Clinical Gerontologist最新文献

Objectives: Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients.

Methods: From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes.

Results: Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement.

Conclusions: There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage.

Clinical implications: Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.

Objectives: The current study investigated whether hope and its two components (agency and pathways) weakened the relations between perceived burdensomeness, thwarted belongingness, and fearlessness about death and suicidal ideation among older adults living in rural Nepal.

Methods: A community sample of 300 people aged from 60 to 90 years (M_age = 67.07, SD_age = 6.23) who resided in the rural mid-hills of Nepal completed standardized measures.

Results: Hope and agency moderated the relationship between perceived burdensomeness and suicidal ideation and pathways moderated the relationship between thwarted belongingness and suicidal ideation.

Conclusions: Hope, and particularly agency, may play a protective role in reducing suicidal ideation among older Nepali adults living in rural areas who experience perceived burdensomeness. In contrast, pathways may be an additional risk factor for older adults experiencing unmet belongingness needs. Research is required to understand fearlessness about death and suicidality among older Nepali adults.

Clinical implications: Increasing hope and particularly agency may be associated with a reduction in suicidal ideation among older Nepali adults who experience feelings of being a burden. However, increasing pathways may be associated with an increase in suicidal ideation among those who experience unmet belongingness needs. Research is needed to understand how to accurately assess suicide risk among Nepali older adults.

Objectives: Previous research has identified the critical role of primary care for suicide prevention. Although several suicide prevention resources for primary care already exist, it is unclear how many have been created specifically for older veterans. This environmental scan sought to assemble a compendium of suicide prevention resources to be utilized in primary care.

Methods: We searched four academic databases, Google Scholar, and Google to identify available suicide prevention resources. Data from 64 resources was extracted and summarized; 15 were general resources and did not meet inclusion criteria.

Results: Our scan identified 49 resources with three resources specifically developed for older veterans in primary care. Identified resources shared overlapping content, including implementing a safety plan and lethal means reduction.

Conclusion: Although only 10 of the identified resources were exclusively primary care focused, many of the resources had content applicable to suicide prevention in primary care.

Clinical implications: Primary care providers can use this compendium of resources to strengthen suicide prevention work within their clinics including: safety planning, lethal means reduction, assessing for risk factors that place older veteran at increased risk of suicide, and mitigating risk factors through referral to programs designed to support older adult health and well-being.

Objectives: Use of firearm locking devices may reduce the risk of suicide and injury among older adults. This study describes older adults' preferences when choosing a firearm locking device.

Methods: We conducted a secondary analysis of a nationally representative survey of US adult firearm owners (N = 2,152). We compared older adults (≥65y) with relatively younger adults (<65y), stratified by self-reported gender.

Results: The top three factors cited as impacting firearm locking device selection included speed (53.6%) and ease of firearm access from device (52.4%), and cost of the device (28.7%). These top factors were comparable for all adults across genders. A larger proportion of older vs younger males reported that a primary preference was whether the device allows the firearm to remain loaded with ammunition; smaller proportions of older vs younger males reported strength of device (device durability) and costs.

Conclusions: Preference among older adults, particularly older males, for locking devices that maintain the firearms easy to access - especially, loaded with ammunition - might impact firearm injury prevention efforts for this high-risk group.

Clinical implications: For harm reduction, use of any firearm locking device may reduce the risk of firearm injury or death. Clinicians are encouraged to explore reasons for locking device selection within motivational interviewing frameworks.

Objectives: Determine strategies and resources used by VA Home-Based Primary Care (HBPC) teams to discuss firearm safety and suicide risk with older veterans and their families or caregivers. Training and resource needs for promoting firearm safety with older veterans were also ascertained.

Methods: Ten focus groups (N = 37) were conducted virtually in 2022 with HBPC directors and psychologists. Qualitative rapid response coding identified domains and themes within transcripts.

Results: Analysis revealed three major domains: firearm safety, suicide risk, and resources/trainings. Firearm safety themes included discussions during clinical procedures, firearm-related challenges, veteran culture, and barriers and facilitators to effective conversations. Suicide risk themes included assessment procedures, frequency/types of risk conversations, factors related to suicidal ideation/behavior, challenges, and strategies to enhance communication. Resource/training themes included those currently used and perceived needs.

Conclusions: Participants described strategies for facilitating firearm safety and suicide prevention discussions with older veterans, their families, and caregivers. Using respectful language and attending to values related to firearm ownership were identified as essential.

Clinical implications: Additional clinician/staff training/resources are needed for addressing older veteran firearm safety and suicide risk, including how to conduct more effective conversations with older veterans on these topics and better engage families/caregivers in prevention efforts.

Introduction: Medications are common means of suicide. Rural areas have high suicide rates, greater proportions of older adults and veterans, and few providers. We assessed the implementation potential of community pharmacy interventions for lethal means management (LMM).

Methods: The feasibility, acceptability, and appropriateness of 8 LMM interventions were assessed by pharmacists in seven southeastern states via an online survey. Descriptive statistics were calculated.

Results: Pharmacists (N = 61) responded from 42 zip codes. The majority indicated that five (62.5%) interventions were very/extremely feasible, appropriate and acceptable. The greatest proportion rated medication therapy management (MTM) as very or extremely feasible, appropriate and acceptable (82%) followed by limiting prescription drug days' supplies (75.4%), blister packaging (68.9%), dispensing naloxone (62.3%), and suicide prevention training (59.0%). No pharmacies were currently distributing gun locks; however, some were already managing suicide risk with limited days' supply (31.7%), MTM (26.7%), naloxone distribution with every opioid dispensed (15.0%), monitoring patients for suicidal adverse events (16.7%), limits on sales or stock of non-prescription products (16.7%) or blister packaging (1.7%).

Discussion: Pharmacists endorsed LMM interventions, and most were already offering the endorsed interventions but not for LMM.

Clinical implications: The rural community pharmacists in this study believed several LMM services were highly feasible, acceptable and appropriate for use in preventing suicide.

Objectives: Veterans experience high rates of fatal and non-fatal firearm injuries. This risk may be compounded among Veterans who are rural-residing, aging, and/or experiencing cognitive decline or dementia. Firearm safety discussions are not broadly implemented across Department of Veterans Affairs (VA) healthcare settings due, in part, to concerns of causing Veterans to disengage from care. This study examines perceptions about firearm safety discussions to inform healthcare-based harm-reduction efforts.

Methods: We conducted interviews with 34 Veterans (median age 70) and 22 clinicians from four VA facilities that treat high rates of rural patients with firearm-related injuries.

Results: Most Veterans accepted the idea of universal firearm safety discussions at the VA. Some reported they might not be forthright in such discussions, but raising the topic would not stop them from engaging with VA care. Veterans and clinicians unanimously endorsed firearm safety discussions for older patients experiencing cognitive decline or dementia.

Conclusions: VA patients and clinicians are amenable to firearm safety discussions during healthcare visits and especially endorse the need for such discussions among high-risk populations.

Clinical implications: Universal firearm safety discussions could be incorporated into standard VA practice, particularly for Veterans experiencing cognitive decline or dementia, without risking Veteran disengagement from care.

Objectives: Health-related factors, such as health status, health anxiety, and health literacy, are established contributors to self-efficacy. However, the relationship between electronic health literacy and self-efficacy is less known. The present study examined the role of electronic health literacy in relation to self-efficacy among community-dwelling older adults.

Methods: Cross-sectional survey data were collected in the United States between September 2022 and March 2023. The survey dataset consisted of 191 responses from individuals in the United States who were ages 65 or older. It provided information about survey respondents' sociodemographic status, perceived health status, health anxiety, electronic health literacy, and self-efficacy. Hierarchical linear regression was conducted to analyze the data.

Results: Electronic health literacy was positively related to self-efficacy, and health anxiety was negatively related to self-efficacy, with sociodemographic status and perceived health status controlled.

Conclusions: The results indicate that electronic health literacy can be a source of self-efficacy among community-dwelling older adults.

Clinical implications: Improving older adults' electronic health literacy may help them maintain self-efficacy, and the improvement should be made, especially in the domains of evaluating health information found on the internet and making decisions based on the information.

Objectives: Extreme Risk Protection Orders (ERPOs) allow a court to restrict firearm access for individuals ("respondents") at imminent risk of harm to self/others. Little is known about ERPOs use for older adults, a population with higher rates of suicide and dementia.

Methods: We abstracted ERPO cases through June 30, 2020, from California, Colorado, Connecticut, Florida, Maryland, and Washington. We restricted our analysis to petitions for older (≥65 years) respondents, stratified by documented cognitive impairment.

Results: Among 6,699 ERPO petitions, 672 (10.0%) were for older adults; 13.7% (n = 92) of these noted cognitive impairment. Most were white (75.7%) men (90.2%). Cognitively impaired (vs. non-impaired) respondents were older (mean age 78.2 vs 72.7 years) and more likely to have documented irrational/erratic behavior (30.4% vs 15.7%), but less likely to have documented suicidality (33.7% vs 55.0%). At the time of the petition, 56.2% of older adult respondents had documented firearm access (median accessible firearms = 3, range 1-160).

Conclusions: Approximately 14% of ERPO petitions for older adults involved cognitive impairment; one-third of these noted suicide risk. Studies examining ERPO implementation across states may inform usage and awareness.

Clinical implications: ERPOs may reduce firearm access among older adults with cognitive impairment, suicidality, or risk of violence.

Objectives: Past geriatric studies related to the mediating role of physical activity in depression are scarce. This is perhaps the first study to examine the mediating effects of physical activity on the associations between depression and age, and education among older adults.

Methods: Statistical analyses of cross-sectional data from a nationally representative survey on Malaysian older adult health were conducted. Structural equation modeling was used to assess the extent to which physical activity mediated the relationships between depression and age, and education. Associations between variables were explored using multivariable logistic regressions.

Results: Analyses were based on a sample of 3974 older adults (aged ≥60 years). Only 12.2% of older adults had depression. Age was positively associated with the odds of depression. Better educated older adults were less likely to experience depression than less educated older adults. Physical activity fully mediated the association between depression and age, whereas it partially explained the depression-education relationship.

Conclusions: Older age and low educational levels were risk factors for depression, and physical activity was identified as a mediator.

Clinical implications: Older and less-educated older adults should be encouraged to participate in physical activity, and those at risk of depression should be given special attention.