Advancing Late-Life Trauma-Informed Care Education: Development and Evaluation of an Educational Podcast.

Posttraumatic stress disorder (PTSD) may emerge in late life in the context of illness, role changes, and life review, leading to complications in disease management. The "Talking Later" podcast was developed as an accessible educational product to improve knowledge about late-life PTSD. We describe the process of systematically developing a ten-episode podcast following Kern's six-step curricular model. Following release, the podcast was evaluated via listenership analytics, external clinician feedback survey (N = 45), and internal team survey (N = 9). In 22 months since release, the podcast was played or downloaded 10,124 times across 45 countries. In the external survey, 97% of clinician experts reported the episodes as engaging and informational; 87% stated that no more than general knowledge of PTSD was required to enjoy the podcast. Qualitative analysis of open-ended feedback items found that participants were interested in learning about additional comorbidities and diversity issues related to late-life trauma reengagement. Both the external and internal survey identified discrete elements for improvement. Results suggest the podcast was engaging and informational to a diverse clinical audience. Podcasts represent a relatively new way to deliver educational content. Further consideration of their pedagogical value and limits is warranted.

Home-based primary care providers' perspectives on the unique challenges of working with late life posttraumatic stress disorder within their population of Veterans.

Posttraumatic stress disorder (PTSD) is more prevalent in medically ill older Veterans in Home-Based Primary Care (HBPC) settings than in the general population, raising unique considerations. The aim of this qualitative project was to explore HBPC mental health providers' perceptions of the presentation and treatment of PTSD and trauma-related symptoms in this population of older Veterans, many of whom face additional barriers to treatment due to living in rural settings. Five focus groups and one one-on-one interview were conducted with 23 HBPC mental health providers serving rural or rural/urban mixed communities across the United States. We applied qualitative content analysis to the data. Three themes were found: (1) Presentation of Trauma-Related Symptoms and PTSD in HBPC Population; (2) Treatment Challenges in HBPC; and (3) PTSD Treatment Strategies. Each theme had multiple subthemes which illustrate unique issues in this population. Results of this project contribute to key insights surrounding the unique presentation of PTSD and trauma-related processes and treatment considerations in a medically, cognitively, and psychosocially complex group of veterans. Efforts to improve access to care should consider the specific needs of veterans who are homebound, live in rural settings and identify with rural cultural norms, and have difficulty engaging in specialized PTSD treatment due to the convergence of these factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maximizing Veterans Health Affairs Community Hospice Collaborations: Review of Perceived Resource Needs to Support Veterans at End of Life.

Within the United States, approximately 330 000 military veterans die annually, but only 5% of deaths occur in Veterans Health Administration (VHA) facilities. To help provide end-of-life care for veterans, the VHA built community partnerships with community hospice and palliative care (HPC) organizations. Veterans experience unique psychosocial factors making it vital to ensure HPC organizations have access to veteran-specific knowledge and resources to reduce suffering. To better understand the strengths and limitations of these partnerships, community HPC staff (N = 483) responded to quantitative and qualitative survey questions developed using an access to care theory for veterans. Survey responses demonstrated variable perceptions of access to VHA care and resources. Respondents reported excellent experiences (44%) and relationships with their local facility (50%) and had a reliable contact who provided needed assistance (92%). Thematic analysis identified a need for VHA care and barriers to access, which were associated with technical characteristics, and geographical and cultural issues. These findings can help inform future research and policy regarding access to VHA resources for end-of-life care for veterans in the community and guide resource development for community HPC providers.

What matters most to older adults: Racial and ethnic considerations in values for current healthcare planning.

BACKGROUND: Clarifying what matters most informs current care planning for adults with multiple comorbidities. We describe how adults aged 55+ rate what matters most and differences in Black and White participants. METHODS: Participants (N = 247, Age M = 63.61 ± 5.26) who self-identified as Black (n = 89), White (n = 96), or other racial and ethnic groups (n = 62) completed an online survey. Healthcare values in four domains, (1) important factors for managing health, (2) functioning, (3) enjoying life, and (4) connecting, were assessed with the What Matters Most-Structured Tool. Frailty was assessed with the FRAIL scale. RESULTS: Concerns about pain and finances were rated as the most influential when making healthcare decisions across groups. Black participants rated religious and racial, ethnic, and cultural considerations as more important in healthcare decision-making than did White participants (Black participant M = 1.93 ± 0.85 vs. White participant M = 1.26 ± 0.52), citing concerns about health equity, disparity, and representation. Across the sample, specific aspects of functioning (e.g., ability to think clearly, walk, and see) and connecting (e.g., with family and friends and with God) were highly valued. Black participants rated the ability to dress or bathe, exercise, and connect with God as more important than did White participants, and they were also more likely to rate length of life as more important relative to quality of life. Value ratings were not associated with other demographic or health factors. CONCLUSIONS: Adults aged 55+ from diverse groups highly value functioning and connections when making health decisions, with important contextual distinctions between Black participants and White participants. This study population was relatively young; future studies in older populations are needed.

Factors Associated With Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans.

CONTEXT: Posttraumatic stress disorder (PTSD) may emerge or re-emerge at end of life (EOL), increasing patient suffering. Understanding factors associated with PTSD at EOL may assist clinicians in identifying high risk veterans. OBJECTIVES: To determine rates of and variables associated with PTSD-related distress at EOL. METHODS: Retrospective observational cohort study including veterans who died within a Veterans Affairs (VA) inpatient setting between October 1, 2009 and September 30, 2018 whose next-of-kin completed the Bereaved Family Survey (BFS; N = 42,474). Our primary outcome was PTSD-related distress at EOL, as reported by veteran decedents' next-of-kin on the BFS. Predictors of interest included combat exposure, demographic variables, medical and psychiatric comorbidity, primary serious illness, and palliative care support. RESULTS: Veteran decedents were majority male (97.7%), non-Hispanic white (77.2%), 65 years or older (80.5%), without combat exposure (80.1%). Almost one in ten (8.9%) veteran decedents experienced PTSD-related distress at EOL. In adjusted analyses, combat exposure, younger age, male sex, and non-white race were associated with PTSD-related distress at EOL. High overall medical comorbidity, dementia, and psychiatric comorbidities including both substance use disorder and depression, were also associated with PTSD-related distress at EOL. Palliative care consultation and emotional support were associated with decreased odds of PTSD-related distress, while pain was associated with increased odds of PTSD-related distress at EOL. CONCLUSION: Trauma and PTSD screening, pain management, and providing palliative care and emotional support at EOL, particularly in at-risk groups such as veterans from racial/ethnic minority backgrounds and those with dementia, are critical to decreasing PTSD-related distress at EOL.