The Columbia Behavior Scale for Dementia (CBS-8): Validity and Reliability of a Rapidly Administered New Instrument for Dementia-Related Behaviors in Long-Term Care Settings.

We developed and evaluated the psychometric properties of the Columbia Behavior Scale for Dementia (CBS-8), a rapid instrument that assesses positive symptoms, to enhance behavioral and psychological symptoms of dementia (BPSD) assessment and treatment in long-term care. Psychometric analyses were performed on CBS-8 data from residents (N = 350, age ≥50 years) in 47 Maryland long-term care facilities referred for neurocognitive and mood evaluation. The CBS-8 demonstrated acceptable internal consistency (α = 0.78) and strong interrater reliability (intraclass correlation coefficient = 1.00). CBS-8 scores were correlated with greater cognitive impairment severity (r = -0.34). The diagnosis of dementia with behavioral disturbance had higher CBS-8 scores than other dementia types (e.g., vascular, unspecified) (p < 0.001, η2 = 0.40). Three CBS-8 factors-motor disinhibition, aggression, and psychosis-explained 65% of the variance in overall BPSD. The CBS-8 could enhance BPSD tracking and treatment, strengthen interdisciplinary collaboration, and aid nursing homes in meeting regulations on unnecessary medication use. [Research in Gerontological Nursing, 14(3), 160-168.].

A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study.

BACKGROUND: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. OBJECTIVE: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. METHODS: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. RESULTS: The M5 demonstrated acceptable internal consistency (Cronbach α=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). CONCLUSIONS: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits.

A path to early diagnosis of mild cognitive impairment and dementia: validity and reliability of the myMemCheck® self-administered screening tool.

BACKGROUND: Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed at home to identify older adults that would benefit from a more comprehensive cognitive evaluation. OBJECTIVE: Two prospective cross-sectional studies were conducted to examine the psychometric properties and clinical utility of myMemCheck®. METHODS: In Study 1, participants were independent living residents referred to an outpatient memory clinic (N = 59); older adults in the community and post-acute nursing home residents (N = 357) comprised Study 2. RESULTS: Psychometric analyses were performed on cognitive and psychological testing data, including myMemCheck®. myMemCheck® evidenced adequate reliability and strong construct validity. Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults at risk for MCI or dementia. myMemCheck® explained 25% of cognitive status beyond basic patient information. CONCLUSIONS: myMemCheck® may help fast-track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in health care and prevent negative outcomes associated with undetected cognitive impairment.

Verbal test of practical judgment (VPJ): a new test of judgment that predicts functional skills for older adults.

OBJECTIVES: The clinical assessment of older adults' judgment is important for mitigating safety risks that often precipitate loss of independence. Our national survey of geriatric healthcare providers (N = 496; M years of experience = 17.11 ± 10.60) indicated that formal judgment tests are underutilized in clinical practice. We developed the Verbal Test of Practical Judgment (VPJ) as a new test of judgment for older adults intended to identify difficulty performing instrumental activities of daily living (IADL). METHOD: In two prospective studies, participants were long-term care facility residents (age ≥ 50) in Maryland, USA (Study 1, N = 51; Study 2, N = 110) referred to licensed psychologists for neuro-cognitive and mood evaluation by facility attending physicians. Psychometric analyses were performed to examine the construct validity of the VPJ. RESULTS: The VPJ evidenced adequate reliability and strong construct validity across both studies. Receiver operating characteristic analysis yielded an optimal VPJ cut score for identifying impaired judgment. The VPJ significantly predicted IADL performance beyond clinician and participant ratings. CONCLUSION: The VPJ appears to be a valid tool for assessing judgment among older adults with suspected cognitive impairment. VPJ score inferences can inform clinicians on the odds of requiring assistance for specific IADLs.

Association of cotherapy supervision with client outcomes, attrition, and trainee effectiveness in a psychotherapy training clinic.

OBJECTIVE: Cotherapy supervision has been hypothesized to enhance client outcomes and trainee effectiveness, but there is little empirical evidence relevant to either claim. This study tested both hypotheses, using data from the supervision of psychology doctoral students conducting cognitive behavioral therapy in a university-based clinic. METHOD: Groups of clients treated by supervisor-trainee duos and groups of clients treated by solo trainees with varying exposure to cotherapy supervision were compared on changes in symptoms as measured with the Outcome Questionnaire (OQ-45) and on dropout rates. RESULTS: Clients showed statistically significant reductions in symptoms from pretreatment to posttreatment. However, there were no significant group differences in the magnitude of change or in client retention. CONCLUSIONS: No support was obtained for the hypothesized benefits of cotherapy supervision. Clients treated by a cotherapy (supervisor and supervisee) team did not improve more than did clients treated by solo trainees. Furthermore, clients treated by (solo) trainees who had received cotherapy supervision did not improve more than did clients treated by trainees who had not received cotherapy supervision.

The effects of the transcendental meditation program on mindfulness.

Mindfulness is associated with low levels of neuroticism, anxiety, and depressive symptoms, as well as high levels of self-esteem and satisfaction with life (Brown & Ryan, 2003). As part of a 3-month randomized waitlist-controlled trial of the effects of the Transcendental Meditation (TM) program on university students (N=295), we examined the impact of TM practice on mindfulness as measured by the Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004). A repeated measures ANOVA on total KIMS scores showed a significant timextreatment interaction, with the TM participants reporting greater increases in mindfulness than the waitlist participants. All KIMS subscales were positively intercorrelated at pretreatment, and there were no differences over time or as a function of treatment condition in subscale intercorrelations. Therefore, previously published findings of a positive correlation between subscales measuring the skills of observing and accepting-without-judgment one's inner experiences only among those with meditation experience may have reflected a self-selection effect rather than a change in the relation of these mindfulness components resulting directly from meditation practice.