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Tyagi P, Bouldin ED, Hathaway WA, D'Arcy D, Nasr SZ, Intrator O, Dang S. Preimplementation Evaluation of a Self-Directed Care Program in a Veterans Health Administration Regional Network: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e57341. [PMID: 38875003 PMCID: PMC11214023 DOI: 10.2196/57341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers. OBJECTIVE We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8. METHODS The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site. RESULTS We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8. CONCLUSIONS The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57341.
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Affiliation(s)
- Pranjal Tyagi
- South Florida Veteran Affairs Foundation for Research & Education, Miami, FL, United States
| | - Erin D Bouldin
- Division of Epidemiology, Department of Internal Medicine, University of Utah Eccles School of Medicine, Salt Lake City, UT, United States
| | - Wendy A Hathaway
- Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Derek D'Arcy
- Canandaigua VA Medical Center, Department of Veterans Affairs, Canandaigua, NY, United States
| | - Samer Zacharia Nasr
- VISN 8 Network Office, Department of Veterans Affairs, St. Petersburg, FL, United States
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
- Geriatrics and Extended Care Data Analysis Center, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Stuti Dang
- Miami VA GRECC, Miami VA Healthcare System, Miami, FL, United States
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Korinek K, Young Y, Schmidt J, Toan TK, Zimmer Z. War-Related Life Course Stress and Late-Life Subjective Age in Northern Vietnam. Innov Aging 2024; 8:igae048. [PMID: 38912425 PMCID: PMC11192863 DOI: 10.1093/geroni/igae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 06/25/2024] Open
Abstract
Background and Objectives The role of early life stressors in subjective aging is weakly understood, especially in low- to middle-income countries. This paper investigated how early life stressors encountered in armed conflict influence subjective age among Vietnamese older adults who experienced war over decades of their early life. Research Design and Methods We analyzed survey data from the 2018 Vietnam Health and Aging Study involving 2,447 Vietnamese older adults who encountered diverse war-related stressors in early adulthood. The analytical sample (N = 2,341) included 50.9% women and 49.1% men, with an average age of 69.8. 41.1% are military veterans. We conducted survey-adjusted multinomial logistic regression analyses with mediation to predict the probability of feeling younger or older than one's chronological age. We examined how childhood adversity (i.e., childhood hunger and low parental SES) and wartime stressors (i.e., war-related violence, malevolent environment, and military service) influenced late-life subjective age, both directly and as mediated by late-life mental, functional, and physical health. Results We found significant associations between early adulthood war-related stressors and subjective age. Formal military service significantly lessened the relative risk of feeling subjectively old, and more plentiful wartime violence exposures significantly increased the risk of feeling younger than one's chronological age. Violence exposure's effects were both direct and indirect through functional and mental health. Conversely, greater exposure to wartime malevolent conditions (e.g., shortages of clean water and evacuations) and multiple episodes of severe hunger in childhood increased the risk of feeling older, effects both direct and mediated by late-life functional and mental health. Discussion and Implications Results suggest wartime stressors, especially war's malevolent environments and severe childhood hunger, experienced in many conflict-affected populations globally, have the potential to subjectively "age" survivors. Yet, not all war exposures are equal, and some may yield psychological and socioeconomic resources that support healthy aging.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Yvette Young
- Laboratory of Migration and Mobility, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Jefferson Schmidt
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Tran Khanh Toan
- Department of Preventive Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, Center for Global Aging and Community, Mount Saint Vincent University, Halifax, Canada
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Ayalon L, Cohn-Schwartz E, Sagi D. Global Conflict and the Plight of Older Persons: Lessons From Israel. Am J Geriatr Psychiatry 2024; 32:509-511. [PMID: 38135594 DOI: 10.1016/j.jagp.2023.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.
| | - Ella Cohn-Schwartz
- Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel
| | - Doron Sagi
- Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business, Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation, Israel
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Wang P, Tao W, Zhang Z, Xu C, Qiu Y, Xiao W. Assessing causality between inflammatory bowel diseases with frailty index and sarcopenia: a bidirectional Mendelian randomization study. Eur J Med Res 2024; 29:23. [PMID: 38183088 PMCID: PMC10768401 DOI: 10.1186/s40001-023-01614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Previous studies have found that frailty and sarcopenia are commonly diagnosed in inflammatory bowel disease (IBD) patients, indicating an association between these conditions. Nonetheless, the cause‒effect connection between IBD, frailty, and sarcopenia remains unclear. METHODS We sourced the genetic variants for the exposures and outcomes from publicly accessible, extensive genome-wide association studies (GWAS). Specifically, we obtained IBD data from the International IBD Genetics Consortium, frailty index (FI) data from the United Kingdom Biobank and Swedish TwinGene, and sarcopenia data from a recent GWAS meta-analysis. Five methods, including inverse variance weighted (IVW), simple mode, MR-Egger, weighted mode, and the weighted median, were used to proceed with MR estimates. We also performed heterogeneity and horizontal pleiotropy tests. RESULTS Our results indicated a positive causal relationship between ulcerative colitis (UC) (IVW: β = 0.014, 95% CI, 0.006 to 0.021, p = 0.001) and Crohn's disease (CD) (IVW: β = 0.012; 95% CI, 0.006 to 0.018, p = 2e-04) with the FI. However, we uncovered no proof of a cause-and-effect relationship between UC (IVW: β = 0.001, 95% CI, -0.015 to 0.017, p = 0.344) or CD (IVW: β = 0.003, 95% CI, -0.009 to 0.015, p = 0.214) and sarcopenia. Additionally, in the inverse order, we also discovered no cause-and-effect connection between FI or sarcopenia on UC or CD in this study. CONCLUSION The MR analysis showed a positive causal association between IBD and FI, indicating that IBD patients may exhibit aging-related characteristics. Therefore, frailty assessments should be conducted as early as possible in IBD patients.
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Affiliation(s)
- Peng Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, No. 183 Xinqiao Road, Chongqing, 400037, China
| | - Wei Tao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, No. 183 Xinqiao Road, Chongqing, 400037, China
| | - Zhiqiang Zhang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, No. 183 Xinqiao Road, Chongqing, 400037, China
| | - Cong Xu
- Department of General Surgery, Xinqiao Hospital, Army Medical University, No. 183 Xinqiao Road, Chongqing, 400037, China
| | - Yuan Qiu
- Department of General Surgery, Xinqiao Hospital, Army Medical University, No. 183 Xinqiao Road, Chongqing, 400037, China.
| | - Weidong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, No. 183 Xinqiao Road, Chongqing, 400037, China.
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Teerawichitchainan B, Zimmer Z, Low TQY, Toan TK. Respiratory Health Among Older Adults in Vietnam: Does Earlier-Life Military Role and War Exposure Matter? J Aging Health 2023; 35:168-181. [PMID: 35941715 DOI: 10.1177/08982643221118445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectiveWe explore how earlier-life military roles and war trauma associate with later-life respiratory health in Vietnam. Method: The population-based sample aged 60+ is from the 2018 Vietnam Health and Aging Study. Poisson and binary logistic regressions investigate correlates of overall lung health, measured as total number of four conditions, and individual conditions, with focus on earlier-life wartime experiences. Results: Exposure is associated with lung conditions. Overall, a one-standard deviation increase in exposure results in 0.529 more conditions (p ≤ .001). Association varies across military roles and is partially explained by PTSD and smoking. Civilians heavily exposed to war trauma exhibit worse lung health than similarly exposed formal and informal military personnel. Discussion: Earlier-life war exposure is an important predictor of late-adulthood respiratory health in lower- and middle-income countries. Evidence calls for attention to the long-term impacts of war on health among not only formal and informal military personnel but also civilians.
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Affiliation(s)
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, 3684Mount Saint Vincent University, Halifax, NS, Canada
| | - Timothy Qing Ying Low
- Centre for Family and Population Research, 37580National University of Singapore, Singapore
| | - Tran Khanh Toan
- Family Medicine Department, 106156Hanoi Medical University, Hanoi, Vietnam
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Kazberouk A, Sinha SK. Too old to flee: Addressing the needs of older persons in conflict zones. J Am Geriatr Soc 2023; 71:299-301. [PMID: 36184754 DOI: 10.1111/jgs.18057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Alexander Kazberouk
- Department of Medicine, University of California, San Francisco, California, USA
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Preparedness and Disaster Health Sub-Council, Scientific Advisory Council, American Red Cross, Washington, District of C, USA
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Zimmer Z. War exposure: an under-appreciated determinant of population health in Asia. ASIAN POPULATION STUDIES 2022. [DOI: 10.1080/17441730.2022.2142394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zachary Zimmer
- Global Aging and Community Initiative and Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Canada
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Li S, Fan W, Zhu B, Ma C, Tan X, Gu Y. Effects of age, period, and cohort on the prevalence of frailty in Chinese older adults from 2002 to 2014. Front Public Health 2022; 10:935163. [PMID: 36033734 PMCID: PMC9412743 DOI: 10.3389/fpubh.2022.935163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
Background Currently, longitudinal studies on frailty are in an early stage, particularly in low- and middle-income countries. Only one study was conducted in Hong Kong to examine age-period-cohort effects on the prevalence of frailty among Chinese older adults. Objectives This study aims to shed light on the prevalence trajectory of frailty among older adults in mainland China through the APC model and to analyze the effects of age, period, and cohort on the prevalence trajectory. Methods The sample for this study was older adults aged 65-109 years old from the 2002 to 2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty status was measured by Rockwood FI. An age-period-cohort model was used to describe the effects of age, period, and cohort on the prevalence trajectory of frailty. Results The prevalence of frailty among Chinese older adults changed significantly with age, period, and cohort. Furthermore, the effect of age was much stronger than the effect of period and cohort. The prevalence of frailty in the 101-103 and 104-106 age groups was 8.998 (95% CI 13.667-5.924) and 8.699 (95% CI 13.037-5.805) times higher than the in the 65-67 age group, respectively. The sensitivity analysis based on Fried's frailty phenotype showed similar results, confirming the robustness of our findings. Conclusion All of the age effect reflecting the individual aging process, period effect reflecting change in the social environment, and birth cohort effect reflecting different generations could influence the prevalence of frailty at the population level. In contrast, the age effect was the main effect.
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Affiliation(s)
- Siying Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Wenye Fan
- School of Public Health, Wuhan University, Wuhan, China
| | - Boya Zhu
- School of Public Health, Wuhan University, Wuhan, China
| | - Chao Ma
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Xiaodong Tan
| | - Yaohua Gu
- School of Nursing, Wuhan University, Wuhan, China,Yaohua Gu
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