Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Bartsch, D. A., & Rodgers, V. K. Senior Reach outcomes in comparison with the Spokane Gatekeeper program. Care Management Journals, 10(3), 82-88.
Supplementary Materials Colorado Department of Human Services, Division of Mental Health, Data and Evaluation Section. Interrater Reliability Study, CCAR.
Greenberg, S. A. The Geriatric Depression Scale (GDS). Try This: Best Practices in Nursing Care to Older Adults, Issue 4, Revised. New York, NY: Hartford Institute for Geriatric Nursing.
Kurlowicz, L. The Geriatric Depression Scale (GDS). Try This: Best Practices in Nursing Care to Older Adults, Issue 4. New York, NY: Hartford Institute for Geriatric Nursing.
National Guideline Clearinghouse. Guideline summary: Depression in older adults. In: Evidence-based geriatric nursing protocols for best practice.
Senior Reach. Keys to building fidelity manual. Lakewood, CO: Author.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., et al. Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49.
Outcomes
| Outcome 1: Isolation |
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Description of Measures
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Isolation was measured using the Care Manager Survey. Using a 5-point scale ranging from 0 (no impairment) to 4 (major, serious, or complete impairment or impact), research staff rated participants on the following factors that contribute to isolation among older adults: social isolation (e.g., lives alone, has no one to confide in), economic disadvantage (e.g., lacking necessary income from all sources to meet basic needs), emotional disturbance (e.g., anxious, depressed), physical impairment, and cognitive impairment (e.g., confusion; loss of judgment, memory, or concentration).
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Key Findings
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Senior Reach clients served were compared with clients served by the Spokane Gatekeeper program. The Spokane Gatekeeper program, upon which Senior Reach was modeled, educated the community on how to identify older adults who may benefit from care management but did not address the need for mental health treatment or information and referral assistance. Both groups were assessed at baseline (after being referred and agreeing to accept services) and at a second assessment, which was 12 months later for Spokane Gatekeeper participants and at discharge (after an average of 5.5 months) for Senior Reach participants. Findings from this study are as follows:
- Social isolation: From baseline to the second assessment, social isolation decreased among Senior Reach participants (p < .05) and increased among comparison group participants (p < .05). Relative to comparison group participants, Senior Reach participants were more socially isolated at baseline (p < .05) and less socially isolated at the second assessment (p < .05).
- Economic disadvantage: From baseline to the second assessment, economic disadvantage decreased among Senior Reach participants (p < .05) and stayed the same among comparison group participants. Senior Reach participants were more economically disadvantaged than comparison group participants at both baseline (p < .05) and the second assessment (p < .05).
- Emotional disturbance: From baseline to the second assessment, emotional disturbance decreased among Senior Reach participants (p < .05) and stayed the same among comparison group participants. Senior Reach participants were less emotionally disturbed than comparison group participants at both baseline (p < .05) and the second assessment (p < .05).
- Physical impairment: Neither group had a significant change in physical impairment from baseline to the second assessment, although Senior Reach participants were less physically impaired at the second assessment than comparison group participants (p < .05).
- Cognitive impairment: From baseline to the second assessment, cognitive impairment decreased among Senior Reach participants (p < .05) and increased among comparison group participants (p < .05). Senior Reach participants were less cognitively impaired than comparison group participants at both baseline (p < .05) and follow-up (p < .05).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.3
(0.0-4.0 scale)
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| Outcome 2: Depression |
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Description of Measures
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Depression was measured using the Geriatric Depression Scale (Short Form), a 15-item scale designed to screen older adults for depression. Participants respond either "yes" or "no" to each question (e.g., "Are you basically satisfied with your life?" "Do you often get bored?" "Are you afraid that something bad is going to happen to you?"). Scores range from 0 to 15, with higher scores indicating greater depression.
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Key Findings
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Senior Reach participants were assessed at baseline (after being referred and agreeing to accept services) and at discharge, which occurred after an average of 5.5 months. From baseline to discharge, Senior Reach participants had a decrease in depression (p < .05).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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| Outcome 3: Physical, social, and mental health functioning |
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Description of Measures
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Physical, social, and mental health functioning were measured using the Colorado Client Assessment Record Excerpt. Using a 9-point scale ranging from 1 (no concern) to 9 (most severe), research staff rated participants on the following 12 functioning dimensions: physical health, self-care/basic needs, attention issues, anxiety issues, interpersonal relationships, social support relationships, empowerment, hopefulness, activity involvement, overall mental health symptom severity, overall level of functioning, and overall recovery.
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Key Findings
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Senior Reach participants were assessed at baseline (after being referred and agreeing to accept services) and at discharge, which occurred after an average of 5.5 months. From baseline to discharge, Senior Reach participants had improvement in all 12 dimensions of physical, social, and mental health functioning (all p values < .05).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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55+ (Older adult)
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72.6% Female
27.4% Male
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Data not reported/available
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Isolation
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1.5
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2.0
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2.8
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2.5
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2.5
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2.8
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2.3
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2: Depression
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3.3
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3.3
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2.8
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2.5
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2.5
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2.8
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2.8
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3: Physical, social, and mental health functioning
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3.0
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3.0
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2.8
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2.5
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2.5
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2.8
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2.8
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Study Strengths For two of the measures used in the study, internal consistency is acceptable. All measures have face validity, with two of the measures having some evidence of content and construct validity. Efforts to maximize intervention fidelity are well described and included the use of protocols (e.g., implementation manual, self-evaluation tool) sufficient to support fidelity to the model and goal attainment. There was a small amount of missing data for two of the measures, and there was an indication that missing data were random. Although the length of time between data collection for the Senior Reach and Spokane Gatekeeper programs was approximately 10 years, the researchers demonstrated that the population demographics remained constant during that time period. The analyses employed were appropriate, and sample size was adequate, based on power calculations.
Study Weaknesses One measure has not been previously investigated for reliability and validity, and internal consistency for this measure in the present study was low. Attrition and missing data were not sufficiently addressed. Potential confounding variables were not sufficiently addressed; for example, for the isolation outcome, statistically significant findings could be related to differences between the populations served (e.g., demographic characteristics, baseline ratings on four of the five factors contributing to isolation).
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Readiness for Dissemination
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Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Legault, T., Smith, L., & Rodgers, V. Senior Reach materials for marketing and community training [Packet]. Lakewood, CO: Senior Reach.
Rodgers, V. Senior Reach implementation and training manual. Lakewood, CO: Senior Reach.
Rodgers, V. Senior Reach training manual. Lakewood, CO: Senior Reach.
Senior Reach. Keys to building fidelity manual. Lakewood, CO: Author.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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4.0
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3.8
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4.0
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3.9
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Dissemination Strengths The implementation manual is comprehensive, detailed, and clearly written in a step-by-step format to guide developers throughout the process of building community support, developing a local adoption plan, and implementing the program. Training materials include high-quality, colorful, and informative marketing materials in a variety of media and extensive resources for further knowledge and skill development. Training materials are designed for implementers with varied skill levels and roles, and materials are easily accessible in a variety of formats. The fidelity manual includes protocols for fidelity assessment, specific benchmarks for the fidelity measurement process, and examples of data and reports to illustrate how new implementers should use the provided tools. The developer emphasizes the importance of ongoing data collection for quality improvement and outcome monitoring.
Dissemination Weaknesses Additional guidance is needed on issues of culture, race, ethnicity, and language that may be relevant for Senior Reach community partners.
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