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Han BH, Bronson J, Washington L, Yu M, Kelton K, Tsai J, Finlay AK. Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans. Med Care 2023; 61:477-483. [PMID: 37204150 PMCID: PMC10330246 DOI: 10.1097/mlr.0000000000001864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. OBJECTIVES To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. RESEARCH DESIGN Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. SUBJECTS Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). METHODS Mental illness, SUD, medical multimorbidity. RESULTS An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35-5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04-2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01-1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35-2.49). CONCLUSIONS Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population.
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Affiliation(s)
- Benjamin H. Han
- University of California San Diego Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, CA
| | - Jennifer Bronson
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, VA
| | - Lance Washington
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, VA
| | - Mengfei Yu
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA
| | - Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Andrea K. Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs
- Schar School of Policy and Government, George Mason University
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2
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Krompa GM, O'Mahony E, Tan J, Mulligan O, Adamis D. The Effectiveness of Community Mental Health Teams in Relation to Team Cohesion, Authentic Leadership and Size of the Team: A study in the North West of Ireland. Community Ment Health J 2022; 58:1393-1402. [PMID: 35122580 DOI: 10.1007/s10597-022-00951-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/27/2022] [Indexed: 11/03/2022]
Abstract
Community Mental Health Teams (CMHTs) are increasingly being considered effective models of recovery focused care, however their effectiveness and factors that may affect it have not fully evaluated. Cross-sectional study in Ireland included 106 members from 8 CMHTs. We examined CMHT's effectiveness and the effects of authentic leadership, team cohesion, team members' experience and team tenure on effectiveness, by administering the Team Effectiveness Scale, Authentic Leadership Questionnaire, and Organizational Cohesion Scale. Data on demographics, discipline, years of experience, tenure in the same team, full or partial membership, and number of team members were collected. Results from multilevel regression analysis indicated significant association (p < 0.05) between effectiveness of CMHTs and factors including team cohesion, authentic leadership, size of the team and full membership. Therefore, to increase CMHTs effectiveness, interventions are needed to those areas: a switch to make leadership styles more authentic, to improve team cohesion, smaller team size and full membership.
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Affiliation(s)
- Georgia Maria Krompa
- Sligo/Leitrim Mental Health Services, Business School, Dublin City University, Dublin 9, Ireland
| | - Edmond O'Mahony
- Sligo/Leitrim Mental Health Services, Clarion Rd, Sligo, F91 CD34, Ireland
| | - Jason Tan
- Sligo/Leitrim Mental Health Services, Clarion Rd, Sligo, F91 CD34, Ireland
| | - Owen Mulligan
- Sligo/Leitrim Mental Health Services, Clarion Rd, Sligo, F91 CD34, Ireland
| | - Dimitrios Adamis
- Sligo/Leitrim Mental Health Services, Clarion Rd, Sligo, F91 CD34, Ireland.
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Patient Interaction Involving Older Adults: Provider vs. Caregiver Expectations. Geriatrics (Basel) 2022; 7:geriatrics7050101. [PMID: 36136810 PMCID: PMC9498497 DOI: 10.3390/geriatrics7050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
This paper presents a study of the interaction between healthcare providers (HCPs) and older patients and their caregivers. The paper first presents results from a rapid review and narrative synthesis using PubMed and Google Scholar of HCP/patient/caregiver interactions involving older patients; these results then informed the design of a survey administered to HCPs and caregivers using a range of scenarios and their ratings of appropriateness of different responses, to explore where expectations align or differ between HCPs and caregivers. In analyzing ratings, the research found HCPs and caregivers generally approach the older adult encounter with similar expectations, but differences for specific situations are informative. HCPs appear to better recognize when there is a need to show empathy, as when a patient is frustrated or anxious. HCPs, overall, offer more calming responses, especially in embarrassing, upsetting, or worrying situations. For older patients of advanced age, HCPs value engagement with patients more than caregivers, but HCPs are more aligned with caregivers in their ratings of how to engage caregivers. Compared to caregivers, HCPs focus more on simplifying the description of treatment rather than using thorough explanations when a patient expresses hesitancy or avoidance. The results from this work suggest that having a fuller understanding of the different participants’ expectations may improve communication and identify potential pitfalls. A better understanding may also lead to changes in how students in the healthcare fields are trained; having better insight into this relationship will prepare them for interacting with older patients while addressing the needs of caregivers.
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4
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Karel MJ, Wray LO, Adler G, Hannum AOR, Luci K, Brady LA, McGuire MH. Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations. Clin Gerontol 2022; 45:252-271. [PMID: 31971092 DOI: 10.1080/07317115.2020.1716910] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.
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Affiliation(s)
- Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Health Care System, Buffalo, New York, United States.,Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Geri Adler
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Alisa O' Riley Hannum
- Mental Health Service, VA Eastern Colorado Healthcare System, Colorado Springs, Colorado, United States
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, United States
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Marsden H McGuire
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
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5
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Kube E, Harris G, Hicken B. The graying of integrated health: the specialized role of psychology in geriatric primary care. Aging Ment Health 2021; 25:1941-1949. [PMID: 32456549 DOI: 10.1080/13607863.2020.1768215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Integrating behavioral health services into primary care is an important global initiative to improve access to mental health services. Within the Veterans Health Administration (VHA), Geriatric Patient Aligned Care Teams (GeriPACTs) are one model of integrated care for frail older adults to serve older Veterans with geriatric syndromes and increased probability of cognitive impairment. Understanding of the role of psychology in GeriPACT is limited. This study examines this role, describes the practice of these psychologists, and evaluates the integration of psychology into geriatric primary care. METHODS A mixed-methods design was used. Recruitment occurred through two VHA listservs for GeriPACT and Primary Care Mental Health Integration (PC-MHI) psychologists. Surveys examined referral processes, service access, clinical services provision, and use of psychotherapy modalities. Twenty psychologists participated. Structured follow-up interviews were conducted with five participants. RESULTS A large minority of psychologists did not have FTE allotted for GeriPACT work they provided (40%). Sixty percent were assigned to one GeriPACT team. Twenty percent served four to seven GeriPACT teams. Eighty percent provided same-day services. Cognitive assessment was provided weekly by over sixty percent of providers who had FTE allotment to this role. Qualitative data provided a rich description of psychologists' perceptions of their role, team functioning, referral processes, visit structure, and other factors. CONCLUSION Findings are discussed in the context of the World Health Organization's guidelines for integrating mental health into primary care. Data suggest a need for an integrated model that adapts to the special needs of older adults in primary care.
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Affiliation(s)
- Erin Kube
- VISN 19 Clinical Resource Hub, Tele-PCMHI & Health Psychology, Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Grant Harris
- Department of Mental Health, St. Louis VA Healthcare System, St. Louis, MO, USA
| | - Bret Hicken
- Veterans Rural Health Resource Center, Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
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Huh JWT, Rodriguez RL, Gregg JJ, Scales AN, Kramer BJ, Gould CE. Improving Geropsychology Competencies of Veterans Affairs Psychologists. J Am Geriatr Soc 2021; 69:798-805. [PMID: 33453084 DOI: 10.1111/jgs.17029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Abstract
Older adults are more likely to seek mental health care through integrated care settings such as primary care. Currently, there exists a significant shortage of mental health providers trained in geropsychology and integrated care competencies. To address this need within the Veterans Health Administration, a national workforce development program was extended to include psychologists, which is called the Geriatric Scholars Program-Psychology Track (GSP-P). The GSP-P has two overarching educational program aims: (1) to improve geropsychology competencies of practicing VA psychologists, particularly those working within integrated settings (e.g., primary care) and (2) enrich psychologists' abilities to enact change in their clinical settings. Ninety-eight VA clinicians participated in the GSP-P, which includes a multi-day in-person course, from 2014 to 2018. Participants completed measures assessing confidence and self-reported knowledge in geropsychology and integrated care competencies pre-course and 3-months post-completion. Two-weeks post-course participants responded to open-ended survey questions regarding their perceptions of the course and potential applications of learning. Significant improvements in confidence in and knowledge of geropsychology and integrated care competencies emerged from pre-course to 3-months post-completion. Qualitative findings demonstrated that participants valued the face-to-face, integrated multimodal educational program. Findings provided insights regarding clinicians' planned application of the knowledge acquired, such as modifying treatments for older patients. Specialized workforce programs such as the GSP-P have a significant, positive impact on the care of older Veterans.
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Affiliation(s)
- J W Terri Huh
- VA San Francisco Health Care System, San Francisco, California, USA.,Wright Institute Clinical (PsyD) Program and Berkeley CBT Clinic, Berkeley, California, USA
| | - Rachel L Rodriguez
- Mental & Behavioral Health Service, Durham VA Health Care System, Durham, North Carolina, USA
| | - Jeffrey J Gregg
- Mental & Behavioral Health Service, Durham VA Health Care System, Durham, North Carolina, USA.,Department of Medicine-Geriatrics, Duke University, Durham, North Carolina, USA
| | - Ashley N Scales
- Palo Alto Geriatric Research, Education, and Clinical Center, VA Palo Alto, Health Care System, Palo Alto, California, USA.,Research Service, Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - B Josea Kramer
- Greater Los Angeles Geriatric Research Education and Clinical Center, Greater Los Angeles Health Care System, Los Angeles, California, USA.,Division of Geriatric Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Christine E Gould
- Palo Alto Geriatric Research, Education, and Clinical Center, VA Palo Alto, Health Care System, Palo Alto, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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7
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Hawley CE, Genovese N, Owsiany MT, Triantafylidis LK, Moo LR, Linsky AM, Sullivan JL, Paik JM. Rapid Integration of Home Telehealth Visits Amidst COVID-19: What Do Older Adults Need to Succeed? J Am Geriatr Soc 2020; 68:2431-2439. [PMID: 32930391 DOI: 10.1111/jgs.16845] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits. DESIGN We used an exploratory sequential mixed-methods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot. SETTING Veterans Affairs geriatrics-renal clinic. PARTICIPANTS Patients with scheduled clinic visits from October 2019 to April 2020. MEASUREMENTS We conducted an in-person needs assessment and telephone postvisit interviews. RESULTS Through 50 needs assessments, we identified patient-perceived barriers in interest, access to care, access to technology, and confidence. A total of 34 (68%) patients were interested in completing a home telehealth visit, but fewer (32 (64%)) had access to the necessary technology or were confident (21 (42%)) that they could participate. We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit: interested and capable, interested and incapable, uninterested and capable, and uninterested and incapable. These phenotypes allowed us to create trainings to overcome patient-perceived barriers. We completed 32 home telehealth visits and 12 postvisit interviews. Our formative evaluation showed that our pilot was successful in addressing many patient-perceived barriers. All interviewees reported that the home telehealth visits improved their well-being. Home telehealth visits saved participants an average of 166 minutes of commute time. Five participants borrowed a device from a family member, and five visits were finished via telephone. All participants successfully completed a home telehealth visit. CONCLUSIONS We identified patient-perceived barriers to home telehealth visits and classified patients into four phenotypes based on these barriers. Using principles of implementation science, our home telehealth pilot addressed these barriers, and all patients successfully completed a visit. Future study is needed to understand methods to deploy larger-scale efforts to integrate home telehealth visits into the care of older adults.
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Affiliation(s)
- Chelsea E Hawley
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Nicole Genovese
- Department of Pharmacy, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Montgomery T Owsiany
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Lauren R Moo
- New England Geriatric Research, Education and Clinical Center, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.,General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Paik
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Renal Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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8
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Solimeo SL, Steffen MJA, Gardner EE, Adjognon O, Shin MH, Moye J, Sullivan JL. Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams. J Am Geriatr Soc 2020; 68:2006-2014. [PMID: 32379919 DOI: 10.1111/jgs.16498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/20/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN Cross-sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS Using the PACT Resources Framework, we identified facility-, clinic-, and team-level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource-trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real-time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.
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Affiliation(s)
- Samantha L Solimeo
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Veterans Rural Health Resource Center- Iowa City, Iowa City VA Health Care System, Washington, DC, USA.,University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Melissa J A Steffen
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Veterans Rural Health Resource Center- Iowa City, Iowa City VA Health Care System, Washington, DC, USA
| | - Ellen E Gardner
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Omonyêlé Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA
| | - Jennifer Moye
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA.,New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA.,Boston University, Boston, Massachusetts, USA
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9
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Bowen ME, Rowe MA, Ji M, Cacchione P. A research proposal testing a new model of ambulation activity among long-term care residents with dementia/cognitive impairment: the study protocol of a prospective longitudinal natural history study. BMC Res Notes 2019; 12:557. [PMID: 31481129 PMCID: PMC6724297 DOI: 10.1186/s13104-019-4585-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 12/25/2022] Open
Abstract
Background Excessive and patterned ambulation is associated with falls, urinary tract infections, co-occurring delirium and other acute events among long-term care residents with cognitive impairment/dementia. This study will test a predictive longitudinal data model that may lead to the preservation of function of this vulnerable population. Methods/design This is a single group, longitudinal study with natural observations. Data from a real-time locating system (RTLS) will be used to objectively and continuously measure ambulation activity for up to 2 years. These data will be combined with longitudinal acute event and functional status data to capture patterns of change in health status over time. Theory-driven multilevel models will be used to test the trajectories of falls and other acute conditions as a function of the ambulation activity and demographic, functional status, gait quality and balance ability including potential mediation and/or moderation effects. Data-driven machine learning algorithms will be applied to run screening of the high dimensional RTLS data together with other variables to discover new and robust predictors of acute events. Discussion The findings from this study will lead to the early identification of older adults at risk for falls and the onset of acute medical conditions and interventions for individualized care.
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Affiliation(s)
- Mary Elizabeth Bowen
- School of Nursing, University of Delaware, STAR Tower, 100 Discovery Blvd., Newark, DE, 19713, USA. .,Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave., Philadelphia, PA, 19104, USA.
| | - Meredeth A Rowe
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA
| | - Ming Ji
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA
| | - Pamela Cacchione
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
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10
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Wiechers I, Epstein-Lubow G, Thielke S. Engage for Change: The Imperative to Increase Our Efforts in Geriatric Mental Health Policy. Am J Geriatr Psychiatry 2019; 27:97-99. [PMID: 30558850 DOI: 10.1016/j.jagp.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Ilse Wiechers
- Department of Psychiatry, Yale University School of Medicine; Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs.
| | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; Department of Health Services, Policy and Practice, Brown University School of Public Health; Department of Psychiatry, Harvard Medical School; Center for Memory Health at Hebrew SeniorLife
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington; Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center
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