Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility.

OBJECTIVE: Implement a memory impairment screening procedure for elderly Hispanic primary care patients, and analyze its yield and challenges to further triage and diagnostic evaluation. METHODS: Three hundred twenty nine Hispanic patients aged ≥60 years or proxy informants were enrolled from outpatient primary care clinics at an urban safety-net medical center. Patients were screened for memory impairment using the WHO-UCLA AVLT; for those without consent capacity, proxies were given the IQCODE. Bilingual research assistants conducted in-person or telephone screening. Age, gender, education, comorbidities, acculturation, overall health, access to care, and memory concerns were assessed as potential predictors of memory impairment. Based on identified implementation challenges, a multi-disciplinary stakeholder committee proposed revised approaches to increase diagnostic evaluation and sustainability. RESULTS: Of 677 eligible patients approached, 329 (49%) were screened, and 77 (23%) met criteria for memory impairment using the WHO-UCLA AVLT (N=60) or the IQCODE (N=17). Only male gender and higher comorbidity uniquely predicted memory impairment (ps<0.05). Few screen-positive patients declined further triage and evaluation, but a substantial proportion could not be subsequently contacted. Challenges to implementing a memory screening program included staff time and adequate clinic space for in-person screening; challenges to follow-up of positive screening results included inability to contact patients and lack of primary care continuity to facilitate further triage and referral. CONCLUSIONS: Nearly one-fourth of primary care Hispanic elders screened as memory-impaired, but few factors predicted positive screening. Stakeholder-guided adaptations are needed-particularly in resource-constrained settings-to overcome challenges to further diagnostic evaluation and referral.

Development and preliminary evaluation of a quality of life measure targeted at dementia caregivers.

BACKGROUND: Providing care for individuals with a progressive, debilitating condition such as dementia can adversely impact the quality of life (QOL) of informal caregivers. To date, there is no existing caregiver quality of life measure for dementia caregivers with breadth of coverage or that is applicable to caregivers of diverse ethnic backgrounds. The purpose of this study was to develop and evaluate a caregiver-targeted quality-of-life measure (CGQOL) for informal caregivers of persons with dementia that can be used with caregivers from a variety of ethnicities. METHODS: 91 items were field tested by telephone interviews with 179 English-speaking and 21 monolingual Spanish-speaking caregivers of persons with dementia. Repeat interviews were conducted with 71 caregivers. Administration time, scale score distributions, item-scale correlations, reliability, and associations of scales with patient and caregiver demographic and caregiving characteristics were estimated. Structure of associations among scales was examined using exploratory factor analysis. RESULTS: Item analysis yielded 80 items distributed across 10 scales, with median administration time of 17 minutes [IQR 13.5-22 minutes] and minimal missing data. There were few floor or ceiling effects in scale score distributions. Internal consistency reliability was >or= 0.78 for all scales; test-retest reliability (intraclass correlation) estimates exceeded 0.70 for 6 scales. More hours weekly spent in caregiving was uniquely associated with worse quality of life on 8 scales (p's

The effects of sad mood on memory in older adults: a test of the mood congruence effect.

Mood congruence effects have long been studied in younger adults, but not in older adults. Socioemotional selectivity theory (SST) suggests that mood congruence could operate differently in older adults. One hundred and nineteen younger and 78 older adults were randomly assigned to sad or neutral mood inductions, using combined Velten and music induction procedures. Results indicated that during sad mood induction both older and younger adults showed enhanced recall of sad words on delayed word list recall task and in autobiographical memory. However, only older adults displayed mood congruence effects on lexical ambiguity and lower recall of positive words in the word list task. Results provided partial support for developmental effects on mood congruence derived from SST.