Development and Initial Validation of the Attitudes Towards Older Adult Sexuality in Long-term Care Scale (AOASLC).

In long-term care facilities where older adults may reside, negative attitudes about later life sexuality can result in restrictive facility policies and staff behaviors that suppress residents' rights to sexual expression. No assessment instrument specifically focuses on the sexual behaviors of long-term care residents and existing measures of attitudes toward older adult sexuality do not include sexual expression in long term care, nor do they assess a full range of sexual behaviors. We developed the Attitudes toward Older Adult Sexuality in Long-term Care Scale (AOASLC). A large, diverse sample of 295 community-dwelling adults in the United States completed an online survey through Amazon Mechanical Turk. The survey included the AOASLC and self-report measures of related constructs. Two-hundred-and-ninety-five participants completed the survey (Mage = 49.16, SD = 14.69, range = 18- 84 years). Of the sample, 50.2% identified as female, 49.5% identified as male, and one person identified as transgender male. An exploratory factor analysis indicated a two-factor structure. Factor 1 represented general attitudes toward sexual behaviors, and Factor 2 represented acceptability of various sexual behaviors. The instrument evidenced good reliability and validity. While further validation research is necessary, the AOASLC is a promising new measure.

The Geriatric Feelings of Burdensomeness Scale (GFBS).

OBJECTIVES: The present article describes the development and psychometric evaluation of the Geriatric Feelings of Burdensomeness Scale using two samples of older adults collected through Amazon Mechanical Turk. The scale is a 25-item measure of general subjective feeling of being a burden on or problem for others. The goal of the measure is to capture a broad conceptualization of burdensomeness that is relevant to a variety of important psychological variables. METHOD: Two studies are described, including item development and selection, and the examination of reliability and validity evidence in a sample of 192 older adults. RESULTS: The estimates of reliability (coefficient alpha and average interitem correlations) were strong. Preliminary examination of convergent validity evidence found significant moderate correlations between the Geriatric Feelings of Burdensomeness Scale and measures of conceptually related constructs (hopelessness, suicidality, perceived burdensomeness, thwarted belongingness). Small, non-significant correlations were found between three indices of religiosity, providing preliminary discriminant validity evidence. CONCLUSIONS: Our results provide initial psychometric support for a more general and inclusive assessment tool for measuring older adults' feelings of burdensomeness. CLINICAL IMPLICATIONS: With further research on clinical significance of feelings of burdensomeness and predictive validity, this measure may be used to identify concerns and beliefs about burdensomeness among distressed older adults.

Risk and protective factors for college students' psychological health during the COVID-19 pandemic.

Objective: College students' psychological health may be compromised due to the COVID-19 pandemic. Here, we aimed to identify risk (eg, perceived risk of contracting COVID-19) and protective factors (ie, social support, mindfulness) for positive (ie, subjective happiness, satisfaction with life) and negative (ie, depression, anxiety, stress) aspects of psychological health. Participants: Participants were 251 college students at a mid-Atlantic university. Method: Self-report online survey data were collected between March and May 2020 using established measures of risk perception, mindfulness, social support, and psychological health. Results: Greater perceived risk of contracting COVID-19 was associated with greater depression, anxiety, and stress. Greater mindfulness was a protective factor for psychological health. Greater social support was associated with less depression, and greater happiness and life satisfaction. Conclusions: Programs that teach students how to cultivate mindfulness and supportive relationships and reduce their risk of contracting COVID-19 may help protect against depression, stress, and anxiety.

Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic.

OBJECTIVE: Surrogate medical decision making is common in the United States healthcare system. Variables that may influence surrogate decision making have been proposed. Little work has examined relations between these variables and outcomes of surrogate decision making. This study investigated whether surrogates' characteristics, including their knowledge of treatment options, and interpersonal factors predicted surrogates' accuracy and intervention selections. Specifically, predictor variables included: trust in the medical profession, trait-level anxiety, depression, anxiety about COVID-19, religiosity, perceived emotional support, understanding of treatment options, empathy, willingness to accept responsibility for medical decisions, reluctance to burden others, and perceived similarity between oneself and the patient. METHODS: 154 pairs of patients and their surrogates completed an online survey. Patients indicated preferred treatments in hypothetical decision scenarios. Surrogates indicated the treatment that they thought the patient would prefer. RESULTS: When taken all together in a predictive model, the variables significantly predicted surrogates' accuracy, F (6) = 3.03, R2 = .12, p = .008. Variables also predicted selection of intensive interventions, F (4) = 5.95, R2 = .14, p = .00. Surrogates reporting greater anxiety about COVID-19 selected more intensive interventions. CONCLUSIONS: Consistent with prior research, this study found that surrogates' characteristics influence the interventions they choose, with anxiety about COVID-19 having considerable bearing on their chosen interventions. PRACTICE IMPLICATIONS: These findings can inform development of decision-making interventions to improve surrogates' accuracy. Providers may attend to variables highlighted by this study to support surrogates, particularly within the stressful context of COVID-19 and possible future pandemics.

Accuracy in Surrogate End-of-Life Medical Decision-Making: A Critical Review.

BACKGROUND: Increasing age is accompanied by a greater need for medical decisions, due in part to age-related increases in chronic disease and disability. In later life, medical decisions about end-of-life care in particular are likely. However, a significant percentage of these decisions are made by surrogate decision-makers. "Surrogates" are most often instructed to use the substituted judgment standard and make decisions that patients would choose if they were able. Whether surrogates make decisions that adequately match patients' preferences is a concern. Surrogates are generally poor predictors of patient preferences (Shalowitz et al., 2006). However, no critical review of this literature has yet been published. METHOD: A critical review was conducted to summarise and provide a methodological critique of 25 studies. RESULTS: These studies generally concur that patient-surrogate agreement on medical decisions is poor. However, this conclusion is qualified by inconsistencies in methodological quality and the potentially limited generalisability of these findings. CONCLUSIONS: Clinical research incorporating standardised hypothetical decision-making protocols, as well as triangulated data collection methods, would bolster confidence in future findings. Investigations prioritising the surrogate decision-making process, rather than solely the decisional outcome, could better identify ways to improve the decision-making process for incapacitated patients.

What would people think? Perceived social norms, willingness to serve as a surrogate, and end-of-life treatment decisions.

BACKGROUND: Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals' willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options. METHOD: An online sample (N = 172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined person of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers) and choice of end-of-life treatments. RESULTS: Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients' physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments. SIGNIFICANCE OF RESULTS: The current study's consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making - the initial decision to serve as surrogate, and the surrogate's selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making. For instance, providers can be sensitive to potential cultural differences in surrogate decision-making tendencies or employing decision aids that bolster surrogates' confidence in their decisions.

Factors predicting collaborative willingness of surrogates making medical decisions on the Physician Order for Scope of Treatment (POST).

Objective: The Physician's Order for Scope of Treatment (POST) indicates patient preferences regarding cardiopulmonary resuscitation (CPR), levels of care, and fluids/nutrition provision decisions. When patients become incapacitated, 'surrogates' often collaborate with physicians on POST decisions. Surrogates may vary in their willingness to collaborate, which can be problematic when physicians expect shared decision-making. No research has yet investigated collaborative decision-making among surrogates on the POST. This study investigated how six psychological variables predicted participants' desires for collaboration when completing an online decision-making task.Methods: Participants served as hypothetical surrogates and made decisions for another person on the three sections of the West Virginia POST. One-hundred-and-seventy-two adults were recruited from Amazon Mechanical Turk.Results: The six variables contributed significantly to the prediction of collaborative willingness, F (6, 163) = 5.29, p < .001, R2= 0.19. Two variables uniquely contributed: confidence and consideration of future consequences. The model most strongly predicted collaborative willingness for the CPR decision.Conclusion: This study provides a novel examination of under-researched areas: surrogate collaborative willingness and the POST. Differing risks associated with the three POST decisions may influence how surrogates value collaboration. Ways to enhance collaborative willingness when making POST decisions are discussed.

Words Matter.

Palliative care consultation teams (PCCTs) provide input to other health-care providers working with patients who have life-limiting disease. This study examines whether the diction and phrasing of consultation recommendations in the electronic health record influence their implementation. We reviewed 288 verbatim PCCT recommendations that were made for 111 unique patients in a Veterans Affairs hospital and available in the electronic health record. Recommendations were coded for linguistic features, such as the presence of conditionals (e.g., "could") and tentative phrasing (e.g., "would suggest"). Each patient's subsequent treatment was followed in the medical record to determine whether PCCT recommendations were implemented. Only 57% of the consultation recommendations were eventually implemented. Recommendations that included a conditional word or phrase were significantly less likely to be implemented. In particular, recommendations that included the words "could" and "consider" were less likely to be implemented. PCCTs may enhance their effectiveness by attending to the subtle pragmatics of how they communicate with other health-care providers, particularly in electronic communication where nonverbal features of communication are unavailable.