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T.L. Brink
Crafton Hills College
Yucaipa CA 92399
TLBrink@
craftonhills.edu
Interviewing Elders:
Achieving rapport,
depth and clarity
with clinical
assessments and
multiple time frames
Interviewing Elders
Elders have more difficulty with
• Written formats
Elders have more difficulty with
• Written formats
• Numbers
Elders have more difficulty with
• Written formats
• Numbers
• Ordinal scaling
Elders have easiest time with
• Yes / No
Elders have easiest time with
• Yes / No
• Open ended
Establish Rapport
Opening Questions
How is your
health?
Opening Questions
How is your
memory?
Validity
is measuring
what you
should measure
False positive:
over-diagnosis
Subjects who score high on
the test, but are actually
low on the variable
False positives
validity is hurt by a
lack of test specificity
Validity
New test
Standard measure
Standard measure
Present
Absent
Agree
Disagree
False positive
Disagree
False negative
Agree
Present
New test
Absent
Venn diagram for false positives
False negatives:
under-diagnosis
Subjects who score low
on the test, but should
have scored high
False negatives
Validity is hurt by a lack
of test sensitivity
Validity
New test
Standard measure
Standard measure
Present
Absent
Agree
Disagree
False positive
Disagree
False negative
Agree
Present
New test
Absent
Venn diagram for false negative
Both false positives and false
negatives can occur
Valid?
How is your
health?
Valid?
How is your health?
Could be measuring
hypochondriasis
Hypochondriasis
Delusions of illness
Hypochondriasis
Delusions of illness
Exaggeration of
suffering & disability
HSIG
Hypochondriasis Scale:
Institutional Geriatric
HSIG: why?
MMPI scale #1
not valid for
elders
HSIG
False positives:
patients with real
physical problems
Or use Staff Ratings
False positives:
patients with real
physical problems
Paranoia
Suspicion
of others
Paranoia
•Suspicion of others
•No self assessment
Paranoia
•Suspicion of others
•No self assessment
•Use staff ratings
Dementia diagnosis
Alzheimer’s?
Other untreatable
dementia?
Treatable
dementia?
Depression?
Valid?
How is your
memory?
Valid?
How is your memory?
Could be measuring
depression.
Screening
Not a
comprehensive
assessent
Symptoms of Dementia
Short term
memory loss
Dementia Assessment
One question:
What day of the
week is today?
Dementia Assessment
One question:
What day of the week is today?
False positives in
institutionalized aged
Dementia Assessment
Ask it again in
five minutes:
What day of the week is today?
Dementia Assessment
Ask it again in five minutes:
What day of the week is today?
Removes most
false positives.
Depression
Most common mental disorder
Depression
Most common mental disorder
Feelings of sadness,
guilt, inferiority
Depression
Most common mental disorder
Feelings of sadness, guilt,
inferiority
Helplessness &
hopelessness
Staff Ratings for depression?
False negatives: staff
will overlook
depression in many
GDS
Geriatric
Depression Scale
GDS: why?
Self-rating
scales hard to
do orally
GDS: notice
Lacks somatic
symptoms
GDS
Need APP for
Spanish
language GDS
Life History Interview
Anchor all events to dates
Life History Interview
Anchor all events to dates
Life History Interview
Anchor all events to dates
Year
Life History Interview
Anchor all events to dates
Year
Age
Life History Interview
Anchor all events to dates
Year
Age
Other Event
Cohort
People born during a
period of history
Before 1945 vs. after
Questions:
Where were
you born?
Questions:
Where were you born?
When were
you born?
Life History: relationships
Parents
Life History: relationships
Parents
Siblings
Life History: relationships
Parents
Siblings
Spouse(s)
Life History: relationships
Parents
Siblings
Spouse(s)
Children
Life History: relationships
Parents
Siblings
Spouse(s)
Children
Grandchildren
other relative
Life History: relationships
Parents
Siblings
Spouse(s)
Children
Grandchildren
other relative
Friends
Life History: relationships
Parents
Siblings
Spouse(s)
Children
Grandchildren
other relative
Friends
Pets
Life History: activities
Education
Life History: activities
Education
Military
Life History: activities
Education
Military
Career
Life History: activities
Education
Military
Career
Recreation
Life History: activities
Education
Military
Career
Recreation
Religion
Religion is defined as a system of
•
•
•
•
•
Doctrines to be accepted
Ethics to be followed
Rituals to be performed
Myths to be retold
Symbols to be revered
Religion is
a series of choices
people make and
remake
throughout life.
Question:
In which religion
were you raised?
Christian?
Would that be
Catholic?
Evangelical?
Pentecostal?
They will tell you if
• Mormon (LDS)
• Jehovah Witness
• SDA
Question:
Was there a time
when you left that
church and joined a
different one?
Religion is defined as a system of
• Doctrines to be accepted
Religion is defined as a system of
• Doctrines to be accepted
What do you think
will happen after
you die?
Religion is defined as a system of
• Doctrines to be accepted
• Ethics to be followed
Religion is defined as a system of
• Ethics to be followed
Does your religion serve
as your guide to what is
right and wrong?
Religion is defined as a system of
• Ethics to be followed
Does your religion serve as your
guide to what is right and wrong?
Have you changed your
views on some things at
some point in your life?
Religion is defined as a system of
• Doctrines to be accepted
• Ethics to be followed
• Rituals to be performed
Religion is defined as a system of
• Rituals to be performed
Were baptisms,
weddings, and funerals
important for you?
Religion is defined as a system of
• Rituals to be performed
What about
Bible study?
Or prayer?
Religion is defined as a system of
•
•
•
•
Doctrines to be accepted
Ethics to be followed
Rituals to be performed
Myths to be retold
Religion is defined as a system of
• Myths to be retold
Did you like to tell
your children stories
from the Bible?
Religion is defined as a system of
•
•
•
•
•
Doctrines to be accepted
Ethics to be followed
Rituals to be performed
Myths to be retold
Symbols to be revered
Religion is defined as a system of
• Symbols to be revered
Do you have any sacred
objects in your home?
Religion is
how we choose
to be spiritual
Religious traditions
Religiosity is
how spiritual
we are
Norenzayan & Hansen (2006)
one item measures
of religiosity are
commonly
employed
Religiosity
(Gallup, 2013)
How important
would you say
religion is in your
own life?
Religiosity norms
(Gallup, 2013)
Very 56%
Fairly
22%
Not very 22%
Religiosity
(Mitofsky, 2014)
¿Siente religioso?
0 hasta 10
Religiosity
(Mitofsky, 2014)
¿Siente religioso?
Promedio cerca 8
Religiosity
About how
religious one is.
Religiosity
Religiosity: countries
Religiosity: states
Life History: challenges
Illnesses
Life History: challenges
Illnesses
Accidents
Life History: challenges
Illnesses
Accidents
Disasters
Life History: challenges
Illnesses
Accidents
Disasters
Historical
Events
Economic
Life History: challenges
Illnesses
Accidents
Disasters
Historical
Events
Economic
Divorce
Life History: geographical
Go through the life
again identifying
locations
Life History: topics to avoid
Sexual history
Life History: topics to avoid
Sexual history
Cohabitation
Life History: topics to avoid
Sexual history
Cohabitation
Drug use
Life History: topics to avoid
Sexual history
Cohabitation
Drug use
Criminal record
Life History: topics to avoid
Sexual history
Criminal record
Cohabitation
Drug use
Psychiatric
treatment
T.L. Brink
Crafton Hills College
Yucaipa CA 92399
TLBrink@
craftonhills.edu
Interviewing Elders:
Achieving rapport,
depth and clarity
with clinical
assessments and
multiple time frames
Interviewing Elders
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