Alice Verstaen is a Clinical Psychologist in Mental Health Services; Emily Trittschuh is a Neuropsychologist at the Geriatric Research, Education, and Clinical Center; Holly Rau is a Research Health Scientist Specialist in Research and Development; all at VA Puget Sound Health Care System Seattle Division. Emily Trittschuh is an Associate Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine in Seattle. Correspondence: Alice Verstaen (alice.verstaen@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies..
This study had a limited sample size and no control group. However, evidence of significant improvements in depressive symptoms, self-efficacy, and life satisfaction in the development groups without a control group is encouraging. This is particularly noteworthy given that older veterans as a group have higher rates of frailty and mortality than do other similarly aged counterparts.17An additional weakness is the absence of a brief cognitive assessment or other formal assessment as part of the inclusion/exclusion criteria. However, this program development project provides data from a realistic condition (recruited broadly and with few exclusions, offered in similar format as other VA classes), thus adding strength to the interpretation and possibly the generalizability of these findings.
Conclusions
Future directions include disseminating HAP-B materials and procedures across a variety of sites, both VA and non-VA. In line with this goal, we hope to increase sample size and sample diversity while optimizing protocol integrity during the exportation phase. With a greater sample size and power, we aim to examine the role of self-efficacy and other premorbid factors (eg, cognitive functioning at baseline) as mediators for observed changes in pre-/postmeasures and outcomes. We also hope to incorporate objective measures of behavior change, such as fitness trackers, heart rate/pulse monitors, and actigraphy for monitoring sleep. Finally, we are interested in conducting follow-up with past and future participants to detect changes that may occur with learning new skills following the completion of the group (eg, changes in sleep behavior that take time to take effect) and the extent to which participants continue to use the health behavior skills and strategies to maintain or enhance progress in behavioral goals. Finally, although this intervention was initially designed for use with older veterans receiving health care through the VA, we believe the concepts and work products described here can be used with older adults across a wide range of health care settings. Providers interested in trialing HAP-B at their local site are encouraged to contact the authors.
