The 2023 Practitioner Pulse Survey was emailed to a random sample of licensed psychologists in the United States from Aug. 30 to Sept. 29, 2023. The analysis included a total of 561 responses.

According to the survey, more than half of psychologists (52%) say they are seeing an increase in severity of symptoms among their patients, with 41% saying they are seeing an increase in the number of sessions spent treating each patient, which may reduce their capacity to accept new patients. Further, more than half (56%) say they have no openings for new patients. Among psychologists who maintain wait lists, more than two-thirds (69%) say the average wait is up to three months for a first appointment, but 31% report wait times longer than three months. Increased demand for treatment was seen among patients with anxiety disorders (68%) and trauma- and stressor-related disorders (50%).

“This paints a clear picture of psychologists operating at the brink of their capacity,” Arthur C. Evans Jr., PhD, chief executive officer of the American Psychological Association, said in a statement. “To better meet demand, it is essential that we develop comprehensive public health strategies that reach people throughout their lifespan and robustly address behavioral health alongside physical health.”

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Lewis B. Morgenstern, MD, from Michigan Medicine in Ann Arbor, and colleagues conducted a population-based, prospective cohort study involving stroke patients and their surrogate decision-makers, enrolled soon after any stroke if surrogates made decisions about life-sustaining treatments. Surrogates completed validated measures of posttraumatic stress, anxiety and depression at three, six and 12 months. Data were included for 301 family surrogates of 241 severe stroke patients who were followed for a mean of 315 days.

The researchers found that 17 to 28% of surrogates had high scores on measures of psychological distress. Overall, 17 to 43% of surrogates had one or more high levels of the psychological outcomes; 12 to 27% had two or more; and 5 to 16% had all three. In unadjusted analyses, all psychological outcomes were worse among MAs; post-traumatic stress remained worse in MAs in fully adjusted models (0.36), but ethnic differences were attenuated and no longer significant for anxiety and depression. The trajectory for depression differed by ethnicity; over time, depression scores improved more rapidly among non-Hispanic white people than MAs. Ethnic differences were not confounded by advance care plans.

“Additional research and care should be directed at surrogate decision makers that have long-term negative consequences after their loved ones suffer a severe stroke,” the authors write.

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Understanding the effects loneliness can have, Arrow Senior Living first launched its Holiday Cheer initiative in 2020, when COVID-19 forced many senior communities across the country into lockdown. Back then, social media was one of the best ways residents could connect with family and friends, so Arrow initiated a 38-day photo challenge starting on Dec. 1. Today, Holiday Cheer continues to evolve, with daily events scheduled across every Arrow community, beginning Thanksgiving Day and running through Orthodox Christmas on Jan. 7.

This year’s 46 Days of Holiday Cheer enlivens the spirit while encouraging the pursuit of new knowledge. Residents have been invited to observe traditional religious holidays, including Christmas and Hanukkah, attending both tree-lighting ceremonies and the lighting of the menorah. The opportunity to find moments of joy sweeps over each community, bringing both nostalgia for the past and hope for the future.

Arrow has scheduled plenty of fun, creative events to engage in all season long. From cookie-baking and wreath-making to festive door decorating contests and caroling, there’s something for everyone to enjoy. Even the Grumps, Grinches and Bah Humbugs who seem just a little annoyed by all the holiday cheer soon find themselves immersed in community merrymaking too. Those less enthused about the festivities can celebrate Festivus on Dec. 23.

Holiday Cheer easily is a favorite among residents and employees, as the team recognizes that the holiday season is also the perfect time to explore lifelong learning and appreciation for different cultures and traditions. In addition to all the fun events and traditions residents experience during this year’s 46 Days of Holiday Cheer, they also have an opportunity to gather at other cultural and educational events to learn about the land they occupy; to break bread with their neighbors while celebrating Las Posadas; and to discover the seven principles of Kwanzaa. Those shared learning experiences are designed to help Arrow Senior Living continue to cultivate more inclusive communities and reinforce our core values — listening to understand and believing kindness can drive change in the world.

It’s not too late for senior living providers to think about their own holiday initiatives for this year and future years. Start by building on the existing calendar to include holiday traditions from around the world. Celebrations don’t have to be overwhelming or hosted on a large scale; smaller gatherings easily can include opportunities for residents to learn and share their own experiences. Partner with local historians or other experts to host fun, intergenerational celebrations and activities, and if they are open to it, ask residents to contribute by sharing the unique ways they celebrate their cultural traditions.

The absence of human connection can have devastating effects on mental health and well-being, and the Department of Health and Human Services has labeled loneliness as an epidemic. Senior living providers have an opportunity to offer solutions, cultivating communities where residents are not just surrounded by their peers — they are building meaningful relationships with one another, too.

This season, as Arrow celebrates its fourth annual Holiday Cheer initiative, our team is more dedicated than ever to ensuring residents have an amazing experience and something exciting to look forward to through the new year. No one should feel the sting of loneliness or social isolation, especially when surrounded by community. Arrow’s events are focused on bringing people together in an environment that encourages purpose and intentional connection.

So, whether residents are sipping gourmet hot cocoa by the fire, recording their own rendition of “Have Yourself A Merry Little Christmas” at local recording studios, building the most epic gingerbread houses or learning about Icelandic folklore and the mischievous Yule lads, our team expects this year’s 46 Days of Holiday Cheer to have been our most joyous celebration yet.

Amanda Tweten is chief operating officer at Arrow Senior Living.

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The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Older adults don’t need to have spent decades in show-business to benefit from a late-stage softshoe routine. 

One recent music and movement intervention program designed for seniors combines several different technologies, including augmented reality, to help them combat depression and anxiety from their condition, researchers say. 

Music, and music therapy, have been recognized as a way to help enrich life for senior living community residents.

So although the concept is not new, the idea behind the recent program, Music With Movement, is to make it easier for caregivers to learn, and teach, the intervention to the residents they serve, particularly residents in memory care, the researchers said.

The program can be run on a tablet or smartphone and combines several different concepts, including augmented reality and games, the Music With Movement developers explained.

The program not only improved the mental health of older adults who used it; it also strengthened the relationship between them and their caregivers, according to published research.

The program, designed by experts at Honk Kong Polytechnic University, won a Consumer Electronics Show 2024 Innovation Award, it was announced earlier this month.

“Music is a medium of communication when one’s verbal ability is diminished,” said Daphne Cheung, PhD, Music With Movement project leader. “Technology is not for replacing human interaction but facilitating the implementation of meaningful human-to-human interaction through activities.”

One of the more popular tools that involves multisensory sounds and games for memory care residents has been the ToverTafel, which runs via an overhead projector.

Beyond dementia, another recent music therapy program uses software to help stroke victims with their physical rehabilitation, the McKnight’s Tech Daily reported earlier this year.

A lot of new artificial intelligence tools are being deployed in senior care settings, with one main goal being the assumption of administrative tasks to lessen the mental strain on staff members

Now, a new study is looking at whether AI can directly detect levels of anxiety and depression in caregivers.

The AI-evaluated transcripts of psychiatric appointments of more than 800 healthcare workers, roughly half of them nurses, and found a higher risk for anxiety and depression among this cohort, study authors reported.

AI also was able to categorize employees’ concerns into useful groupings, such as whether their fears were related to viruses such as COVID-19, or to working with patients.

Although the psych consultations took place during the pandemic period, senior living remains a high-risk environment for viral breakouts, either for a new COVID strain or the flu. Additionally, caregivers at skilled nursing facilities, the same as in hospitals, may work long hours while tending to many patients.

High levels of mental staff burnout are a major challenge in healthcare, perhaps worst of all in senior living. Within the last year, 96% of senior living communities said they were facing a staffing shortage; at one point, there was an unfilled need for 400,000 senior caregivers overall, McKnight’s reported earlier this year.

The researchers touted the AI’s ability to identify specific mental health concerns via language patterns, and in a manner less intrusive than a formal survey. 

“Unlike traditional assessment methods, such as surveys and interviews, NLP [natural language processing] markers from psychotherapy platforms present a passive and less burdensome way to assess therapy-seekers’ mental health,” the study authors explained.

“It’s akin to the digital biomarkers developed from wearable and smartphone data. Defining and validating markers of anxiety and depression could lead to more accurate and reliable assessments, which would be beneficial for health care providers. ”The study was led by a research team at NYU and was published recently in the Journal of Medical Internet Research AI.

Beyond the familiar adage, “You are what you eat,” this article will explore the profound significance of proper nutrition in senior living and care and the interconnectedness between aging and nutritional needs. But it doesn’t stop there. Confronting the silent but alarming epidemic of malnutrition allows us to identify and necessary implement strategies that detect and combat this insidious threat. Nutrition is a powerful ally in safeguarding cognitive health, preserving independence and functional ability, and nurturing emotional well-being. 

It isn’t often we stop to view senior care through the lens of culinary innovation, but creativity and passion in the kitchen can elevate the standard of long-term care to new heights.

Aging and nutritional needs

As the senior population continues to grow, understanding their changing nutritional needs is critical to providing exceptional care. Aging brings about a myriad of physiological changes that affect how our bodies absorb, use and process nutrients. Such changes can lead to deficiencies in key vitamins and minerals, heightening the vulnerability of our elderly population to various health issues. From a decline in appetite and taste changes to alterations in metabolism, those age-related factors create unique challenges in meeting the nutritional requirements of our elderly residents.

Senior living and care executives must recognize the intricate interplay between aging and nutrition so we can gain the knowledge and insight necessary to tailor individualized dietary plans for residents. One size does not fit all in nutrition; meal options must address specific nutritional deficiencies, support immune function and enhance overall well-being.

Beyond physical health, nutrition also plays a crucial role in maintaining mental acuity and emotional stability as we age. Studies have linked certain nutrients to cognitive health, such as antioxidants that help protect brain cells from oxidative stress and inflammation. Therefore, it is essential to incorporate those brain-boosting nutrients into the diets of our elderly residents, to promote cognitive function and potentially reduce the risk of cognitive decline. And eating well not only promotes a positive outlook but also fosters a sense of dignity, independence and self-worth as well.

Addressing malnutrition: A silent epidemic

Despite its pervasive impact, malnutrition remains an insidious and often overlooked epidemic within the senior living and care industry. Malnutrition affects a significant number of elderly individuals, regardless of care setting, and its consequences can be devastating. From compromised immune systems to increased susceptibility to infections and delayed wound healing, malnutrition poses a severe threat to the health and well-being of our elderly residents.

Early detection and intervention are paramount in confronting this silent enemy head on. Implementing regular and comprehensive nutrition assessments conducted by qualified professionals can help identify older adults at risk of malnutrition, even before visible symptoms manifest. We must adopt a multidisciplinary approach involving not only nutrition experts but also caregivers, nurses and other healthcare professionals as well. Fostering a culture of collaboration and communication allows senior living communities and skilled nursing facilities to customize nutrition plans that align with the unique needs and preferences of each resident. 

It’s also important to engage in open dialogue with residents about their dietary choices. Incorporating their input into the meal-planning process can enhance their sense of autonomy and improve overall compliance with recommended dietary changes. This effort also helps make meals more enjoyable and appealing.

Presentation, variety and flavor are essential factors that influence an older adult’s appetite. Incorporating diverse cuisines and textures into meal plans entices residents to savor their food, fostering a positive dining experience that transcends the mere act of sustenance.

Maintaining cognitive health

Cognitive health is a key concern for older adults and their families, and nutrition plays an integral role in maintaining brain function.

Foods that are rich in antioxidants, omega-3 fatty acids and essential vitamins, such as vitamins E, C and B-complex, can support cognitive function in residents and potentially reduce the risk of neurodegenerative disorders such as Alzheimer’s disease and dementia. 

We should help residents embrace a balanced diet that includes a variety of fruits, vegetables, whole grains, lean proteins and healthy fats, which can provide a holistic approach to nurturing brain health. A Mediterranean-style diet, in particular, has garnered significant attention for its positive effects on cognitive function, as it combines those brain-boosting nutrients with ample plant-based foods and healthy fats such as those found in olive oil and nuts.

The timing and frequency of meals also can influence cognitive health. Establishing regular eating patterns and avoiding long periods of fasting are important for enhanced brain function.

Dehydration also can impair cognitive performance and exacerbate existing cognitive decline, so proper hydration becomes critical as well.

Promoting independence, functional ability

A well-balanced and nutrient-dense diet provides the necessary energy to fuel everyday activities and supports muscle strength and bone health, essential components for maintaining physical functionality.

Protein, for instance, takes center stage in preserving muscle mass and function. Incorporating protein-rich foods such as lean meats, fish, eggs and legumes into our residents’ diets can contribute to maintaining their physical strength and independence. Ensuring an adequate intake of calcium and vitamin D also fosters bone health, reducing the risk of fractures and falls.

It also is essential to consider individual preferences and cultural backgrounds to tailor meal plans that resonate with our residents’ tastes, ensuring that they look forward to each dining experience.

Cultivating emotional well-being

The gut-brain connection, often referred to as the “second brain,” links the digestive system and the central nervous system, affecting mood, emotions and mental health. A diet rich in nutrients can improve emotional well-being and reduce the risk of depression and anxiety.

Mealtime also can be transformed into a social gathering, a time of camaraderie and an opportunity for emotional connection. Additionally, providers can consider incorporating more comfort foods into meal plans, which also can go a long way in alleviating stress and enhancing emotional health.

When possible, consider adding cooking classes or baking sessions to your community’s social activities calendar, as they provide an avenue for self-expression and creativity while also serving as an opportunity for residents to share their culinary expertise with others.

The long-term care sector must champion nutrition as a vital component of the industry’s mission of providing holistic care to the aging population.

Melissa Powell is the executive vice president and chief operating officer of Kennett Square, PA-based Genesis HealthCare, a holding company with subsidiaries that, on a combined basis, comprise one of the nation’s largest long-term care providers, with almost 250 senior living communities and skilled nursing facilities across 22 states. She previously was president and chief operating officer of The Allure Group, a New York City-based long-term care operator. She has 20 years of experience coordinating, assessing and improving senior care using a market-focused model in New Jersey and New York. In 2021, she was honored as a McKnight’s Women of Distinction Hall of Honor inductee.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

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A recall of defective artificial joints has put hundreds of thousands of older adults’ health in flux and could result in costly new surgeries.

Since artificial joint manufacturer Exactech first began “quietly” recalling its artificial knees, hips and ankles beginning in late 2021, more than 1,000 patients have sued the company as the prospect of new surgeries or complications becomes a reality.

Certain plastic components of the limbs wear prematurely, which affects 140,000 individuals, a KFF story notes.

Many who opt for new surgery will end up in assisted living communities or nursing homes for rehabilitation, and current residents of long-term care facilities who are affected could have new, and costly, care management needs. 

Some common complications that people experience post-surgery include pulmonary embolism, deep vein thrombosis, heartbeat irregularities, pneumonia, sepsis and urinary tract infection, the McKnight’s Clinical Daily has reported.

Operators concerned about defective or faulty devices used by residents — or in the case of joint replacements, inside them — always can consult the US Food and Drug Administration’s searchable database of flagged items.

Joint replacement is becoming more common, with approximately 2.4 million surgeries for knee and hip replacements taking place between 2012 and 2020, according to one study. The average age for hip or knee replacement surgeries is 66 and 67 years old, respectively. 

Most implants are meant to last for about a decade before needing to be replaced, the KFF story noted. 

For people with faulty implants, the result is not just increased pain and decreased quality of life but also possible depression and anxiety from the fallout, including weariness over the prospect of another surgery and lengthy rehab process, those affected said in the article.

The recall has been ongoing, with Exactech writing to surgeons last year that a knee component it sold since 2004 could have parts that are “out-of-specification.” The long delay in notifying those affected, or tracking the issues, is a big component of the lawsuits, which currently are moving through the court system. 

Matteo Malgaroli, PhD, from the Grossman School of Medicine at New York University in New York City, and colleagues used natural language processing methods to examine deidentified psychotherapy transcripts from telemedicine treatment during the initial wave of COVID-19 in the United States to identify specific concerns emerging in treatment for HCWs. The case-control study included a sample of 820 HCWs and 820 matched non-HCW controls who received digitally delivered psychotherapy in 49 states during the first COVID-19 wave. Depression and anxiety were assessed using the Patient Health Questionnaire-9 and the General Anxiety Disorder-7 questionnaire.

The researchers identified four treatment topics centered on healthcare and five on mental health for HCWs based on a structural topic model (STM) analysis of transcripts. For controls, three STM topics on pandemic-related disruptions and five on mental health were identified. Significant associations were seen for several STM treatment topics with moderate-to-severe anxiety and depression, including working on the hospital unit, mood disturbances and sleep disturbances (topic prevalence rates, 0.035, 0.014 and 0.016, respectively). For non-HCW controls, there were no significant associations observed between pandemic-related topics and moderate-to-severe anxiety and depression.

“These results suggest that natural language processing may one day become an effective screening tool for detecting and tracking anxiety and depression symptoms,” senior author Naomi Simon, MD, from NYU Langone, said in a statement.

Several authors disclosed ties to the biopharmaceutical industry. One author is an employee of the platform that provided the data.

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As war escalates in Israel, thousands of older adults living in the Holy Land are being gifted virtual headsets to help combat stress and post-traumatic stress disorder. 

Some 10,000 VR headsets are coming courtesy of Boston-based XRHealth. In total, 30 assisted living communities, nursing homes and hospitals in Israel are to receive them, the company announced. 

Through the VR devices, users can access dozens of alternative environments designed to help facilitate meditation or a sense of calm, such as the woods or a sunny coastline. 

“As soon as we heard about the attacks in Israel, we wanted to make sure that as a company we were positioned to help assist the people of Israel through the recovery process,” XRHealth CEO Eran Orr said in a statement. “It is clear to us that the need for mental health interventions combined with the shortage of mental health clinicians in the current situation requires even more [assistance].”

The company plans to deploy 10,000 headsets overseas, Orr said. The XRHealth platform also allows for older adults and caregivers to track their progress and therapy via a mobile app. The virtual headset collects data on users, although the quantitative data captured by XR’s software is mostly based around therapy for mobility or memory care.

XRHealth first received a patent for its technology over the summer. In addition to helping with stress and PTSD, the VR platform also targets older adults living with autism and other conditions, such as chronic pain and fibromyalgia. 

The company’s technology is part of a recent initiative by some companies to use VR as more than just entertainment within long-term care and healthcare.

In addition to developing VR programming for therapy and rehabilitation, some tech companies are designing VR tools to help train caregiving staff and clinicians by virtually simulating situations that they may face in real settings. 

William R.G. McGhee, from Queen’s University in Belfast, and colleagues conducted a systematic review of the literature to examine immersive VR in adult populations with chronic physical illness to examine the impact on psychological well-being. A total of 31 studies met the inclusion criteria.

The researchers found that among adults with cancer, dementia, cardiovascular disease, kidney disease and multiple sclerosis, relaxing and engaging immersive VR interventions were shown to be acceptable and feasible. The evidence about effectiveness was more limited because many of the studies reviewed were feasibility or pilot studies. Immersive VR was suggested to have a positive effect on anticipatory anxiety symptoms and pain, based on evidence mainly from patients with cancer.

“Our findings suggest that VR interventions are acceptable treatments that have the potential to improve physical and psychological consequences of physical illness,” the authors write. “There is good-quality research to suggest that these VR interventions are effective in reducing pain and distress, particularly among people with cancer.”

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