Individualized Colorectal Cancer Screening Discussions Between Older Adults and Their Primary Care Providers: A Cross-Sectional Study.
colorectal cancer screening; individualized decision making; older adults; patient preference; screening discussions
Introduction. Discussions of colorectal cancer (CRC) screening with older adults should be individualized to maximize appropriate screening. Our aim was to describe CRC screening discussions and explore their associations with patient characteristics and screening intentions. Methods. Cross-sectional survey of 422 primary care patients aged \textgreater/=70 years and eligible for CRC screening, including open-ended questions about CRC screening discussions. Primary outcomes were the frequency with which CRC screening discussions occurred, who had those discussions, and the domains that emerged from thematic analysis of participants' brief reports of their discussions. We also examined the associations between 1) patient characteristics and whether a screening discussion occurred and 2) the domains discussed and what screening decisions were made. Results. Of 422 participants, 209 reported having discussions and 201 responded to open-ended questions about CRC discussions. In a regression analysis, several factors were associated with increased odds of having a discussion: participants' preference to pursue screening (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3, 3.9), good health (OR 2.9, 95% CI 1.7, 4.8), and receipt of the decision aid (OR 2.1, 95% CI 1.4, 3.2). Our thematic analysis identified five domains related to discussion content and three related to discussion process. The CRC screening-related information domain was the most commonly discussed content domain, and the timing/frequency domain was associated with increased odds of intent to pursue screening. Decision-making role, the most commonly discussed process domain, was associated with increased odds of the intent to forgo CRC screening. Conclusions and Relevance. CRC screening discussions varied by type of participant and content. Future work is needed to determine if interventions focused on specific domains alters the appropriateness of participants' colorectal cancer screening intentions.
Kistler Christine E; Golin Carol; Sundaram Anupama; Morris Carolyn; Dalton Alexandra F; Ferrari Renee; Lewis Carmen L
MDM policy & practice
2018
2018-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/2381468318765172" target="_blank" rel="noreferrer noopener">10.1177/2381468318765172</a>
A systematic review of ketamine for the treatment of depression among older adults.
older adults; major depressive disorder; bipolar depression; ketamine; treatment-resistant depression
Objective: To review the currently available data on the use of ketamine in the treatment of depression among older adults from randomized controlled studies.; Design: Randomized controlled trials.; Setting: Variable.; Participants: 60 years and older with depression.; Intervention: Ketamine.; Measurements: Change in Montgomery-Asberg Depression Rating Scale (MADRS) scores.; Results: Two studies met the inclusion criteria. The first study showed a significant reduction in depression symptoms with use of repeated subcutaneous ketamine administration among older adults with depression. The second study failed to achieve significance on its primary outcome measure but did show a decrease in MADRS scores with intranasal ketamine along with a higher response and remission rates in esketamine group compared with the placebo group. The adverse effects from ketamine generally lasted only a few hours and abated spontaneously. No cognitive adverse effects were noted in either trial from the use of ketamine.; Conclusions: The current evidence for use of ketamine among older adults with depression indicates some benefits with one positive and one negative trial. Although one of the trials did not achieve significance on the primary outcome measure, it still showed benefit of ketamine in reducing depressive symptoms. Ketamine was well tolerated in both studies with adverse effects being mild and transient.
Gupta A; Dhar R; Patadia P; Funaro M; Bhattacharya G; Farheen SA; Tampi RR
International Psychogeriatrics
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1017/S1041610220000903" target="_blank" rel="noreferrer noopener">10.1017/S1041610220000903</a>
"Advocating Every Single Day" so as Not to Be Forgotten: Factors Supporting Resiliency in Adult Day Service Centers Amidst COVID-19-Related Closures.
Adult day centers; caregivers; COVID-19; dementia; older adults; resilience
Adult day centers (ADCs) are nonresidential settings that support the health and social needs of vulnerable older adults. Due to ADCs' congregate nature and participants' compromised health status, many ADCs have been forced to close during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Activation Framework, we (a) identified consequences resulting from closures of ADCs during the COVID-19 pandemic and (b) described factors that have enabled the ADC community to remain resilient in the wake of challenges brought on by the pandemic. We conducted 2 focus groups in California (n = 12), and individual interviews with ADC staff members (n = 8) in 7 other states. The results of a directed content analysis revealed perceived declines in physical, cognitive, and mental health of ADC users and increased caregiver strain. Access to human, social, economic, and political capital were essential for supporting ADCs in buffering the impacts of the pandemic on the older adults they serve but were not consistently available. Research is urgently needed that quantifies the impacts of the pandemic on ADC users and their caregivers to inform policy and advocacy efforts in the wake of the pandemic.
Sadarangani T;Zhong J;Vora P;Missaelides L
Journal Of Gerontological Social Work
2021
2021-01-29
journalArticle
<a href="http://doi.org/10.1080/01634372.2021.1879339" target="_blank" rel="noreferrer noopener">10.1080/01634372.2021.1879339</a>