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Objectives The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms. Methods 4,219 participants (65 or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models’ outcome was elevated anxiety (≥12 on 5-item Beck Anxiety Inventory) or depressive symptoms (≥ on 8-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of 7 self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses. Results Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95% CI: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of 7 medical conditions, with the exception being stroke, were present in the majority of triads. Conclusion Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. Since anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity.

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Background: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. Design: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. Setting: Veteran’s Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. Intervention: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. Measurements: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. Results: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. Conclusion: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.

In the present systematic review, we summarize the feasibility, usability, efficacy, and effectiveness of mental health-related apps created by the Veterans Affairs (VA) or the Department of Defense (DoD). Twenty-two articles were identified, reporting on 8 of the 20 VA/DoD mental health self-management and treatment companion apps. Review inclusion criteria were studies that reported original data on the usability, acceptability, feasibility, efficacy, and effectiveness, or attitudes toward the app. We collected data from each article regarding type of study, sample size, participant population, follow-up period, measures/assessments, and summary of findings. The apps have been tested with patients seeking treatment, patients with elevated mental health symptoms, and clinicians. The strongest area of support for the apps is regarding evidence of their feasibility and acceptability. Research support for efficacy and effectiveness of the apps is scarce with exceptions for two apps (PTSD Coach, Virtual Hope Box). Until more evidence accumulates, clinicians should use their judgment and be careful not to overstate the potential benefits of the apps.

Contemporary theories of false memory suggest there are two processes that combine to produce false memory: one that increases false memory (error-inflating processes) and one that counteracts false memory (error-editing processes). Two experiments using the DRM paradigm (Deese, 1959; Roediger & McDermott, 1995) explored the influence of manipulating the number of associates studied, study item presentation frequency, backward associative strength, and study time on error-inflating and error-editing processes separately by examining speeded and unspeeded recognition decisions. The results of these studies indicate that (1) increasing the number of associates studied primarily influenced error-inflating processes; (2) increasing backward associative strength increased error-inflating processes and impaired error-editing processes; (3) increasing study item presentation frequency increased both error-inflating and error-editing processes; and (4) increasing study time had a weak effect on error-editing processes. Further, the results of these studies suggest that comprehensive theories of false memory phenomena must propose the existence of two different factors: one that increases false memory and is available early in memory retrieval, and one that usually, but not always, decreases false memory and is available later in retrieval.

Background Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits. Methods We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants’ preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes. Results Survey respondents’ (N=249) average age was 84.6 (SD 6.6) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor’s degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor’s degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives.