addiction specialists improved clinician comfort in caring for this high-risk patient group. Specific areas that yielded the greatest clinician satisfaction ratings included didactics on how to identify at-risk patients and techniques on how to manage the patient in a general rehab setting. Utilizing an interdisciplinary approach, and an iterative process, at all stages was critical to the success of the CLC Addictions Task Force, as it improved buy-in and motivation from all disciplines. Improvements have been made to enhance patient safety, improve communication amongst providers, and provide a foundation to improve patient outcomes. Our preliminary work to enhance the identification and management of opioid use disorders at our CLC is an important first step towards a standardized curriculum that could be applied to other VA and non-VA subacute rehab settings.
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Affiliation(s)
| | - Samata Sharma
- a VA Boston Healthcare System , Boston , Massachusetts , USA
| | - Joe Thurston
- a VA Boston Healthcare System , Boston , Massachusetts , USA
| | | | - Grace H Chang
- a VA Boston Healthcare System , Boston , Massachusetts , USA
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12
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Abstract
An ongoing fear in the gay and lesbian community is that long-term care (LTC) facilities may not be sensitive to their needs. In the present study, 218 LTC staff members responded to one of three vignettes in which resident sexual contact was observed, with only the gender of the characters changing, to create different gender pairings. Results suggested that staff rated male-male and female-female pairings more negatively than heterosexual intimacy. Knowledge about older adult sexuality made little difference in staff ratings. However, staff attitudes were directly related to ratings of negative reaction and level of acceptability of same-gender sexuality.
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