Graduate education in geropsychiatric nursing: findings from a national survey.

By 2030, the numbers of older adults with mental illness will strain our health care system. Sufficient advanced practice nurses (APNs) with specialized knowledge to provide care will be critical. All 339 graduate nursing programs in the US were surveyed regarding the extent and nature of geropsychiatric nursing (GPN) content in their curricula. Of 206 schools responding, 15 reported having a GPN subspecialty. Regarding the 60 schools with a psychiatric/mental health nursing (PMHN) graduate program, only one third (n = 23) included some GPN content, while more than half (n = 116) of all schools reported integration of GPN content in a non-psychiatric nurse practitioner program. Thus, currently, the greatest numbers of APNs receiving education on mental health needs of older adults are prepared in non-psychiatric nurse practitioner programs. This article discusses the implications for nursing education and practice.

An exploratory study of depression among older African American users of an academic outpatient rehabilitation program.

Variation in the presentation of depressive illness among older African Americans may complicate assessment of depression, especially among those with multiple medical comorbidities and functional disabilities. The purpose of this study was to explore the prevalence of depression among older poor African Americans attending an academic outpatient rehabilitation program, using a depression measure with low somatic item content. Correlates of depression in this population also were explored. Health-care records of 150 older African Americans seen over a 2-year period were examined. Depression was assessed on admission using the 30-item Geriatric Depression Scale (GDS). Using a GDS cutoff score for depression of 11 or higher, 30% of the sample (age 75.5 +/- 7.16 years, range 65-95, 75% women) scored positive for depression. Nine percent also reported having suicidal thoughts within the previous week. Consistent with existing literature, depressed patients, as compared to nondepressed patients, were significantly younger, more suicidal, more likely to rate their general health as poor, had higher mean ratings of pain, and more often limited their social activities. Six GDS items were found to have little ability to discriminate between depressed and nondepressed patients: satisfaction with life, getting bored easily, prefer staying at home, find life exciting, getting started on new projects, and full of energy. The authors recommend further testing of the GDS with similar populations of older, poor, medically ill, and functionally disabled older adults.

Evaluation of outcomes in Psychiatric Consultation-Liaison Nursing practice.

This report describes and evaluates the current status of outcome analysis in Psychiatric Consultation-Liaison Nursing (PCLN) and offers suggestions for future development. The status of outcome evaluation generally in psychiatric nursing is described with attention given to the scope of practice of PCLN and outcomes used by psychiatric consultation-liaison nurses (PCLNs) to evaluate their interventions. An evaluation framework based on Donabedian's paradigm of structure, process, and outcome is presented and its applicability shown to PCLN. This framework is further explicated with regard to a review of published studies of PCLN within the outcome domains of cost reduction, satisfaction with services, changes in clinical status, and perceptions of work environment. Finally, recommendations for further development of outcomes in PCLN are offered, based on the strengths and limitations of the extant literature.

A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population.

OBJECTIVE: The authors conducted a psychometric evaluation of the Cornell Scale for Depression in Dementia (CSDD) through factor analysis and assessment of criterion validity in an older, frail nursing home population, with a secondary analysis of pre-intervention data from a longitudinal clinical trial aimed at reducing restraints in nursing homes. METHODS: The sample for the present study was 642 nursing home residents (mean [SD] age 84.3 [7.6] years; range: 61-105; 82% women) with completed CSDD scores, who were interviewed immediately before the intervention. Nursing home residents' scores from the 19-item CSDD were subjected to exploratory factor analysis and criterion-validity analysis. RESULTS: The factor analysis resulted in four distinct clinically interpretable domains: Depression, Somatic/Vegetative, Disturbed Sleep, and Anxiety. Sixteen items were retained in these domains, and summated score indices and a global score were constructed. The global score and the four indices demonstrated adequate internal consistency and reliability. The indices generated by the factor analysis correlated as expected with criterion variables. CONCLUSION: Results suggest that in frail, institutionalized older adults with high rates of dementia, medical illness, and functional disability, depression measurement methods that are less dependent on items highly sensitive to comorbid conditions and not necessarily associated with depression may be more appropriate. Authors recommend further validity testing of the CSDD with similar populations of frail, institutionalized older adults.