Fellow clinical gerontologists, in this issue we feature articles with intriguing implications for practice and research.
One thing seems clear—compared with 30 years ago, issues surrounding transitions to long-term care are much more complex—in a good way. There are more options and our understanding of how these transitions affect older adults and their families grows in sophistication. Three articles in this issue address such transitions. Ramanathan and Fisher provide insights into the caregivers’ perspectives in a qualitative study of a Singaporean sample. Their rich paper provides keen insights on supporting caregivers through these transitions as we consider familial and cultural norms. Such considerations are critical as the number of adults facing transitions to long-term services and supports will increase from 15 million in 2000 to 27 million in 2050 in the United States alone (Harris-Kojetin, Sengupta, Park-Lee, Valverde, Citation2013). Continuing with the qualitative research, Abbott, Heid, and Van Haitsma give us a rich read on facilitators and barriers to patient centered care within long term care. Their article will help us move closer to the vision and reality of patient centered care.
Plys and Kluge describe “life space mobility” (travel within and outside a CCRC) within one year of moving to a CCRC. Not surprisingly, higher life space mobility was associated with higher levels of functional and cognitive ability. However, in this CCRC lower life space mobility was not associated with more depression or loneliness, contrary to some other studies. Their study focused on a University-partnered CCRC with an extensive wellness program. Future studies might compare features of CCRCs to examine how to replicate the finding of sustained psychosocial health despite a narrowing of life-space mobility. We also need more sharing about the innovative programming at University-affiliated CCRCS; from what I know of such communities, it’s where I’d like to go when the time comes.
Many years back we interviewed older adults waiting for primary care appointments about their unmet needs (Davis, Moye, Karel, Citation2002). What surprised me most was how many (26%) reported insomnia. I learned my lesson and now understand that insomnia is a frequent concern for older adults (Gooneratne & Vitiello, Citation2014). Caregivers might be at particular risk. In an analysis of data from 72 caregivers of adults with dementia, Wang, Yip, and Change’s report that sleep quality and self-efficacy mediated the relationship between perceived stress and depression. As a cross sectional study they could not establish directionality of the relationships. Nevertheless their study reminds us to target sleep quality when intervening with caregivers.
When I ask older veterans in our clinic about their sleep quality a common concern is disruption in sleep for nocturnal urination. I confess I tend to chalk that up to physiology and leave it there. In a survey of 360 adults by Singer and O’Connell, those who reported more sleep disruption due to nocturia also had more sensitivity to environmental cues to urinate during the day. Could interventions that diminish conditioned responses to environmental cues decrease nocturia? Their survey study cannot tell us. However, since nocturia is associated not only with sleep disruption but also falls and mortality (Vaughan et al., Citation2010), it seems worth further study.
Our final article describes the views of 475 professionals surveyed by Gendron, Welleford, Jensen, and Myers about working in teams. Not surprisingly team practice in gerontology was valued and contributed to positive professional identity. The papers in this issue again show that understanding and treating behavioral health issues in older adults—with all their comorbidities and care settings—is best done as an inter-professional enterprise. We hope these articles advance your practice and research.
Additional resources relevant to these topics that may be of interest appear below.
Resources for clinicians and clients
References
- Davis, M. J., Moye, J., & Karel, M. J. (2002). Mental health screening of older adults in primary care. Journal of Mental Health and Aging, 8(2), 139–149.
- Gooneratne, N. S., & Vitiello, M. V. (2014). Sleep in older adults: Normative changes, sleep disorders, and treatment options. Clinics in Geriatric Medicine, 30(3), 591–627. doi:10.1016/j.cger.2014.04.007
- Harris-Kojetin, L., Sengupta, M., Park-Lee, E., & Valverde, R. (2013). Long-term care services in the United States: 2013 overview. National Center for Health Statistics. Vital Health Stat, 3(37), 1–107.
- Vaughan, C. P., Brown, C. J., Goode, P. S., Burgio, K. L., Allman, R. M., & Johnson, T. M. (2010). The association of nocturia with incident falls in an elderly community-dwelling cohort. International Journal of Clinical Practice, 64(5), 577–583. doi:10.1111/ijcp.2010.64.issue-5