Patricia Parmelee - US grants

The Laboratory for the Study of Behavioral Processes is dedicated to elucidating the associations of physical and mental health problems with everyday behavioral and emotional functioning. Previous activities of this lab have made important substantive and methodological contributions to the study of mental health in older people. Currently proposed activities will continue and extend those activities in keeping with the focus of the CRC on efficacy and effectiveness of interventions to treat and prevent mental disorders among older persons with co-morbid health problems. Specific aims of the Behavioral Processes Lab are: (1) to characterize the effective and behavioral concomitants of depression and other mental disorders among older persons with co-morbid medical illness, including dementia; (2) to identify affective and behavioral predictors of the development, course, and responsivity including dementia; (2) to identify affective and behavioral predictors of the development, course, and responsivity to treatment of late life mental disorders; (3) to develop and validate innovate behavioral methods for prevention and treatment of late life mental disorders, and (4) to develop and validate innovate methods and measures for evaluating the efficacy and the effectiveness of such interventions. The Behavioral Processes Laboratory will achieve these aims primarily through a series of focused research projects examining psychological, behavioral, and interpersonal processes associated with physical and mental health in late life. These studies focus on diverse populations, measures, and methods, but all deal with intrapersonal and interpersonal processes, leading to, or resulting from depressive illness among physically frail older persons. Specific projects proposed for this funding period include: (1) development and implementation of an intervention to facilitate adaptation to long-term residential care; (2) pilot research on everyday social support and quality of life during and following chemotherapy for breast cancer; (3) development and implementation of a treatment protocol for conducting psychotherapy with depressed older persons with dementia; (4) examination of coping and adaptation in end-stage renal disease, and (5) interrelated studies of daily interactions between two populations of chronically ill individuals and their family caregivers: Persons with AIDS of all ages, and cognitively intact, chronically ill older persons.

[unreadable] DESCRIPTION (provided by applicant): The long-term care industry faces a staffing crisis that threatens quality of care for elderly nursing home (NH) residents nationwide. This research addresses that problem by developing a feasible intervention to enhance work-related efficacy (perceived control) among nursing assistants (NAs). Presumably, NAs who feel able proactively to manage the demands of their jobs will respond more positively and effectively. This should translate to reduced turnover, improved job performance and, as a result, improved functional health and quality of life for elderly nursing home residents. This project will therefore develop a multifaceted intervention to enhance NAs' work-related efficacy. Specific aims are: (1a) to use NAs' own input to develop content for an efficacy-enhancing intervention targeting basic knowledge of care of the aged, strategies for dealing with work demands, and interpersonal skills for interacting with coworkers, supervisors, and residents; (1b) to develop a complementary intervention aimed at sensitizing registered nurses (RNs) and licensed practical/vocational nurses (LPNs) to how their own attitudes and behaviors influence NAs' motiva- tion and performance, and teaching supervisory skills designed to enhance NAs' work efficacy; (2) to select, develop and test outcome measures to evaluate intervention effectiveness, and (3) to conduct a limited field test of a prototype intervention. These aims will be pursued in a 2-year developmental research project comprising 4 main activities: content generation through qualitative and quantitative data gathering with direct care staff, management, and consumers in diverse Georgia NHs; selection and/or development of self-report and observational outcome measures; intervention development, yielding manuals and materials for coordinated prototype interventions for NAs and professional nursing staff, and a field test to ensure feasibility and garner feedback for fine-tuning the intervention as a grant application is prepared for full-scale implementation and evaluation. [unreadable] [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): The long-term care industry faces a staffing crisis that threatens quality of care for elderly nursing home (NH) residents nationwide. This research addresses that problem by developing a feasible intervention to enhance work-related efficacy (perceived control) among nursing assistants (NAs). Presumably, NAs who feel able proactively to manage the demands of their jobs will respond more positively and effectively. This should translate to reduced turnover, improved job performance and, as a result, improved functional health and quality of life for elderly nursing home residents. This project will therefore develop a multifaceted intervention to enhance NAs' work-related efficacy. Specific aims are: (1a) to use NAs' own input to develop content for an efficacy-enhancing intervention targeting basic knowledge of care of the aged, strategies for dealing with work demands, and interpersonal skills for interacting with coworkers, supervisors, and residents; (1b) to develop a complementary intervention aimed at sensitizing registered nurses (RNs) and licensed practical/vocational nurses (LPNs) to how their own attitudes and behaviors influence NAs' motiva- tion and performance, and teaching supervisory skills designed to enhance NAs' work efficacy; (2) to select, develop and test outcome measures to evaluate intervention effectiveness, and (3) to conduct a limited field test of a prototype intervention. These aims will be pursued in a 2-year developmental research project comprising 4 main activities: content generation through qualitative and quantitative data gathering with direct care staff, management, and consumers in diverse Georgia NHs; selection and/or development of self-report and observational outcome measures; intervention development, yielding manuals and materials for coordinated prototype interventions for NAs and professional nursing staff, and a field test to ensure feasibility and garner feedback for fine-tuning the intervention as a grant application is prepared for full-scale implementation and evaluation. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This research examines relationships among pain, everyday activities and mood states, and long-term quality of life among African American (AA; Black) and non-Hispanic White (NHW; White) older adults with osteoarthritis (OA) of the knee. Recent evidence suggests considerable divergence in the experience and effects of this potentially very debilitating disorder among AAs and NHWs. Unfortunately, there has been little in-depth research on racial/ethnic (R/E) differences previous work on racial/ethnic (R/E) disparities in basic experience of OA symptoms, and in the emotional impact of those symptoms and related disability. This research addresses that gap in a longitudinal study of OA pain, functional disability and emotional well-being of AAs and NHWs. Working from a biopsychosocial model, we shall use functional assessments, self-reports, and real-time assessments of activities, symptoms and mood states to construct a comprehensive view of how OA affects physical and emotional functioning. Specific aims are (1) to describe racial/ethnic differences in associations among pain, disability, and emotional well-being of persons with OA of the knee; (2) to identify origins of those differences in (a) biological factors such as disease process and general health, (b) social factors such as demographic characteristics, and (ii) psychological factors, including stable personal characteristics and transitory (within-day) affective, cognitive and behavioral responses to knee symptoms; (3) to use experience sampling methods (ESM) and actigraphy to investigate how racial/ethnic differences in global associations among pain, functional limitations and emotional distress are reflected in the daily lives of OA sufferers, and (4) to explore how the interplay of transitory (within-day) symptoms, activities and mood states influences long-term physical and emotional well-being. These aims will be achieved in a 5-year, multi- site project examining cross-sectional and longitudinal associations among demographic and health characteristics, OA-related pain and disability, restriction of everyday activities, and emotional well-being. A sample of 220 AA and 220 NHW adults aged 50+ with physician-diagnosed OA of the knee will complete a comprehensive baseline assessment tapping biological, psychological and social vulnerability to OA pain and its effects; objective functional limitations; pain; activity restriction, and emotiona distress. Immediately post- baseline, participants will complete a 7-day ESM procedure comprising actigraphic assessment of activity levels along with 4 daily telephone contacts to assess current symptoms, activities, and moods. One year later, participants will repeat all measures, including the ESM component, to capture changes in overall physical and emotional well-being as well as patterns of daily activity and moods. Resulting data will offer unprecedented insight into the global factors that differentiate AAs' and NHWs' experience of OA symptoms, and how daily experiences are concatenated to influence longer-term physical and emotional well-being. PUBLIC HEALTH RELEVANCE: Osteoarthritis (OA) is the most common chronic illness and the leading cause of pain and disability among older adults. As the population ages, prevalence of OA is rising sharply; this, in turn, portends rising rates of disability and health care costs. Osteoarthritis's characteristic pain and functional limitations place persons at increased risk of significant emotional distress; that distress may, in turn, fuel OA pain and hasten functional decline. There are clear differences in the epidemiology of OA among African American (AA) and non-Hispanic White (NHW) older adults, but surprisingly little is known about racial/ethnic disparities in the functional and emotional effects of OA. This study fills that gap by examining how OA of the knee affects everyday activities and emotional well-being of older AAs and NHWs, and how those effects change over a one-year period.

DESCRIPTION (provided by applicant): This project will develop and pilot an accessible, feasible and sustainable one-on-one, peer-led problem-solving intervention for family caregivers (CGs) of frail older adults. Negative effects of care provision on CGs' mental and physical well-being, and even longevity, are well documented. Despite a growing number of supportive programs for CGs, few meet real world needs and limitations. This exploratory/developmental research addresses this gap by developing and testing an intervention designed specifically to circumvent known barriers to implementing supportive programs for family CGs. Specifically, we shall develop and pilot an evidence-based, peer support intervention that capitalizes on the expertise of persons who best know the demands of family caregiving-former CGs themselves. Caregivers Help in Problem Solving (CHIPS) will train persons who previously cared for an elder relative but have transitioned out of that role to deliver a semi-structured intervention to persons currently caring for an impaired elder relative. The intervention, based in concepts of problem-solving therapy and peer support, will be designed expressly to address problems of accessibility, feasibility and sustainability that have plagued previous interventions for family CGs. Importantly, we proposed to examine the beneficial impact of CHIPS upon well- being not just of current CGs receiving the intervention, but also of the former CGs who will serve as lay interventionists. The proposed work sets the stage for full-scale intervention by delineating CHIPS program content, identifying and resolving barriers to effective implementation, and testing feasibility of the program. Specific aims are: (1) to develop a comprehensive, problem-solving intervention for family CGs, including intervention materials based on stakeholder input and a manualized training program to prepare former CGs to be- come peer counselors for current CGs; (2) to establish feasibility of the prototype intervention in a small field pilot, and(3) to estimate its positive impact on CGs and PCs. These aims will be pursued in a 2-year project culminating in an evidence-based psychoeducational intervention that will train former CGs to implement a semi-structured, individualized problem-solving intervention for persons currently caring for an impaired elder relative. This research, a first step toward a full-scale randomized trial (RCT), comprises two primary activities: (1) intervention development based on existing knowledge, new data collection with CGs and practitioners, and input from a panel of experts in the field, and (2) a field test to document feasibility and recruitment process, and establish sampling and staffing pa- rameters for the RCT.

Osteoarthritis is the most common chronic illness and the leading cause of pain and disability among older adults, affecting more than 12% of the total US population and as many as 90% of persons over 65. As the population ages, prevalence of OA is rising sharply; it is projected that by 2030, 1 in 40 Americans will have arthritis, the majority of cases being OA. For those already living with OA, the capacity to monitor symptoms and identify exacerbating factors would significantly improve quality of life. However, current techniques for characterizing and monitoring OA-related inflammation fail to deliver a cost effective and simple solution that can be widely used by patients for continuous self-monitoring. In this study we propose developing a wearable to collect quantitative information on inflammation which have the potential to monitor disease progression without costly and invasive technologies. Such devices have strong potential to provide OA patients and providers with insight into the origins of pain and other symptoms and factors that may influence progression of the disease. First we will engage consumer input from practitioners and OA patients to identify their human fac- tors necessary for adoption of the wearable device. Second, we will devise and test a device that collects lo- calized electrical impedance measures of the knee, previously shown able to differentiate between groups with and without OA, in laboratory conditions to validate its operation. Finally, executing a small-scale field trial to test user acceptance and collect preliminary data linking observed variability in inflammatory biomarkers to self-reported OA symptoms and affect.