Established in 1987, the Braceland Center for Mental Health and Aging at The Institute of Living/Hartford Hospital, conducts research and education to improve the health and well-being of older persons.
There are a number of diverse research, evaluation, and education projects underway at the Braceland Center. Major areas of research address mental health issues and access, long term care and Alzheimer's disease, and health care quality and evaluation.
Mission and Activities:
- Alzheimer's Disease Neuroimaging Initiative, a public-private research partnership organized by the National Institute of Health. This 60 million dollar, five-year study is developing improved methods of tracking biomarkers and early changes associated with Alzheimer's disease and memory decline and has created a tremendous, publicly accessible database that is available to qualified researchers worldwide.
- Conduct research and education aimed at improving health care of older persons
- Provide comprehensive assessment and treatment planning for persons with cognitive impairments and dementia
- Provide consultation to physicians and agencies caring for patients and families with dementia
- Improve access of persons with memory decline and their families to research trial participation
- Collaborate with federal and state governments, local service and educational organizations to carry out research and evaluation projects
- Work in close partnership with The Institute of Living's clinical geriatric services
- Provide training to undergraduate and graduate physicians, nurses, social workers and other therapists
- Maintain affiliation with the Center on Aging at the University of Connecticut School of Medicine
Staff holds faculty appointments within:
- UConn Department of Psychiatry
- UConn Department of Medicine, Division of Geriatrics
- UConn School of Social Work
Research partnerships include:
- The larger Hartford Hospital community
- Yale School of Epidemiology and Public Health
- The Connecticut Coalition to Improve End of Life Care
- The Institute for Community Research
- The North Central Area Agency on Aging
- The Connecticut Association of Not-for-Profit Facilities for the Aged
- The Connecticut Association of Health Care Facilities
- Karen Blank, M.D.
- Jacqueline Camarro, M.S, OTR/L
- Denise Fogel, Psy.D.
- Meghan Lawrence, ACSW
- Charles Wilber, M.Ed.
Major areas of research address Alzheimer's Disease and related dementias, mild cognitive impairment, older drivers, neuroimaging, end-of-life decision-making, ethics in geriatric care, minority mental illness and dementia, and depression. Projects are funded through a variety of federal and state sources (NIH's National Institute of Aging, Administration on Aging, CMS, Connecticut Office of Policy and Management, Connecticut Department of Social Services) and private foundations (Robert Wood Johnson Foundation, Alzheimer's Association, Donaghue Medical Research Foundation).
Video Intervention Project: Depression and Anxiety in Older Latino Adults
Principal Investigator: S. Gaztambide, Collaborators: J. Robison & K. Blank
This project involves developing two 30-minute Spanish language videotapes about depression and anxiety aimed at Latino elders and their families. The purpose of these videotapes is to increase awareness and knowledge of depression and anxiety as mental health problems that affect not just individual Latino elders but also their families, to teach skills to help target group members to cope with these illnesses, and to increase motivation to seek and adhere to medical care. The videos will be aired in the Connecticut access program throughout the state (Hartford County census is over 30,000 Hispanic adults).
Dying Experience Among Racially Diverse Hospitalized Older Adult Patients
IOL Research Funds
This study involves a retrospective analysis of medical records data for patients age 65+ who died in Hartford Hospital in a two-year period. The goal of the research is to determine whether racial differences exist in the use of advance directives and life-sustaining medical treatments for older adults.
Computer-Based Driving Assessment in Early Alzheimer’s Disease
G. Pearlson (Olin Neuropsychiatry Research Center) & K. Blank
Hartford Hospital Research Funds
This project uses a computer-based driving simulation program which presents elderly drivers with simulated driving situations known to lead to crashes for individuals with Alzheimer’s disease. The driving simulator will be validated using 20 patients with moderate Alzheimer’s’ disease and 20 matched healthy community controls. The simulator will then be used to evaluate the driving of 40 people with early, mild Alzheimer’s disease. Driving and cognitive skills will also be assessed using neuropsychiatric instruments, spatial-visual tests, and driving history. A 12 month follow-up of the forty subjects with mild Alzheimer’s disease will determine the predictive value of the various assessments in identifying motor vehicle accidents in the intervening time period.
Burden and Morbidity in Families of People with Psychotic Spectrum Disorders
J. Robison & L. Haber (Ambulatory and Young Adult Services)
Hartford Hospital Research Funds
Through interviews with family members of patients with psychotic spectrum disorders, this study examines the effects on family member burden and morbidity of patient characteristics, illness history and symptomology, as well as the effects of the family’s own characteristics and experiences.
Quantification of Factors that Prolong Length of Stay in the IOL Geriatric Unit
Hartford Hospital Research Funds
Length of stay (LOS) for inpatients is one of the outcome measures tracked through the quality improvement process and is reflected in the quality compass under the financial indicators. Although the LOS for inpatients on the geriatric psychiatry unit at the IOL has dropped steadily and significantly in recent years, there continues to be a cohort of patients whose LOS is notably longer than the rest. This study synthesizes and analyzes retrospective chart data to determine any contributing factors. This analysis will be used to develop treatment protocols and revise patient care processes, with the ultimate goal of improving patient care and shortening length of stay.
The Institute of Living’s Program for the Residents of Elderly Housing Facilities
E. Hickey (Institute of Living Geriatric Programs), K. Bullock (Evaluator) & J. Robison (Evaluator)
Hartford Foundation for Public Giving
This grant provides mental health services to residents of Hartford senior housing buildings, in partnership with the research grant, "Improving Access to Mental Health Services for Older Hartford Residents." Building staff receive training and education in identifying and assisting residents in need of psychiatric treatment. The Braceland Center is conducting the evaluation of this three year service grant.
Improving Access to Mental Health Services for Older Hartford Residents
J. Schensul (Institute for Community Research), J. Robison, & Carmen Reyes (North Central Area Agency on Aging)
Patrick and Catherine Weldon Donaghue Medical Research Foundation
This study conducted depression and anxiety screenings in 13 senior housing buildings in Hartford, referred those who screened positive for treatment, and conducted follow-up interviews with referred participants. Older adults and service providers engaged in qualitative interviews to identify definitions of depression, help seeking behaviors, and barriers to treatment.
Service Use in Depressed Middle-Aged and Older Puerto Rican Patients: Does a Family-Focused Intervention Make a Difference?
J. Robison & K. Blank
Hartford Hospital Research Funds
The study assessed middle-aged and older Puerto Rican primary care patients’ use of Hartford Hospital based medical services and compared the medical service use of patients with no or few depressive symptoms to those who screen positive for depression. It also tested the effectiveness of an intervention for depressed patients, focused on educating close family members about depression and treatment.
Depression and Related Psychiatric Symptoms in Puerto Rican Middle-Aged and Older Adults: Culturally Sensitive Screening and Obstacles to Treatment
J. Robison, K. Blank, C. Gruman, & L. Curry
Hartford Hospital Research Funds
The project involved: a) comprehensive psychiatric evaluations to investigate rates of depression and other psychiatric symptoms in 300 Puerto Rican middle aged and elderly individuals in primary care settings, b) determining the utility of brief depression screening instruments for Puerto Rican individuals age 50 and older and making specific recommendations as to appropriate screens that could be readily incorporated for use in primary care settings, and c) examination of social and cultural factors which impede access to care.
Screening for Depression in the Elderly: How Many Questions are Needed?
K. Blank, C. Gruman, L. Curry, & Gerard Kerins (University of Connecticut Health Center)
Hartford Hospital Research Funds
This study used three different geriatric populations to determine the optimal depression screening instruments for elderly patients. The three study populations examined were: 1) ambulatory medical outpatients, 2) hospitalized medical patients from Hartford Hospital, and 3) nursing home residents.
Effects of Depression on Elderly Patients’ Attitudes About Life Sustaining Treatments and Assisted Suicide
K. Blank & J. Duffy (Psychiatric Consultation Liaison Services, Hartford Hospital)
Hartford Hospital Research Funds
This study examined the influence of depression on patients’ preferences regarding resuscitation status, other life-sustaining medical decisions, and attitudes about assisted suicide. It also explored whether the stability of those preferences over time is affected by the presence of depression.
Behavioral Symptoms Associated With Alzheimer’s Disease And Related Dementias: Characteristics And Predictors Of Effective Management
L. Curry & J. Robison
Donaghue Medical Research Foundation
Patients were followed after discharge from an inpatient geriatric psychiatry unit to track status of behavioral symptoms, physical or cognitive changes, community or nursing home caregiver characteristics, and implementation and maintenance of the treatment plan. The data allowed investigators to understand factors that influence effective management of behavioral symptoms in patients with Alzheimer’s disease over time. From this study, a Discharge Planning Form was developed which is currently used with any IOL geriatric patients with a diagnosis of dementia.
Publications (last updated 7/24/07):
- Allen PD, Kellett, K, Gruman, C. Elder abuse and neglect in Connecticut’s nursing homes. Journal of Elder Abuse and Neglect, 15(1), 19-4, 2003.
- Allen PD, Klein WC, Gruman C. Correlates of complaints made to the Connecticut long-term care ombudsman program: The role of organizational and structural factors. Research on Aging, 26(6):631-654, 2003.
- Blank K, Hixon L, Gruman C, Robison J, Hickey G, Schwartz HI. Determinants of geropsychiatric inpatient length of stay. Psychiatric Quarterly 76:195-212, 2005.
- Blank K. Late-life depression: Lessons and hope. Lessons learned from geriatric psychiatry. CD-ROM. American Association of Geriatric Psychiatry, Omni Press, 2004.
- Blank K (Ed.). Late-life depression: Lessons and hope. Lessons learned from geriatric psychiatry. American Association of Geriatric Psychiatry, Washington, DC, 2004.
- Blank K. Legal and ethical issues. In Grossberg G, Sadavoy J, Jarvik LF, Meyers BS (eds.). Comprehensive Review of Geriatric Psychiatry, 3rd Edition. WW Norton & Company, New York, 1183-1206, 2004.
- Blank K. (Section editor) Medical-legal, ethical, and financial issues. In Grossberg G, Sadavoy J, Jarvik LF, Meyers BS (eds.). Comprehensive Review of Geriatric Psychiatry, Third Edition. WW Norton & Company, New York, 1182-1279, 2004.
- Blank K. Medical-legal, ethical and financial issues. In Cheong J, Blank K, Kirwin PD, Lantz MDS, Lyness JM, Steffens DC, VanGerpen M. (eds). Geriatric Psychiatry Self-Assessment Program, 2nd edition. American Association for Geriatric Psychiatry, Bethesda MD, 251-258, 2004.
- Blank K, Gruman C, Robison, JT. Case-finding for depression in the elderly: Balancing ease of administration with validity in varied treatment settings. Journal of Gerontology: Medical Sciences, 59(4): M378-M384, 2004.
- Blank K, Kennedy G, Lantz M. (Eds.). Progress and hope. Lessons learned from geriatric psychiatry. Monograph and CD-ROM. American Association of Geriatric Psychiatry, Washington, DC, 2004.
- Blank K. Virtual testing device determines skills of graying drivers. The New York Times, 12, October 22, 2003.
- Blank K, Gruman C, Robison J. Are the ultra-brief one or two question screening instruments suitable for late-life depression? The Gerontologist, 43, 301, 2003.
- Blank K. Respectful decisions at the end of life. American Journal of Geriatric Psychiatry, 10(4), 362-364, 2002.
- Blank K, Cohen CI, Cohen GD, Gaitz C, Gottlieb GL, Katz IR, Leuchter A, Maletta G, Margolin R, Sakauye, K, Shamoian C. Failure to adequately detect suicidal intent in elderly patients in the primary care setting. Clinical Geriatrics, 9(1), 26-36, 2001.
- Blank K, Robison J, Doherty E, Prigerson H, Duffy J, Schwartz HI. Life-sustaining treatment and assisted death choices in depressed older patients. Journal of the American Geriatrics Society, 49(2), 153-161, 2001.
- Blank K, Robison J, Prigerson H, Schwartz HI. Instability of attitudes about euthanasia and physician assisted suicide in depressed older hospitalized patients. General Hospital Psychiatry, 23, 326-332, 2001.
- Bradley EH, Curry LA, McGraw SA, Webster TR, Kasl SV, Andersen R. Intended use of informal care for long-term care needs: The role of race/ethnicity. Ethnicity and Health, 9:37-54, 2004.
- Bradley EH, Curry L, Williams CS, van Doorn C, Fried TR, Fortinsky R, Kasl SV. Social support and social networks in the last year of life. Journal of Mental Health and Aging, 8(1), 7-18, 2002.
- Bradley EH, McGraw SA, Curry L, Buckser A, King KL, Kasl SV, Andersen R. Expanding the Andersen Model: The role of psychosocial factors in long-term care use. Health Services Research, 37(5), 1221-1242, 2002.
- Bullock K. Get thee behind me: African American grandparents raising grandchildren exposed to domestic violence. In RL Hampton, T Gullotta (Eds), Interpersonal Violence in the African American Community: Evidence-Based Prevention and Treatment Practices. New York, Springer, pp.149-163, 2006.
- Bullock K. Promoting advance care directives among African Americans: A faith-based model. Journal of Palliative Medicine 9:183-195, 2006.
Bullock K. McGraw SA. A community capacity-enhancement approach to breast and cervical cancer screening among older women of color. Health & Social Work. 31:16-25, 2006.
- Bullock K. Ahora le voy a cuidar mis nietos: Rural Latino grandparents raising grandchildren of substance abusing parents. Reprint in M. Delgado (ED.), Latinos and alcohol use/abuse revisited: Advances and challenges for prevention and treatment programs. New York, Haworth Press, pp. 107-130, 2005.
- Bullock, K. Ahora le voy a cuidar mis nietos: Rural Latino grandparents raising grandchildren of substance abusing parents. Alcoholism Quarterly, 23: 107-130, 2005.
- Bullock, K. Prevention from the Inside Out. Journal of Primary Prevention, 26(1), 63-65, 2005.
- Bullock K, McGraw SA, Blank K, Bradley EH. What matters to older African-Americans facing end-of-life decisions? A focus group study. Journal for Social Work in End-of-life and Palliative Care, 1(3), 3-19, 2005.
- Bullock K. The changing role of grandparents in rural families: The results of an exploratory study in southeastern North Carolina. Families in society. The Journal of Contemporary Social Services, 85:45-54, 2004.
- Bullock K. Family Social Support. In P. J. Bomar (3rd Ed.). Promoting health in families: Applying family research and theory to nursing practice. WB Saunders Publisher, 142-161, 2004.
- Bullock K. Healthy family systems: The changing role of grandparents in rural areas. The Gerontologist, 43:48, 2003.
- Bullock K, Crawford SL, Tennstedt SL. Employment and caregiving: An exploration of African American caregivers. Social Work, 48 (2), 150-162, 2003.
- Carter AL, Wilber C, Sahl R. Motivational interviewing techniques and the harm-reduction model in a short-term substance-abuse group for adolescents with psychiatric problems. Connecticut Medicine, 69: 535-541, 2005.
- Cheong JA, Blank K, Kirwin PD, Lantz MS, Lyness JM, Steffens DC, Van Gerpen M (Eds.). Geriatric Psychiatry Self-Assessment Program, Question Book and Critique Book, Second Edition. American Association for Geriatric Psychiatry, Bethesda, MD, 2004.
- Cohen GD, Blank K, Cohen CI, Gaitz C, Liptzin B, Maletta G, Meyers B, Sakauye K. Mental health problems in assisted living residents. The physician’s role in treatment and staff education. Geriatrics, 58(2), 44, 54-55, 2003.
- Covington TM, Morphy M, Conwell Y, Schohn M, Ossip-Klein D, Sprafkin R P, Lantinga LJ. Documentation of suicidal behavior: Is it accurate? Federal Practitioner,18(1), 10-18, 2001.
- Curry L, Bradley E, Robison J. Individual decisions regarding financing nursing home care: Psychosocial considerations. Journal of Aging Studies, 18:337-352, 2004.
- Curry, L, Jackson J. Recruitment and retention of diverse ethnic and racial groups in health research: An evolving science. In Curry L, Jackson J (Eds.), The Science of Inclusion: Recruiting and Retaining Racial and Ethnic Elders in Health Research. Washington, DC: The Gerontological Society of America,1-7, 2003.
- Curry L, Jackson, J. The science of including older ethnic and racial group participants in health-related research. The Gerontologist, 43(1), 15-17, 2003.
- Curry L, Jackson J. (Eds.). The Science of Inclusion: Recruiting and Retaining Racial and Ethnic Elders in Health Research. Washington, DC: The Gerontological Society of America, 2003.
- Curry L. Ethical and legal considerations in health services research. In M. B. Kapp (Ed.), Ethics, Law, and Aging Review. New York, NY: Springer Publishing Company, 57-75, 2002.
- Curry L, Robison J. Consumer and family caregiver views on assisted living. Southwest Journal on Aging, 18(1), 43-50, 2002.
- Curry L, Schwartz HI, Gruman C, Blank K. Could adequate palliative care obviate assisted suicide? Death Studies, 26(9), 757-774, 2002.
- Curry L, Gruman C, Robison J. Medicaid estate planning: Perceptions of morality and necessity. The Gerontologist, 41(1), 34-42, 2001.
- Diefenbach GJ, Robison JT, Tolin DF, Blank K. Late-life anxiety disorders among Puerto Rican primary care patients: Impact on well-being, functioning, and service utilization. Journal of Anxiety Disorders, 18:841-858, 2004.
- Disch W, Schensul J, Reyes C, Brockman K, Robison J. Integrating social network measures in a mixed-methodological study of urban adults and depression. The Gerontologist, 43:283, 2003.
- Gaztambide S, Baez E, Desmarais K, Schensul J. Cultural definitions of depression. The Gerontologist, 43:283, 2003.
- Gould BE, Grey MR, Huntington, CG, Gruman C, Rosen JH, Storey E, Abrahamson L, Conaty AM, Curry L, Ferreira M, Harrington KL, Paturzo D, Van Hoof TJ. Improving patient care outcomes by teaching quality improvement to medical students in community-based practices. Academic Medicine, 77(10), 1011-1018, 2002.
- Gruman C, Kellett K, Allen P. Elder abuse and neglect in Connecticut’s nursing homes. The Gerontologist, 43:411, 2003.
- Kellett K. (Book Review) Mental wellness in aging: Strengths-based approaches. Educational Gerontology 30(6):557-558, 2004.
- Kellett K. (Book Review) Personal control in social and life course contexts. Educational Gerontology, 30(3):257-258, 2004.
- Kellett K. (Book Review) Vital connections in long-term care: Spiritual resources for staff and residents. Educational Gerontology, 30(1):73-74, 2004.
- Kellet K, Gruman C, Robison J, Nuss L, Kerins G. Research issues related to individuals with intellectual disabilities. Connecticut Medicine, 68:525-529, 2004.
- Kellett K, Gruman C, Porter M, Porter A. Connecticut’s personal assistance services program: An evaluation of workforce barriers. The Gerontologist, 43:427, 2003.
- Kenny AM, Rowland H, Gruman C. Understanding the components of publication success: A survey of academic award recipients. Connecticut Medicine, 67(4), 205-214, 2004.
- Kenny AM, Bellantonio S, Gruman, CA, Acosta RD, Prestwood KM. Effects of transdermal testosterone on cognitive function and health perception in older men with low bioavailable testosterone levels. Journal of Gerontology: Medical Sciences, 57A(5), M321-M325, 2002.
- Kenny AM, Prestwood KM, Gruman CA, Marcello KM, Raisz LG. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels. Journal of Gerontology: Medical Sciences, 56A(5), M266-M272, 2001.
- King MB, Whipple RH, Gruman CA, Judge JO, Schmidt JA, Wolfson LI. The performance enhancement project: Improving physical performance in older persons. Archives of Physical Medicine and Rehabilitation, 83, 1060-1069, 2002.
- Lyketsos CG, Colenda CC, Beck C, Blank K, Doraiswamy MP, Kalunian DA, Yaffe K. Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer Disease. American J Geriatr Psychiatry, 14:7, 561-572, 2006.
- Pillemer K, Suitor JJ, Henderson CR, Meador R, Schultz L, Robison J, Hegeman C. A cooperative communication intervention for nursing home staff and family members of residents. The Gerontologist, 43(Special Issue 2), 96-106, 2003.
- Radda K, Gaztambide S, Hickey E, Reyes C, Robison J. Integrating qualitative and quantitative measures of barriers to mental health care for older adults. The Gerontologist, 43:283, 2003.
- Robison J. Partners in Caregiving in a special care environment. The Gerontologist 43:587, 2003.
- Robison J, Curry L, Gruman C, Covington T, Gaztambide S, Blank K. Depression in later-life Puerto Rican primary care patients: The role of illness, stress, social integration, and religiosity. International Psychogeriatrics, 15(3):239-251, 2003.
- Robison J, Schensul J, Diefenbach G, Radda K. Measuring mental health of older residents of senior housing. The Gerontologist, 43:283, 2003.
- Robison J, Schensul J, Mills T. Measurement issues in improving access to mental health care for older residents of senior housing. The Gerontologist, 43:283, 2003.
- Robison J, Gruman C, Gaztambide S, Blank K. Screening for depression in middle-aged and older Puerto Rican primary care patients. Journal of Gerontology: Medical Sciences, 57A(5), M308-M314, 2002.
- Schwartz HI, Curry L. Physician-assisted suicide and palliative care: Beliefs and empiricism in the policy debate. Connecticut Medicine, 66(11), 699-702, 2002.
- Schwartz HI, Curry L, Blank K, Gruman C. Physician-assisted suicide or voluntary euthanasia: A meaningless distinction for practicing physicians? Journal of Clinical Ethics, 12(1), 51-63, 2001.
- Tolin DF, Robison JT, Gaztambide S, Horowitz S, Blank K. Ataques de nervios and psychiatric disorders in older Puerto Rican primary care patients. J of Cross-Cultural Psychology, in press.
- Tolin DF, Robison JT, Gaztambide S, Blank K. Anxiety disorders in older Puerto Rican primary care patients. American Journal of Geriatric Psychiatry, 13(2), 150-156, 2005.
- Unson CG, Dunbar N, Curry L, Kenyon L, Prestwood K. The effects of knowledge, attitudes, and significant others on decisions to enroll in a clinical trial on osteoporosis: Implications for recruitment of older African-American women. Journal of the National Medical Association, 93(10), 392-404, 2001.
- Webster T, Curry L, McGraw S, Buckser A, Bradley E. The role of intended use on actual use of home care: Is race a factor? Home Health Care Services Quarterly, 23:57-68, 2004.
- Weingartner K, Robison J, Fogel D, Gruman C. Depression and substance use in a middle aged and older Puerto Rican population. Journal of Cross-Cultural Gerontology, 17, 173-193, 2002.
- Wild-Wesley R. Learning narratives of older adult participants in a community leadership training program. The Gerontologist, 43:109, 2003.