A Brewed Awakening: Neuropsychiatric Effects of Caffeine in Older Adults.

This article provides a current review of the literature examining caffeine use in older adults. Caffeine use is prevalent among older adults; thus, providers need to be aware of the prevalence and diagnostic criteria of caffeine use disorder versus nonproblematic use. The relationship between caffeine and various neuropsychiatric disorders, including Parkinson's disease, Alzheimer's disease, insomnia, and late-life depression, is reviewed. The neurobiological effects of caffeine are described, along with clinically relevant interactions between caffeine and common psychotropic medications.

Examining the Complicated Relationship Between Depressive Symptoms and Cognitive Impairment in Preclinical Alzheimer Disease.

INTRODUCTION: The relationships between Alzheimer disease (AD), cognitive performance, and depression are poorly understood. It is unclear whether depressive features are a prodrome of AD. In addition, some studies of aging exclude depressed individuals, which may inappropriately limit generalizability. The aim of the present study was to determine whether depressive symptoms affect cognitive function in the context of preclinical AD. METHODS: Cross-sectional multivariate analysis of participants in a longitudinal study of aging (n=356) that evaluates the influence of depressive symptoms on cognitive function in cognitively normal adults. RESULTS: There is no relationship between the presence of depressive symptoms and cognitive function in those with either no evidence of preclinical AD or biomarker evidence of early-stage preclinical AD. However, in later stages of preclinical AD, the presence of depressive symptoms demonstrated interactive effects, including in episodic memory (0.96; 95% confidence interval, 0.31-1.62) and global cognitive function (0.46; 95% confidence interval, 0.028-0.89). CONCLUSIONS: The presence of depressive symptoms may be a late prodrome of AD. In addition, studies investigating cognitive function in older adults may not need to exclude participants with depressive symptomology, but may still consider depressive symptoms as a potential confounder in the context of more extensive neuronal injury.

Supporting Clinicians After Adverse Events: Development of a Clinician Peer Support Program.

BACKGROUND: Many healthcare organizations have developed processes for supporting the emotional needs of patients and their families after medical errors or adverse events. However, the clinicians involved in such events may become "second victims" and frequently experience emotional harm that impacts their personal and professional lives. Many "second victims," particularly physicians, do not receive adequate support by their organizations. METHODS: A multidisciplinary team was assembled to create a clinician peer support program (PSP) at a large academic medical center including both adult and pediatric hospitals. A curriculum was developed to train clinicians to provide support to their peers based on research of clinician response to adverse events, utilization of various support resources, and clinician resiliency and ways to enhance natural resilience. Between April 2014 and January 2017, 165 individuals were referred to the program including 68 (41.2%) residents, 17 (10.3%) fellows, 70 (42.4%) faculty members, 6 (3.6%) nurse practitioners/physician assistants, and 4 (2.4%) certified registered nurse anesthetists. An average of 4.8 individuals were referred per month (range = 0-12). Of the 165 clinicians referred, 17 (10.3%) declined follow-up from the program. Individuals receiving support had a median of two interactions (range = 1-10). Among those receiving support from the clinician PSP, 16 (10.8%) required referral to a higher level of support. CONCLUSIONS: We describe the multiple steps necessary to create a successful PSP focused on physicians and midlevel providers. There is an unmet need to provide support to this group of healthcare providers after medical errors and adverse events.