Adverse childhood experiences (ACEs), resilience, and outcomes in older adulthood: A scoping review.

BACKGROUND: Previous research has demonstrated a dose-response relationship between exposure to adverse childhood experiences (ACEs) and adverse outcomes in adulthood. Despite widely known associations, previous reviews have primarily focused on outcomes in younger and middle-aged adults exposed to ACEs to the exclusion of older adults and do not consider the potential role of resilience for understanding outcomes in older adulthood. OBJECTIVE: The present scoping review aimed to examine the extent and nature of existing literature on the influence of ACEs and resilience on the cognitive, physical, mental, and social health outcomes among older adults. METHODS: We conducted a search of five electronic databases (CINAHL, MEDLINE, PsycINFO, AgeLine, Scopus) using the following keywords: adversity, resilience, aging, and older adults. We limited our inclusion criteria to works published in English or French after 1998 as Felitti et al. published the first study describing ACEs in this year. RESULTS: Of the 4926 studies screened, 27 studies met the inclusion criteria. Overall, results from the included studies indicated that exposure to adversity during childhood was associated with worse outcomes in older adulthood. Additionally, we found that resilience and resiliency-related factors (e.g., problem-focused coping strategies) mitigated or reduced harms associated with ACEs to improve outcomes in older adulthood. CONCLUSIONS: Exposure to ACEs is associated with reduced functioning in later adulthood. Findings from this review indicate a need for further exploration into the role of ACEs, and the potential effects of resilience, on health outcomes in older adults to develop better individual- and population-level interventions for this group.

Developing a Productive Workgroup Within a Community Coalition: Transtheoretical Model Processes, Stages of Change, and Lessons Learned.

BACKGROUND: Addressing complex problems such as health disparities requires collaboration among individuals and agencies. Yet, methods by which productive and cohesive community-based volunteer workgroups are developed and activated to improve health outcomes are often not discussed. OBJECTIVE: Using the transtheoretical model (TTM) as a framework, we discuss effective processes for developing an action-oriented community-based workgroup committed to producing evidence-based information relevant to health policy. METHODS: Workgroup members answered open-ended survey questions and participated in focused coalition-wide discussions to identify factors that facilitated movement of the embedded workgroup from precontemplation to committed action. Frequency and content of e-mail exchanges and workgroup meetings were also considered.Results and Lessons Learned: Activating the group's process of social support or helping relationships was essential throughout the stages of change to promote cohesion and trust. Consciousness raising (awareness), and dramatic relief (emotional arousal) were particularly critical for initial movement from precontemplation to contemplation to preparation. Using group time to promote member's self-reevaluation (how work is relevant) and self-liberation (commitment) prevented attrition and facilitated effort. As the workgroup enacted planned activities, stimulus control and reinforcement management processes facilitated movement through the action and maintenance stages of change. CONCLUSIONS: By attending to both individual and organizational processes of change, we effectively created an action-oriented multidisciplinary workgroup focused on obtaining evidence to guide local and regional health policy decisions and improve health outcomes for under-resourced patients.

ACTively Integrating Suicide Risk Assessment Into Primary Care Settings.

Adequate evaluation and response to suicide risk require (i) awareness of need, (ii) comfort gathering key information, and (iii) ongoing training. A survey administered at 2 urban primary care settings in the process of implementing integrated care measured awareness, comfort, and training related to suicide risk assessment among 31 primary care providers (PCPs). Greater PCP comfort asking patients about psychological trauma was associated with more frequent engagement in safety planning with suicidal patients. Findings highlight the need for trauma-informed primary care while showcasing the importance of enhancing PCP training to support their expanded role within the integrated health team.

Differential effects of gender on perceptions of stalking and harassment behavior.

This study examined the effect of gender on perceptions of stalking following the breakup of a romantic relationship. Three hundred forty-nine university students were presented with 11 brief scenarios in which the gender of the target and pursuer of the harassment behavior were systematically varied. Participants were asked to rate the degree to which they considered the behavior stalking, how concerned they would be if this was happening to a friend, and the likelihood that they would recommend help seeking. Participants were significantly more likely to express concern for and to recommend both informal and formal help seeking when the scenarios described a man stalking a woman. This research is important in understanding factors that influence perceptions of stalking and harassment, which may have repercussions for the legislation and enforcement of stalking laws.