Brenna Nikole Renn

INTRODUCTION: There is a growing proportion of Alzheimer's disease (AD) research participants identifying as two or more races; however, analyses primarily rely on monoracial categories, resulting in exclusion or recategorization of Multiracial participants. METHODS: We conducted semi‐structured qualitative interviews with 21 Multiracial adults to explore preferences and perceptions of racial categorization and reclassification in AD research. Recruitment prioritized diverse Multiracial identities, and interviews were evaluated using thematic analysis. RESULTS: Participants expressed varied preferences for racial categorization, with many assuming a monoracial standard. Preferences corresponded to both racial identity and assumed racial identification, and depended on available options. Participants responded to reclassification with calls for increased transparency about study methods and intended data usage, and concerns for racial misrepresentation. DISCUSSION: Findings underscore the utility of multiple questions and response options for racial categorization, researcher respect of participant experiences and the evolving nature of classification systems, and clear communication about analytic decisions.

Evidence suggests that Alzheimer's disease (AD) presents differently across ethnoracial groups, producing disparate risk and resilience profiles that may be measured through neuropsychological data. Extant AD research primarily examines monoracial groups, despite the fact that Multiracial individuals make up more than 10% of the US population. Failure to incorporate data from Multiracial participants (those endorsing two or more racial identities) limits research and clinical efforts to address AD in minoritized communities. A scoping review examined the use of neuropsychological data from Multiracial participants within AD research. Three databases were searched (APA PsycInfo, Embase, and Web of Science) for studies containing ethnoracially minoritized groups. Two independent researchers reviewed articles and included studies that met the following criteria: published in 2000 (the year the US Census formally allowed self‐identification of multiple races) or later, in English, US‐based cohort (as race is a social construct), reported neuropsychological data, and the research was AD‐related. Searches yielded 855 original articles. Following abstract review, 484 articles were screened in full, resulting in 19 articles that met the inclusion criteria. Most excluded articles (66.67%) contained vague racial descriptions (e.g., use of an undefined Other Race group), making it difficult to know whether Multiracial participants existed in the dataset. Roughly one‐third (29.03%) of articles were excluded because they described only monoracial groups. Analysis of neuropsychological outcomes showed that most articles included Multiracial participant data in larger group‐level analyses (e.g., normal cognition versus dementia) or grouped their data with other, less represented ethnic or racial groups (e.g., Other Races). This review demonstrates the paucity of research and need for intentional consideration of the inclusion of Multiracial participants in AD research. Recommendations to improve reporting of data from Multiracial participants are offered, including considerations for the anticipation and adaptation to changes in the social definitions of ethnicity and race.

Anxiety and depression are highly comorbid in older adults, especially considering subthreshold symptom presentations. Psychotherapies treating both conditions in this population are not well established. This scoping review aimed to quantify how frequently psychotherapy trials for anxiety/depression in older adults utilize measures of the other disorder and describe methodology pertaining to comorbidity. Articles were screened by two reviewers at all stages. Articles published between January 2010 and November 2024 were searched; eligible articles used randomized control (RCT) designs, primarily enrolled older adults, evaluated a psychotherapy for anxiety and/or depression, and included anxiety and/or depression as primary outcomes. In total, 1,066 studies were screened at the title/abstract stage, 264 at the full text stage, and 91 were included. While most RCTs for anxiety included depression outcomes, only a minority of depression trials assessed anxiety. No trials accounted for comorbidity or presence of the other disorder in their primary statistical analyses. Though highly comorbid in practice, most RCTs for anxiety/depression in older adults do not measure the other disorder. Current RCTs of anxiety/depression in later life overlook the reality of comorbidity and complex symptom presentations. Future trials should attend to comorbidity and consider transdiagnostic treatments.

Engage is an empirically-supported brief behavioral intervention for later-life depression yet to translate from randomized controlled trials to implementation. This study evaluated a real-world implementation demonstration of Engage across a geriatric mental health care setting. The exploration, preparation, implementation, sustainment framework guided this demonstration. Interprofessional case managers received training and ongoing consultation in Engage and applied it with older adults with depression over four months. Upon completion of the implementation trial, providers participated in a 1-h focus group to provide feedback about training, treatment perceptions, and facilitators and barriers to implementation. Focus group transcripts were double-coded using thematic analysis to extract themes informed by the Consolidated Framework for Implementation Research (CFIR). Thirteen themes emerged from focus groups (N = 21 provider participant respondents) related to CFIR constructs of innovation adaptability, innovation design, critical incidents, compatibility, access to knowledge and information, need, and capability. Findings suggest that Engage is feasible and fits the needs of providers, patients, and the healthcare system. Implementation barriers included depressive symptom burden, patient complexity, and therapist concerns related to self-efficacy and previous experiences. Provider feedback can inform and strengthen implementation of evidence-based psychotherapies such as Engage.

Background: Methadone is an effective and widely used medication for opioid use disorder (MOUD). Within in the United States (US), older adults represent an increasing proportion of those receiving MOUD, yet little is known about characteristics of older individuals in these programs.Objectives: To evaluate mental and physical health characteristics of younger and older adults receiving MOUD and test whether age moderates the relation between physical and mental health variables.Methods: Data for this secondary analysis are drawn from a cross-sectional survey of a convenience sample of individuals seeking methadone dosing as part of MOUD at four opioid treatment programs in two regions of the US. Descriptive statistics and correlational and moderation analyses examined outcomes of pain severity, pain interference, self-rated health, physical activity, depression, and anxiety across younger (18-49) and older (50+ years) participants.Results: Analyses included 469 participants (mean [range] age, 41.01 [20–70] years). Older participants reported higher pain severity and interference, less physical activity, and worse self-rated health than those in the younger age group (ps < 0.05). Associations between mental and physical health variables were generally weak-to-moderate in the older age group (r = 0.26 to r = 0.44, p < 0.01), and weak in the younger age group, although age did not moderate associations.Conclusion: Clinically significant mental and physical health variables are associated among individuals receiving methadone for MOUD, with older adults facing unique challenges.Clinical implications: Opioid use treatment should include not only pain management but also assessment and treatment of depression and anxiety and optimization of other health behaviors (e.g., physical activity) across age groups. Pain management and health promotion are particularly relevant targets for aging individuals receiving MOUD.