Independent Living Capacity Evaluation in Home-Based Primary Care: Considerations and Outcomes of a Quality Improvement Project.

OBJECTIVES: This article describes results of a quality improvement project review of 5 years of capacity evaluations for independent living conducted in one Home-Based Primary Care (HBPC) Program. METHODS: A retrospective chart review was conducted for all patients evaluated for independent living capacity through the Boston VA HBPC Program (N = 25) to identify differences in outcomes for those with and without capacity. Descriptive information included referral sources, capacity decisions, time remaining in the home, and trajectory of patients following evaluation. RESULTS: All patients evaluated had been diagnosed with a cognitive disorder, and on average, a relatively lower prevalence of mental illness compared with the national HBPC population. Referrals were made primarily by the HBPC team. Patients with capacity were found to have remained in their home longer than those who lacked capacity. CONCLUSIONS: Referral for a higher level of care was typically only recommended when no further intervention could be implemented and active risk in the home could not be managed. CLINICAL IMPLICATIONS: In home capacity evaluations are complex and challenging, yet results help family and HBPC team support patients' preferences for staying in their own home as long as possible.

Assessment of Activities of Daily Living, Self-Care, and Independence.

Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.

Experimentally induced distraction impacts cognitive but not emotional processes in think-aloud cognitive assessment.

Studies have examined the impact of distraction on basic task performance (e.g., working memory, motor responses), yet research is lacking regarding its impact in the domain of think-aloud cognitive assessment, where the threat to assessment validity is high. The Articulated Thoughts in Simulated Situations think-aloud cognitive assessment paradigm was employed to address this issue. Participants listened to scenarios under three conditions (i.e., while answering trivia questions, playing a visual puzzle game, or with no experimental distractor). Their articulated thoughts were then content-analyzed both by the Linguistic Inquiry and Word Count (LIWC) program and by content analysis of emotion and cognitive processes conducted by trained coders. Distraction did not impact indices of emotion but did affect cognitive processes. Specifically, with the LIWC system, the trivia questions distraction condition resulted in significantly higher proportions of insight and causal words, and higher frequencies of non-fluencies (e.g., "uh" or "umm") and filler words (e.g., "like" or "you know"). Coder-rated content analysis found more disengagement and more misunderstanding particularly in the trivia questions distraction condition. A better understanding of how distraction disrupts the amount and type of cognitive engagement holds important implications for future studies employing cognitive assessment methods.

Age-related affective modulation of the startle eyeblink response: older adults startle most when viewing positive pictures.

Previous studies reveal age by valence interactions in attention and memory, such that older adults focus relatively more on positive and relatively less on negative stimuli than younger adults. In the current study, eyeblink startle response was used to measure differences in emotional reactivity to images that were equally arousing to both age groups. Viewing positive and negative pictures from the International Affective Picture System had opposite effects on startle modulation for older and younger adults. Younger adults showed the typical startle blink pattern, with potentiated startle when viewing negative pictures compared to positive pictures. Older adults, on the other hand, showed the opposite pattern, with potentiated startle when viewing positive pictures compared to viewing negative and neutral pictures. Potential underlying mechanisms for this interaction are evaluated. This pattern suggests that, compared with younger adults, older adults are more likely to spontaneously suppress responses to negative stimuli and process positive stimuli more deeply.