BACKGROUND:To examine cross-sectional differences and longitudinal changes in cognitive performance based on the presence of mild behavioral impairment (MBI) among older adults who are cognitively healthy or have mild cognitive impairment (MCI). METHODS:Secondary data analysis of participants (n = 17 291) who were cognitively healthy (n = 11 771) or diagnosed with MCI (n = 5 520) from the National Alzheimer's Coordinating Center database. Overall, 24.7% of the sample met the criteria for MBI. Cognition was examined through a neuropsychological battery that assessed attention, episodic memory, executive function, language, visuospatial ability, and processing speed. RESULTS:Older adults with MBI, regardless of whether they were cognitively healthy or diagnosed with MCI, performed significantly worse at baseline on tasks for attention, episodic memory, executive function, language, and processing speed and exhibited greater longitudinal declines on tasks of attention, episodic memory, language, and processing speed. Cognitively healthy older adults with MBI performed significantly worse than those who were cognitively healthy without MBI on tasks of visuospatial ability at baseline and on tasks of processing speed across time. Older adults with MCI and MBI performed significantly worse than those with only MCI on executive function at baseline and visuospatial ability and processing speed tasks across time. CONCLUSIONS:This study found evidence that MBI is related to poorer cognitive performance cross-sectionally and longitudinally. Additionally, those with MBI and MCI performed worse across multiple tasks of cognition both cross-sectionally and across time. These results provide support for MBI being uniquely associated with different aspects of cognition.

Vocational interest theories imply a person-occupation cross-level interaction effect (e.g., artistic interests predict job performance better in artistic occupations), which has rarely if ever been tested as such. Using a large military sample, we find person-occupation interest congruence effects are supported: (a) on core technical job performance for six of eight interest dimensions, and (b) on job performance ratings for structural/machines and rugged outdoors (i.e., Realistic) interests. Another cross-level interaction involves the person-occupation gender congruence effect. Our data also confirm the job performance gap favors men when in male-dominated occupations, but favors women when in genderbalanced occupations. Due to strong overlap between vocational interests and gender, we conduct a critical test of whether person-occupation interest congruence might be due to person-occupation gender congruence. In only two of six cases (i.e., rugged outdoors and administrative interests), did the person-occupation interest congruence effect disappear after controlling for the person-occupation gender congruence effect; the gender congruence effect also remained significant after controlling for the interest congruence effect. Consequently, the two cross-level interactions on job performance (for vocational interests and for gender) appear to represent distinct effects. In a second, service organization sample, the person-occupation interest congruence effect (for Realistic interests) on job performance ratings and the person-occupation gender congruence effect were both replicated.

Abstract Research on bilingualism has found inconsistent results regarding its potential benefit on the cognitive abilities of older adults. The goal of the current study was to evaluate differences in cognition on a wide array of neuropsychological assessments between monolingual and bilingual cognitively healthy older adults who specifically speak only English and/or Spanish. The sample included cognitively intact older adults who were either monolingual (n=247) English speakers or bilingual (n=42) in English and Spanish. Performance was compared between groups from a battery of neuropsychological assessments that measured executive function, attention, short-term memory, and episodic memory. Compared to English and Spanish bilinguals, monolingual English speakers performed significantly better on a variety of tasks within the domains of executive function, attention, and short-term memory. No significant differences were found in favor of the bilinguals on any domain of cognitive performance. In the present study, we failed to observe a significant advantage for English and Spanish bilingual speakers on the cognitive performance of older adults when compared to monolingual English speakers. This study suggests that the bilingual advantage may not be as robust as originally reported, and the effects of bilingualism on cognition could be significantly impacted by the languages included in the study.

OBJECTIVE:To assess the influence of mild behavioral impairment (MBI) on the cognitive performance of older adults who are cognitively healthy or have mild cognitive impairment (MCI). METHODS:Secondary data analysis of a sample (n = 497) of older adults from the Florida Alzheimer's Disease Research Center who were either cognitively healthy (n = 285) or diagnosed with MCI (n = 212). Over half of the sample (n = 255) met the operationalized diagnostic criteria for MBI. Cognitive domains of executive function, attention, short-term memory, and episodic memory were assessed using a battery of neuropsychological tests. RESULTS:Older adults with MBI performed worse on tasks of executive function, attention, and episodic memory compared to those without MBI. A significant interaction revealed that persons with MBI and MCI performed worse on tasks of episodic memory compared to individuals with only MCI, but no significant differences were found in performance in cognitively healthy older adults with or without MBI on this cognitive domain. As expected, cognitively healthy older adults performed better than individuals with MCI on every domain of cognition. CONCLUSIONS:The present study found evidence that independent of cognitive status, individuals with MBI performed worse on tests of executive function, attention, and episodic memory than individuals without MBI. Additionally, those with MCI and MBI perform significantly worse on episodic memory tasks than individuals with only MCI. These results provide support for a unique cognitive phenotype associated with MBI and highlight the necessity for assessing both cognitive and behavioral symptoms.

OBJECTIVES:To determine whether neuropsychiatric symptoms (NPS) are able to differentiate those with mild cognitive impairment (MCI) and dementia from persons who are cognitively healthy.METHODS:Multinomial and binary logistic regressions were used to assess secondary data of a sample (n = 613) of older adults with NPS. Analyses evaluated the ability to differentiate between diagnoses, as well as the influence of these symptoms for individuals with amnestic MCI (MCI-A), non-amnestic MCI (MCI-NA), and dementia compared with those who are cognitively healthy.RESULTS:Persons with MCI were more likely to have anxiety, apathy, and appetite changes compared with cognitively healthy individuals. Persons with dementia were more likely to have aberrant motor behaviors, anxiety, apathy, appetite changes, and delusions compared with those who were cognitively healthy. Individuals with any type of cognitive impairment were more likely to have anxiety, apathy, appetite changes, and delusions. Specifically, anxiety, apathy, appetite changes, and disinhibition were predictors of MCI-A; agitation and apathy were predictors of MCI-NA; and aberrant motor behaviors, anxiety, apathy, appetite changes, and delusions were predictors of dementia. Finally, nighttime behavior disorders were less likely in individuals with dementia.CONCLUSIONS:The present study's results demonstrate that specific NPS are differentially represented among types of cognitive impairment and establish the predictive value for one of these cognitive impairment diagnoses.

OBJECTIVEThis study examined the temporal sequencing of a first-recorded episode of homelessness and treatment for suicidal ideation or attempt.METHODSData were from the U.S. Department of Veterans Affairs Corporate Data Warehouse and contained medical records of service use dates and associated ICD codes for care provided by the Veterans Health Administration. The analysis examined treatment for suicidality before and after a first record of homelessness ("onset") among 152,519 veterans. The second analysis examined the rate of treatment for suicidality among 156,288 veterans with any indication of homelessness. The third analysis examined the rate of homelessness among 145,770 veterans with indication of suicidality.RESULTSAmong newly homeless veterans, treatment for suicidality peaked just before onset of homelessness. Thirteen percent of homeless veterans had evidence of suicidality. Twenty-nine percent of veterans with evidence of suicidality appeared to have concurrent homelessness.CONCLUSIONSHomelessness should be considered a primary risk factor for suicidality.

Objectives: Increased mortality has been documented in older homeless veterans. This retrospective study examined mortality and cause of death in a cohort of young and middle-aged homeless veterans. Methods: We examined US Department of Veterans Affairs records on homelessness and health care for 2000-2003 and identified 23898 homeless living veterans and 65198 non-homeless living veterans aged 30-54. We used National Death Index records to determine survival status. We compared survival rates and causes of death for the 2 groups during a 10-year follow-up period. Results: A greater percentage of homeless veterans (3905/23898, 16.3%) than non-homeless veterans (4143/65198, 6.1%) died during the follow-up period, with a hazard ratio for risk of death of 2.9. The mean age at death (52.3 years) for homeless veterans was approximately 1 year younger than that of non-homeless veterans (53.2 years). Most deaths among homeless veterans (3431/3905, 87.9%) and non-homeless veterans (3725/4143, 89.9%) were attributed to 7 cause-of-death categories in the International Classification of Diseases, 10th Revision (cardiovascular system; neoplasm; external cause; digestive system; respiratory system; infectious disease; and endocrine, nutritional, and metabolic diseases). Death by violence was rare but was associated with a significantly higher risk among homeless veterans than among non-homeless veterans (suicide hazard ratio = 2.7; homicide hazard ratio = 7.6). Conclusions: Younger and middle-aged homeless veterans had higher mortality rates than those of their non-homeless veteran peers. Our results indicate that homelessness substantially increases mortality risk in veterans throughout the adult age range. Health assessment would be valuable for assessing the mortality risk among homeless veterans regardless of age.

Abstract In this chapter the authors describe and discuss two emerging related issues in the homeless Veteran population: aging and mortality. To facilitate the presentation of the current status of these issues, the authors have divided the chapter into four sections. The first section provides an overview on the current state of homelessness in Veterans and a perspective on the factors contributing to Veteran homelessness. The second and third sections present reviews of aging and mortality in homeless Veterans. These are two separate yet related issues, given that the homelessness is disproportionately represented in older Veterans, the Veteran homeless population is aging, and homeless Veterans have increased mortality risk across the age range but especially in older age. The last section provides a summary with comments on intervention strategies for older homeless Veterans.

OBJECTIVES:In this analysis of a cohort of older homeless veterans, we examined psychosocial, health, housing, and employment characteristics to identify predictors of mortality.METHOD:Our sample of 3,620 older veterans entered Veteran Affairs homeless programs in years 2000-2003. Fifteen variables from a structured interview described this sample and served as predictors. National Death Index data for years 2000-2011 were used to ascertain death. Survival table analyses were conducted to estimate and plot cumulative survival functions. To determine predictors and estimate hazard functions, Cox proportional hazards regression analysis was conducted.RESULTS:Five variables (presence of a serious health issue, hospitalization for alcohol abuse, alcohol dependency, unemployment for 3 years, and age 60+) were associated with increased risk of death; three (non-White, drug dependency, and dental problems) were associated with reduced risk. A risk score, based on total unit-weighted risk for all eight predictors, was used to identify three groups that were found to differ significantly in mortality.CONCLUSIONS:These analyses underline the jeopardy faced by older homeless veterans in terms of early death. We were able to identify several variables associated with mortality; more importantly, we were able to show that a risk score based on status for these variables was significantly related to survival.

OBJECTIVE:National Death Index data were examined to describe mortality patterns among older veterans who are homeless.METHODS:Homelessness and health care records from the U.S. Department of Veterans Affairs were used to identify old (ages 55-59) and older (ages ≥60) veterans who were (N=4,475) or were not (N=20,071) homeless. Survival functions and causes of death of the two samples over an 11-year follow-up period were compared.RESULTS:Substantially more veterans who were homeless (34.9%) died compared with the control sample (18.2%). Veterans who were homeless were approximately 2.5 years younger at time of death compared with the control sample. Older veterans who were homeless had the lowest survival rate (58%). No disease category appeared to be critical in reducing survival time. Suicide was twice as frequent in the homeless (.4%) versus the control (.2%) sample.CONCLUSIONS:Older veterans who were homeless experienced excess mortality and increased suicide risk.

Objective: This study examined age-related differences in general medical and mental health risk factors for veterans participating in the U.S. Department of Veterans Affairs (VA) Grant Per Diem (GPD) transitional supportive housing program. The subpopulation of older homeless veterans is growing, and little is known about the implications of this fact for health care providers and for supportive programs intended to meet homeless veterans' needs. Methods: Data were obtained from the VA records of all veterans (N=40,820) who used the GPD program during fiscal years 2003 to 2009. Unconditional adjusted and unadjusted odds ratios for general medical and psychiatric characteristics were calculated and were the primary study focus. Significant predictors of homeless program completion assessed from univariate models were then evaluated in multivariate models. Results: Younger (<55) and older (≥55) homeless veterans reported an equal number of days homeless before enrollment. Younger veterans averaged 19 fewer days in GPD. Older veterans had more general medical problems and approximately $500 more in program costs. Conclusions: Findings from this study indicate that older homeless veterans are at increased risk of serious medical problems. This group is especially vulnerable to experiencing negative consequences related to homelessness. Addressing these complex needs will allow the VA to provide enhanced care to older homeless veterans.

BACKGROUND/AIMS:Verbal fluency patterns can assist in differential diagnosis during neuropsychological assessment and identify individuals at risk for developing Alzheimer's disease (AD). While evidence suggests that subjects with AD perform worse on category fluency than letter fluency tasks, the pattern in mild cognitive impairment (MCI) is less well known. METHODS:Performance on the Controlled Oral Word Association Test (COWAT) and Animal fluency was compared in control, amnestic MCI, non-amnestic MCI, and AD groups. The sample included 136 participants matched for age, education, and gender. RESULTS:Both MCI groups performed similarly with a category > letter fluency pattern rather than a category < letter fluency pattern typically observed in AD. The pattern in MCI, albeit relatively more impaired than in controls, was more similar to healthy controls who exhibited a category > letter fluency pattern. CONCLUSION:MCI using a category < letter fluency pattern may not represent AD; however, future research requires longitudinal studies of pattern analysis.

Little is known about the impact of hurricanes on people who are homeless at the time a disaster occurs. Although researchers have extensively studied the psychosocial consequences of disaster produced homelessness on the general population, efforts focused on understanding how homeless people fare have been limited to a few media reports and the gray literature. In the event of a hurricane, homeless veterans may be at increased risk for negative outcomes because of their cumulative vulnerabilities. Health care statistics consistently document that homeless veterans experience higher rates of medical, emotional, substance abuse, legal, and financial problems compared with the general population. This study used the 2004 to 2006 Veterans Health Administration (VHA) Outpatient Medical Dataset to examine the effects of hurricanes on use of outpatient mental health services by homeless veterans. Homeless veterans residing in hurricane-affected counties were significantly more likely to participate in group psychotherapy (32.4% vs. 13.4%, p < .002), but less likely to participate in individual 30-40-min sessions with medical evaluations (3.5% vs. 17.3%, p < .001). The study findings have implications for homeless programs and the provision of VHA mental health services to homeless veterans postdisaster.

Handbook of Psychology Preface (I. Weiner). Volume Preface (J. Schinka and Wayne F. Velicer). Contributors. PART ONE. FOUNDATIONS OF RESEARCH: STUDY DESIGN, DATA MANAGEMENT, DATA REDUCTION, AND DATA SYNTHESIS. 1. Experimental Design (R. E. Kirk). 2. Exploratory Data Analysis (J. T. Behrens & C. Yu). 3. Power: Basics, Practical Problems, and Possible Solutions (R. R. Wilcox). 4. Methods for Handling Missing Data (J. W. Graham, et al.). 5. Preparatory Data Analysis (L. S. Fidell & B. G. Tabachnick). 6. Factor Analysis (R. L. Gorsuch). 7. Clustering and Classification Methods (G. W. Milligan & S. C. Hirtle). PART TWO. RESEARCH METHODS IN SPECIFIC CONTENT AREAS. 8. Clinical Forensic Psychology (K. S. Douglas, et al.). 9. Psychotherapy Outcome Research (E. S. Behar & T. D. Borkovec). 10. Health Psychology (T. W. Smith). 11. Animal Learning (R. M. Church). 12. Neuropsychology (R. M. Bauer, et al.). 13. Program Evaluation (M. M. Mark). PART THREE. MEASUREMENT ISSUES. 14. Mood Measurement: Current Status and Future Directions (D. Watson & J. Vaidya). 15. Measuring Personality and Psychopathology (L. C. Morey). 16. The Circumplex Model: Methods and Research Applications (M. B. Gurtman & A. L. Pincus). 17. Item Response Theory and Measuring Abilities (K. M. Schmidt & S. E. Embretson). 18. Growth Curve Analysis in Contemporary Psychological Research (J. J. McArdle & J. R. Nesselroade). PART FOUR. DATA ANALYSIS METHODS. 19. Multiple Linear Regression (L. Aiken, et al.). 20. Logistic Regression (A. DeMaris). 21. Meta--Analysis (F. L. Schmidt & H. E. Hunter). 22. Survival Analysis (J. Singer & J. B. Willett). 23. Time Series Analysis (W. Velicer & J. L. Fava). 24. Structural Equation Modeling (J. Ullman & P. M. Bentler). 25. Ordinal Analysis of Behavioral Data (J. D. Long, et al.). 26. Latent Class and Latent Transition Analysis (S. L. Lanza, et al.). Author Index. Subject Index.