Objectives: Characterize the implementation, benefits, and challenges of an Essential Family Caregiver (EFC) program, a novel policy implemented in long-term care (LTC) settings during the COVID-19 pandemic in Indiana. Characterize LTC administrator perspectives on family/caregiver involvement in the LTC setting. Design: Semi-structured qualitative interviews.Setting and Participants: Administrators from 4 Indiana LTC facilities. Methods: In this qualitative study, a convenience sample of 4 LTC administrators was recruited. Each participant completed 1 interview during January to May 2021. Following transcription, a thematic analysis approach with 2 cycles of qualitative coding identified relevant themes.Results: Four LTC administrators participated, representing both urban and rural nonprofit nursing homes. Participants spoke positively of the program despite implementation challenges including perceived infection risk, policy interpretation, and logistical challenges. The psychological impact of isolation for nursing home residents was emphasized as a critical consideration alongside physical health concerns. LTC administrators desired to support resident well-being while maintaining good standing with regulatory agencies.Conclusions and Implications: Based on a limited sample, Indiana's EFC policy was viewed favorably by LTC administrators as a tool to balance resident and family psychosocial needs with infection-related health risks. LTC administrators desired a collaborative approach from regulators as they worked to implement a novel policy. Consistent with participant desire for broader caregiver access to residents, more recent policymaking has reflected growing recognition of the critical role of family members not only as companions but also as care providers, even in a structured care environment.& COPY; 2023 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Introduction Amyloid imaging is a relatively new tool for diagnostic clarification in Alzheimer's disease and related dementias. It is used in appropriately selected cases to help disambiguate the etiology of cognitive decline based on the burden of beta amyloid on brain imaging. The psychological impact of this new technology on patients and caregivers remains unclear, but is potentially significant given the implications of the findings for diagnosis, clinical trajectory, and quality of life. The LEARN-AD (Learning about the Experience of Amyloid imaging and early RecogNition of Alzheimer's Disease in Veterans and Their Caregivers) pilot study is in progress to describe psychological outcomes, caregiver burden, and neuroimaging data for veterans undergoing amyloid imaging as part of their clinical care. Methods Eligible participants included veterans at the Roudebush VA Medical Center receiving amyloid imaging as part of their usual clinical care in the Older Adult Mental Health Clinic, as well as their caregiver/informant. In the quantitative portion of the study, the relationship between neuroimaging measurements and depression and anxiety outcomes in veterans were assessed at time points prior to the recommendation for amyloid imaging, at follow up for results disclosure, and three months after disclosure. Depression symptoms were assessed using the Geriatric Depression Scale (GDS), while anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item Screener (GAD-7). Neuroimaging analysis will be overseen by the Indiana Alzheimer's Disease Research Center. A subset of twenty participant and caregiver pairs will participate in qualitative interviews to explore their experience of the amyloid scan, results disclosure, and its impact on care decisions. Results Preliminary demographic data from N = 75 veterans demonstrated a study population that is 97% Caucasian with an average of 13.6 years of education. Average age at the time of amyloid scan was 71.9 years. At the visit prior to the recommendation for amyloid imaging, average veteran Geriatric Depression Scale (GDS) score was 3.5 and average GAD-7 score was 4.6 (N = 59). For the subset of N = 29 participants with available data from the follow up for results disclosure, average GDS score was 3.4 and average GAD-7 score was 3.0. The N = 24 participants with currently available data from three months after results disclosure had an average GDS score of 3.5 and GAD-7 score of 3.5. Qualitative data collection will begin soon and preliminary results will be shared at the time of presentation. Conclusions The LEARN-AD study is in progress to characterize quantitative and qualitative aspects of the patient and caregiver experience of amyloid imaging. Findings will expand the literature base related to the psychological impact of amyloid imaging on patients and caregivers as well as the impact of the results on care. This research was funded by LEARN-AD is supported by funding from the Indiana Institute for Medical Research.

Introduction:Alzheimer's disease (AD) is a public health priority. AD biomarkers may vary based on race, but the recruitment of diverse participants has been challenging. Methods:Three groups of Black and White participants with and without prior research advocacy or participation were interviewed individually or in focus groups to better understand perspectives related to AD biomarker research participation. A rapid qualitative data analytic approach was used to analyze the data. Results:Identified barriers to AD biomarker research participation included hesitancy due to fear, distrust of research and researchers, lack of relevant knowledge, and lack of research test results disclosure. Drivers for engagement in biomarker research procedures included knowledge about research, AD, and related clinical procedures, perceived benefits of participation, and outreach from trusted sources. Discussion:Participants' comments related to the need for diversity in research and desire for results disclosure suggest opportunities to engage Black individuals. Highlights:Black Americans experience more salient barriers to Alzheimer's disease (AD) biomarker research participation.Concerns about research diversity influence research participation decisions.Research test disclosure may affect research participation and retention.

Back to table of contents previous chapternext chapter No AccessChapter 5.Use of the Laboratory in the Diagnostic Workup of Older AdultsEdited by:https://doi.org/10.1176/appi.books.9781615375196.ds05AboutSectionsView chapterExcerptView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View chapterSectionsSerological Tests | Toxicology | Urinalysis | Cerebrospinal Fluid Analysis and Plasma Assays for Dementia | Electrocardiogram | Imaging Studies | Electroencephalography | Genetic Testing | Omics Technologies | Conclusion | ReferencesExcerptLaboratory testing is an essential component of the psychiatric evaluation of elderly individuals, who often present with comorbid medical illnesses. The laboratory does not replace the clinician; no test is pathognomonic for a primary psychiatric illness. However, laboratory testing does aid in the evaluation of comorbidities that complicate or contribute to a psychiatric diagnosis. The number and quality of diagnostic tools available have grown significantly. Progress in research and technology, particularly in imaging technology and genetic testing, has advanced rapidly over the past decade. Regardless of the tools available, however, we must balance what we can do with what we should do, as guided by our clinical judgment, relative risk to the patient, and cost expenditure. When all risks are considered, the decision to proceed with a test should be based on the clinical presentation and on how the test results may change a treatment plan. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone The American Psychiatric Association Publishing Textbook of Geriatric Psychiatry Information©American Psychiatric Association Publishing History Published online 8 January 2023 Published in print 9 August 2022

Objectives To characterize pretransfer on-site nursing home (NH) management, transfer disposition, and hospital discharge diagnoses of long-stay residents transferred for behavioral concerns. Design This was a secondary data analysis of the Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care project, in which clinical staff employed in the NH setting conducted medical, transitional, and palliative care quality improvement initiatives and gathered data related to resident transfers to the emergency department/hospital setting. R software and Microsoft Excel were used to characterize a subset of transfers prompted by behavioral concerns. Setting NHs in central Indiana were utilized (N = 19). Participants This study included long-stay NH residents with behavioral concerns prompting transfer for acute emergency department/hospital evaluation (N = 355 transfers). Measurements The measures used in this study were symptoms prompting transfer, resident demographics and baseline characteristics (Minimum Data Set 3.0 variables including scores for the Cognitive Function Scale, ADL Functional Status, behavioral symptoms directed toward others, and preexisting psychiatric diagnoses), on-site management (e.g., medical evaluation in person or by phone, testing, and interventions), avoidability rating, transfer disposition (inpatient vs emergency department only), and hospital discharge diagnoses. Results Over half of the transfers, 56%, had a medical evaluation before transfer, and diagnostic testing was conducted before 31% of transfers. After transfer, 80% were admitted. The most common hospital discharge diagnoses were dementia-related behaviors (27%) and altered mental status (27%), followed by a number of medical diagnoses. Conclusion Most transfers for behavioral concerns merited hospital admission, and medical discharge diagnoses were common. There remain significant opportunities to improve pretransfer management of NH transfers for behavioral concerns.

Anxiety and depressive disorders are common in the pediatric primary care setting, and respond to both psychotherapeutic and psychopharmacologic treatment. However, there are limited data regarding the optimal treatment duration. This article systematically reviews guidelines and clinical trial data related to antidepressant treatment duration in pediatric patients with depressive and anxiety disorders. The extant literature suggests 912 months of antidepressant treatment for youth with major depressive disorder. For generalized, separation and social anxiety disorders, 69 months of antidepressant treatment may be sufficient, though many clinicians extend treatment to 12 months based on extrapolation of data from adults with anxiety disorders. Such extended treatment periods may decrease the risk of long-term morbidity and recurrence; however, the goal of treatment is ultimately remission, rather than duration of antidepressant pharmacotherapy. Moreover, while evidence-based guidelines represent a starting point, appropriate treatment duration varies and patient-specific response, psychological factors, and timing of discontinuation must be considered for individual pediatric patients.

Introduction: Hearing loss is a common issue for older adults, affecting almost two-thirds of Americans over seventy. There are multiple psychiatric implications for this population, as hearing loss is associated with worsened cognitive status, greater depressive symptoms, and, in the case of Deaf patients, a distinct collective identity that necessitates culturally sensitive care. For older adults with hearing loss, multiple studies have shown a lower likelihood of depressive symptoms among those using hearing aids, though this does not imply causality. Given the morbidity associated with depression, strong evidence supporting auditory intervention would signify an important opportunity for clinical impact, particularly in light of the limited utilization of assistive devices; less than one-fifth of adults with hearing loss utilize a hearing aid.