Kimberly D. Acquaviva, PhD, MSW

Are We Teaching Racial Profiling? The Dangers of Subjective Determinations of Race and Ethnicity in Case Presentations

Kimberly D. Acquaviva — Wed, 19 May 2010 11:33:06 PDT

Physicians make subjective visual assessments concerning the race and/or ethnicity of their patients and document these assessments in patient histories every day. Medical students learn this practice through textbooks and the example set by their educators. Although physicians may believe that they are helping their patients, the practice of using visual clues concerning race and/or ethnicity to determine whether a patient is at risk of certain diseases lacks scientific rigor and may put the patient at significant risk of receiving substandard medical care. The authors argue that if the patient's race or ethnicity is of critical importance, the data should be collected through more objective, scientifically rigorous means, such as genetic testing. In this article, the authors call for the widespread transformation of the way medical schools teach tomorrow's physicians about the role of race and ethnicity in taking medical histories, and they challenge physicians to change their current practices.

Transformative Aspects of Caregiving at Life's End

Jennifer Salmon — Fri, 17 Jul 2009 09:59:52 PDT

We do not know to what extent the needs of caregivers involved with patients at the end of life are being met by care providers and whether caregiving at life’s end can be a positive experience. We used the Hospice Experience Model of Care as a framework for understanding the effect of transformative tasks on caregiving at life’s end. We compared current and bereaved caregivers and then, holding background characteristics constant, tested the independent effects of three transformative mediators: self-acceptance, meaning, and closure, as well as comfort with caregiving on several stressors when explaining differences in caregiver burden and gain. Transformative aspects of caregiving do not mediate the stressors associated with burden but do mediate one stressor associated with caregiver gain. Two mediators reduce caregiver burden and all four of the mediators improve caregiver gain. Caregivers who are able to attend to these transformative aspects find more gain in the caregiving experience.

Redefining Health Care Disparities for LGBT Older Adults (and for all Seniors)

Kimberly D. Acquaviva — Fri, 17 Jul 2009 09:54:28 PDT

The Quality Improvement Landscape

Jean E. Johnson — Fri, 17 Jul 2009 09:50:06 PDT

Working with LGBT Clients: Strategies for Geriatric Care Managers

Kimberly D. Acquaviva — Fri, 17 Jul 2009 09:23:03 PDT

Benefits of Training Family Caregivers

Jung Kwak — Fri, 17 Jul 2009 09:20:41 PDT

during the last years of life that focuses on the emotional, spiritual, and practical aspects of life and relationship completion and closure. This study evaluated the effectiveness of CGLE in improving three major outcomes: comfort with caregiving, closure, and caregiver gain. Family caregivers (n = 2,025) participated in programs facilitated by health and human service professionals (n = 142) who completed a CGLE train-the-trainer workshop conducted by The Hospice Institute of the Florida Suncoast. The caregivers completed training rosters and pre- and/or post-surveys. Group differences are reported in baseline characteristics and change in three outcomes for caregivers who completed 1) both pre- and post-survey, 2) presurvey only, and 3) post-survey only. For those who completed both surveys (n = 926), paired t-tests and multiple linear regression tested the impact of program length on caregiver outcomes. Caregivers participated in, on average, four sessions and 7.7 hours of training. The majority of caregivers were Caucasian (88%), female (81%), and on average, 60 years old. Significant improvement was found in all three outcomes (P < 0.001). The program length made a difference for improvement in comfort with caregiving and closure but not in caregiver gain. Caregivers who are caring for someone during the last years of life benefit from a program that focuses on the life-changing or transformative aspects of caregiving in the last years of life, as well as practical aspects of caregiving. The ability to support caregivers in this relatively low impact intervention can be used in hospice and nonhospice settings.

Validation of the Caregiving at Life’s End questionnaire

Jennifer R. Salmon — Fri, 17 Jul 2009 09:10:51 PDT

The researchers in this study developed and validated a questionnaire to measure the needs of end-of-life (EOL) caregivers. The model is used to facilitate meaningful and supportive experiences for both the patient and caregiver. The questionnaire was developed using existing scales of meaning, self acceptance, burden, and gain as well as new scales of caregiver comfort, importance of caregiving tasks, and caregiver closure. The sample included 34 current and 17 bereaved caregivers affiliated with The Hospice Institute of the Florida Suncoast. The scales performed well in terms of concurrent validity, internal consistency, and reliability.

Screening, Diagnosis, and Treatment of Depression in Patients with End-Stage Renal Disease

Scott D. Cohen — Tue, 07 Jul 2009 12:52:18 PDT

Depression is common in patients with end-stage renal disease and has been linked to increased mortality. Screening for depression in the general medical population remains controversial; however, given the high prevalence of depression and its significant impact on morbidity and mortality, a strong case for depression screening in patients with end-stage renal disease can be made. Several studies have been performed to validate the more common depression screening measures in patients with chronic kidney disease. The Beck Depression Inventory, the Hamilton Rating Scale for Depression, the Nine-Question Patient Health Questionnaire, and the Center for Epidemiologic Studies Depression Scale are some of the measures that have been used to screen for depression in patients with end-stage renal disease. Data suggest a higher Beck Depression Inventory cutoff score, of >14 to 16, will have increased positive predictive value at diagnosing depression in patients with end-stage renal disease. There are limited data on the treatment of depression in this patient population. Pharmacotherapy, including selective serotonin reuptake inhibitors, can be used if deemed clinically indicated, and no active contraindication exists. There are even fewer data to support the role of cognitive behavioral therapy, social support group interventions, and electroconvulsive therapy for treatment of depression in patients with chronic kidney disease. Larger randomized, controlled clinical trials aimed at the treatment of depression in patients with end-stage renal disease are desperately needed.

State Recognition of Same-Sex Relationships and Preparations for End of Life Among Lesbian and Gay Boomers

Brian deVries — Tue, 07 Jul 2009 12:35:08 PDT

The authors compared 793 nonheterosexual baby boomers on their relationship status (single or in a civil union) and the state in which they lived (did or did not recognize same-sex civil unions). Analyses revealed patterns attributable to participants’ relationship status, state recognition, and the combination of these variables. Findings showed that state recognition of same-sex unions has an impact not only on nonheterosexual individuals’ current quality of life but also on their future plans and emotional responses to those plans. A lack of legal recognition requires nonheterosexuals to take greater action to ensure that their end-of-life wishes will be carried out, and may lead to their having increased fears about late life.