The Geropsychology Podcast

Tara McBride Afonso, PsyD, is a staff psychologist at VA Boston Healthcare System and Instructor in Psychiatry at Harvard Medical School. Dr. McBride specializes in providing psychotherapy, assessments, and caregiver support to homebound older adults and their families. In addition to in-person care, she has been providing clinical services via telehealth for several years. Dr. McBride earned her doctorate from Nova Southeastern University where she carved out her own geropsychology focused training, went on to complete a pre-doctoral internship at Louis Stokes Cleveland VA in the gero-track, and a postdoctoral fellowship in Geropsychology at VA Boston. In addition to clinical duties, she supervises psychology fellows who rotate through the Home Based Primary Care setting and is a member of the Disruptive Behavior Committee at VA Boston.

Resources discussed in today’s episode:

McKnight Article: ‘Tips for Successful Telehealth Services Implementation in SNFs,’ by Jennifer Birdsall.

APA Articles on Telehealth:

APA Guidelines for the practice of telepsychology

Ethical guidance for the COVID-19 era

How to apply telehealth in Nursing Homes

COVID-19: What the Ethics Code says about reopening your practice now

Further Reading:

Implementation Considerations for Telehealth Programs Serving Older Adults, by the Rural Health Information Hub

‘Therapy Notes’ blog article: “The Therapist’s Telehealth Guide for COVID-19”

Gould, C. E., & Hantke, N. C. (2020). Promoting technology and virtual visits to improve older adult mental health in the face of COVID-19. The American Journal of Geriatric Psychiatry, 28(8), 889-890.

Hantke, N. C., & Gould, C. (2020). Examining Older Adult Cognitive Status in the Time of COVID‐19. Journal of the American Geriatrics Society, 68(7), 1387-1389. https://doi.org/10.1111/jgs.16514

Pimentel, C. B., Gately, M., Barczi, S. R., Boockvar, K. S., Bowman, E. H., Caprio, T. V., ... & Griffiths, P. C. (2019). GRECC Connect: geriatrics telehealth to empower health care providers and improve management of older veterans in rural communities. Federal Practitioner, 36(10), 464.

Resources discussed in today’s episode:

APA COVID-19 and Aging Resources

Gerontological Society of America COVID-19 Updates

Azar, K. M. J., Shen, Z., Romanelli, R. J., et al. (2020). Disparities in outcomes among COVID-19 patients in a large health care system in California. Health Affairs, 39(7). https://doi.org/10.1377/hlthaff.2020.00598

NYT Article on COVID-19 disparities in nursing homes

APA Webinar “African American Older Adults and COVID-19: Addressing Mental Health Needs, Supporting Strengths”

NPR Article describing change in COVID data collection

CDC graph on age-adjusted COVID-19 hospitalization rates by race and ethnicity

CDC COVID data tracker

COVID racial data tracker -- COVID Tracking Project and Boston University

Emory University’s COVID-19 health equity interactive dashboard that allows you to visualize social determinants of health and rates of COVID 19

Racial and ethnic health and social inequities have long existed, compounding the disparities we’ve seen in COVID. The CDC has briefly described some of these factors related to disparities.

NYT Article: “Questions of Bias in COVID 19 Treatment Add to the Mourning for Black Families”

Stat News article on inequitable representation in clinical trial participation. This article provides concrete strategies clinical researchers can implement to promote equity in their own practices.

Further Reading:

McLaren, J. (2020). Racial Disparity in COVID-19 Deaths: Seeking Economic Roots with Census data (No. w27407). National Bureau of Economic Research.

Tai, D. B. G., Shah, A., Doubeni, C. A., Sia, I. G., & Wieland, M. L. (2020). The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clinical Infectious Diseases.

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296-4301.

Alsan, M., & Wanamaker, M. (2018). Tuskegee and the health of black men. The quarterly journal of economics, 133(1), 407-455.

Eleanor Feldman Barbera, PhD is a licensed psychologist and long-term care industry expert, combining her training with decades of experience to offer innovative solutions to problems affecting cost and quality of care. Dr. Barbera counsels older adults and their families as they navigate aging and the healthcare system, speaks internationally on aging and mental health issues and is the writer of the award-winning McKnight’s LTC News column, The World According to Dr. El, which offers a mental health perspective on a medical environment. Dr. Barbera has authored a large-print guidebook for residents and their families, The Savvy Resident’s Guide, contributed to AMDA The Society for Post-Acute and Long-Term Care Medicine’s Younger Adult in the Long-Term Care Setting manual, written a chapter in Bullying in Older Adults, and has a chapter in the forthcoming tentatively-titled book Ageing Concerns Globally. She is a past columnist for iAdvance Senior Care (formerly Long-Term Living Magazine) and her work has been featured in AMDA’s Caring for the Ages magazine and has been seen in USA Today, AARP, Kaiser Health News and Next Avenue. She is writing a novel based on her work.

Dr. Barbera provides training to staff, coaching to families, and has spoken to industry audiences including LeadingAge Florida, MarcusEvans LTC and Senior Living CXO conference, ElderAbuseOntario, Maine Health Care Association Assisted Living Conference, ECRI Institute, American Psychological Association, Activity Professionals of Ontario, Montana Certification Bureau, Louisiana Nurse Home Association and many more. She developed the Violence Prevention Training Program for 1199SEIU United Healthcare Workers East. She is a long-time member of the American Psychological Association and Psychologists in Long-Term Care.

Dr. Barbera is endlessly captivated by her chosen field, from the resilience of elders grappling with life changes, to inspiring caregivers and innovative service providers, to the alternately impressive and alarming efforts of societies to handle their growing aging populations. Her past work in psychiatric hospitals, managed mental health care and other behavioral health settings informs her perspective that addressing the behavioral health needs of elders and their caregivers is the key to success.

Resources discussed in today’s episode:

1. McKnight’s LTC News Column titled The World According to Dr. El

2. Dr. Barbera’s book, titled The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay But Were Afraid to Ask

3. Information on point-of-care testing:

- https://www.npr.org/sections/health-shots/2020/07/14/891116538/despite-shortfalls-and-delays-u-s-testing-czar-says-efforts-are-mostly-sufficien

- https://www.mcknights.com/news/specifics-of-point-of-care-covid-19-testing-coming-to-all-u-s-nursing-homes-providers-welcome-move/

- https://www.mcknights.com/news/point-of-care-tests-offer-more-flexibility-for-facilities-but-implementation-may-pose-problems-experts-warn/

4. Simard, J., & Volicer, L. (2020). Loneliness and isolation in long-term care and the COVID-19 pandemic. JAMDA, 21, 966-967.

Resources discussed in today’s episode:

1. Stokes, E. K., Zambrano, L. D., Anderson, K. N., et al. (2020). Coronavirus disease 2019 case surveillance -United States, January 22-May 30, 2020. Morbidity and Mortality Weekly Report, 69(24), 759-765. Accessed at https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm#suggestedcitation

2. CDC Provisional COVID-19 Death Counts by Sex, Age, and State: https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku

3. COVID in United States Nursing Homes:

https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html

https://www.aarp.org/caregiving/health/info-2020/coronavirus-nursing-home-cases-deaths.html

https://www.nbcnews.com/podcast/into-america/tracking-coronavirus-nursing-homes-n1207296

4. CMS COVID-19 Nursing Home Data: https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg

5. Mueller, A. L., McNamara, M. S., & Sinclair, D. A. (2020). Why does COVID-19 disproportionately affect older people?. Aging, 12(10).

6. APA on Ageism and COVID-19: https://www.apa.org/topics/covid-19/research-ageism

7. Ageism in the media:

https://www.nbcnews.com/news/us-news/texas-lt-gov-dan-patrick-suggests-he-other-seniors-willing-n1167341

Twitter #boomerremover: https://twitter.com/hashtag/boomerremover?lang=en

Older adults and COVID-19 vaccine trials: https://www.nytimes.com/2020/06/19/health/vaccine-trials-elderly.html

https://www.wbur.org/commonhealth/2020/06/25/covid-19-coronavirus-ageism

8. University of California San Francisco’s Geriatrics Department of Medicine “Resources for Older Adults During the COVID-19 Pandemic”: https://geriatrics.ucsf.edu/patient-care/covid-19/resources-older-adults-during-covid-19-pandemic

Resources discussed in today’s episode:

- GeroCentral Website, COVID-19 Resources: https://gerocentral.org/clinical-toolbox/covid-19-resources/

- Coronavirus Anxiety Workbook: https://www.depauw.edu/files/resources/coronavirus-anxiety-workbook.pdf

- COVID-19 Telehealth Support Group for Socially Isolated Older Adults: https://gerocentral.org/wp-content/uploads/2020/03/COVID19-Older-Adult-Telephone-or-Virtual-Support-Group-Manual.pdf

Dr. Nancy A. Pachana is a clinical geropsychologist and professor in the School of Psychology at The University of Queensland (UQ), and is co-director of the UQ Ageing Mind Initiative, providing a focal point for clinical, translational ageing-related research. She has an international reputation in the area of geriatric mental health, particularly late-life anxiety and driving in later life. Dr. Pachana was elected a Fellow of the Academy of Social Sciences in Australia in 2014. Originally from the United States, she was awarded her B.A. from Princeton University in 1987 and her Ph.D. from Case Western Reserve University in 1992. She is an avid bird watcher and a keen traveler.

Learning Objectives:

At the conclusion of this episode, listeners will be able to:

1. List factors that have facilitated the specialization of geropsychology in some countries.

2. List factors that are associated with delayed movement toward the specialization of geropsychology in some countries.

3. Describe the current state of geropsychology training across several countries.

4. Explain the importance of sharing research, clinical practices, and training initiatives on a global scale.

5. Identify ways to broaden your perspective on an international level.

For further reading on topics discussed in today’s episode:

- Woodhead, E. L., Emery-Tiburcio, E. E., Pachana, N. A., Scott, T. L., Konnert, C. A., & Edelstein, B. A. (2015). Clinical and counseling psychology graduate students’ expectations for future work with older adults. Clinical Gerontologist, 38(5), 357-374.

- Pachana, N. A., Emery, E., Konnert, C. A., Woodhead, E., & Edelstein, B. A. (2010). Geropsychology content in clinical training programs: A comparison of Australian, Canadian and U.S. data. International Psychogeriatrics, 22(6), 909-918.

- Pachana, N. A. (2014). Why we need an international clinical geropsychology. In N. A. Pachana & K. Laidlaw (Eds.), The Oxford handbook of clinical geropsychology (pp. 1064-1081). Oxford, UK: Oxford University Press.

- Pachana, N. A. (2015). International trends in geropsychology. In P. A. Lichtenberg, B. T. Mast, B. D. Carpenter, & J. Loebach Wetherell (Eds.), APA handbooks in psychology. APA handbook of clinical geropsychology, Vol. 1. History and status of the field and perspectives on aging (pp. 421-441). Washington, DC, US: American Psychological Association.

Dr. Grant Harris is a geropsychologist currently working in the Geriatric Primary Care Clinic at the St. Louis VA. He received his PhD from The University of Alabama with a clinical and research interest in geropsychology. With the help of his advisor, Dr. Rebecca Allen, Grant was presented with the Outstanding Dissertation Award and the Psychology Department's Award for Outstanding Research by a Doctoral Student for his work in several domains, including dementia caregiving, the stress process in older adults, and the use of religiosity as a coping strategy in chronic illness. Dr. Harris completed his internship at the Memphis VA Medical Center and stayed for a fellowship in Clinical Health Psychology with an emphasis on late life. He joined the St. Louis VA in 2015. He is a member of the facility Dementia Committee and VISN 15 Dementia Committee. In his role as the GeriPACT psychologist Grant has created and implemented an interdisciplinary dementia evaluation clinic and enacted a facility-wide dementia consult to triage cognitive evaluations to the most appropriate clinic. Dr. Harris was integral to the development of the geropsychology fellowship at the Saint Louis VA and acts as the cognitive evaluation preceptor for the psychology internship and fellowship programs. He serves as newsletter editor on the board of the Council of Professional Geropsychology Training Programs.

Learning Objectives:

At the conclusion of this episode, listeners will be able to:

1. Explain the medical home model.

2. List differences between a GeriPACT and a traditional primary care clinic.

3. Describe the role and responsibilities of a geropsychologist in a GeriPACT.

4. Describe the current research on GeriPACTs.

For further reading on topics discussed in today’s episode:

- Moye, J., Harris, G., Kube, E., Hicken, B., Adjognon, O., Shay, K., & Sullivan, J. L. (2019). Mental health integration in geriatrics patient-aligned care teams in the Department Veterans Affairs. The American Journal of Geriatrics Psychiatry, 27(2), 100-108.

- Mast, B. T. (2011). Whole person dementia assessment. Baltimore, MD, US: Health Professions Press.

Jessica Strong, PhD, is a licensed clinical geropsychologist and Assistant Professor in the Department of Psychology at the University of Prince Edward Island. She earned her doctorate in clinical psychology, with a specialty in geropsychology, at the University of Louisville. Dr. Strong recently completed an advanced geriatric fellowship at the New England Geriatric Research, Education and Clinical Center (GRECC). Her research interests are late-life cognitive effects of early music training, cognitive decline in late life, and the use of music as a psychotherapeutic tool.

Learning Objectives:

At the conclusion of this episode, listeners will be able to:

1. Describe the late-life cognitive benefits of early music education and training.

2. Explain the difference between critical period and sensitive period of development and how this relates to music education and training.

3. Describe the difficulty with assessing the dose effect in music training research.

4. Identify ways in which music can be used as a therapeutic tool in both individual and group psychotherapy.

For further reading on topics discussed in today’s episode:

- Strong, J. V., & Mast, B. T. (2019). The cognitive functioning of older adult instrumental musicians and non-musicians. Aging, Neuropsychology, and Cognition: A Journal on Normal and Dysfunctional Development, 26(3), 367-386.

- Strong, J. V., & Midden, A. (2018). Cognitive differences between older adult instrumental musicians: Benefits of continuing to play. Psychology of Music. https://doi.org/10.1177/0305735618785020

- Strong, J. V. (2015). The neuropsychological profile of older adult musicians and non-musicians: Implications for cognitive research in late life (Doctoral dissertation).

- Deason, R. G., Strong, J. V., Tat, M. J., Simmons-Stern, N. R., & Budson, A. E. (2019). Explicit and implicit memory for music in health older adults and patients with mild Alzheimer’s disease. Journal of Clinical and Experimental Neuropsychology, 41(2), 158-169.

- Strong, J. V., & Midden, T. A. (2018). Music and aging from bench to intervention. Innovation in Aging, 2(Suppl 1), 848.

- Strong, J. V. (2017). Cognitive functioning in older musicians: Benefits of training with a music ensemble. Innovation in Aging, 1(Suppl 1), 329.

- Strong, J. V., Plys, E., Hartmann, C., & McCullough, M. (2018). Implementation of a mental health and music group in subacute rehabilitation. Innovation in Aging, 2(Suppl 1), 848-849.

- Strong, J. V., Mast, B., Midden, A., & Leritz, E. (2018). The neuropsychological profile of older adult instrumental musicians. Innovation in Aging, 2(Suppl 1), 338.

Learning Objectives:

At the conclusion of this episode, listeners will be able to:

1. Describe the key principles of quality improvement in healthcare.

2. Explain the importance of quality improvement in geropsychology.

3. Describe the benefits of doing quality improvement in healthcare.

4. Identify the differences between research and quality improvement.

5. Identify avenues for training in quality improvement.

Resources and websites discussed in today’s episode:

- Institute for Healthcare Improvement: http://www.ihi.org/

- Centers for Disease Control and Prevention – Performance Management & Quality Improvement Resources: https://www.cdc.gov/publichealthgateway/performance/index.html

- MAHC 10 – Fall Risk Assessment Tool: https://www.homecaremissouri.org/projects/falls/documents/Oct2012FINALValidatedFallriskassessmenttool.pdf

- U.S. Department of Health and Human Services Health Resources and Services Administration – Quality Improvement Training Module: https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

- Agency for Healthcare Research and Quality – Improving Primary Care Practice: https://www.ahrq.gov/professionals/prevention-chronic-care/improve/index.html

- The Public Health Foundation – Quality Improvement Resources: http://www.phf.org/focusareas/performancemanagement/toolkit/Pages/PM_Toolkit_Quality_Improvement.aspx

- VA Geriatric Scholars Program: https://www.gerischolars.org/mod/page/view.php?id=677

- VA’s Quality Enhancement Research Initiative: https://www.queri.research.va.gov/

- Bonin, L. (2018). Quality improvement in health care: The role of psychologists and psychology. Journal of Clinical Psychology in Medical Settings, 25(3), 278-294.

- McQuaid, E. L., Aosved, A. C., & Belanger, H. G. (2018). Integrating research into postdoctoral training in health service psychology: Challenges and opportunities. Training and Education in Professional Psychology, 12(2), 82-89.

- Health Service Psychology Education Collaborative. (2013). Professional psychology in health care services: A blueprint for education and training. American Psychologist, 68(6), 411-426.

- American Psychological Association (2009). Criteria for the evaluation of quality improvement programs and the use of quality improvement data. American Psychologist, 64(6), 551-557.

- Knight, B. G., Karel, M. J., Hinrichsen, G. A., Qualls, S. H., & Duffy, M. (2009). Pikes peak model for training in professional geropsychology. American Psychologist, 64(3), 205-214.

- Pikes Peak Self Evaluation Tool (available on GeroCentral): https://gerocentral.org/competencies/

Patricia Bamonti, PhD, is a licensed clinical geropsychologist who specializes in providing psychotherapy to older adults and caregivers in an outpatient geriatric mental health setting. She earned a degree in clinical psychology, focusing in geropsychology, at West Virginia University, and then she went on to complete an internship and fellowship with a geropsychology emphasis at the Milwaukee VA Medical Center. Dr. Bamonti's research interests are depression and suicide in late life and coping with chronic medical conditions and adapting to related functional impairment. Currently, she serves as the Secretary for the Council of Professional Geropsychology Training programs and Social Media Overseer for the Society of Clinical Geropsychology, which is APA Division 12 Section II. She is active in training future geropsychologists, providing clinical supervision to trainees at the practicum, internship, and fellowship levels.

Learning Objectives:

At the conclusion of this episode, listeners will be able to:

1. Discuss to how conceptualize and address issues related to transference or patient-therapist boundaries in the context of age differences between the therapist and patient.

2. List modification strategies and one tool to use when providing psychotherapy to older adults who have cognitive impairment.

3. Identify ways in which ageism impacts mental health and treatment for older adults.

4. Discuss factors to consider when thinking about using a trauma-focused treatment.

5. Describe how to orient an older adult patient to mental health treatment.

For resources on clinical issues in outpatient psychotherapy with older adults, visit GeroCentral’s webpage “Psychotherapy for Older Adults” in the Clinical Toolbox: https://gerocentral.org/clinical-toolbox/psychotherapy-for-older-adults/