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Estrada LV, Barcelona V, Dhingra L, Luchsinger JA, Dick AW, Glance LG, Stone PW. Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents. JAMA Netw Open 2024; 7:e249312. [PMID: 38696169 PMCID: PMC11066698 DOI: 10.1001/jamanetworkopen.2024.9312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Importance Nursing home (NH) transfers to hospitals are common and have been associated with cognitive decline; approximately 45% of NH hospital transfers are potentially avoidable hospitalizations (PAHs). Objective To determine PAH incidence for historically marginalized NH residents with severe cognitive impairment compared with non-Hispanic White residents. Design, Setting, and Participants This cross-sectional study merged 2018 Centers for Medicaid & Medicare Services datasets and LTCFocus, a public dataset on US NH care, for US NH residents aged 65 years and older who had a hospitalization. Analyses were performed from January to May 2022. Exposure Race and ethnicity of NH residents. Main Outcomes and Measures Racial and ethnic differences in resident-level annual rates of PAHs were estimated for residents with and without severe cognitive impairment (measured using the Cognitive Function Scale), controlling for resident characteristics, comorbidities, dual eligibility, and time at risk. PAHs were defined as NH hospital transfers that resulted from neglectful NH care or for which NH treatment would have been appropriate. Results Of 2 098 385 NH residents nationwide included in the study, 7151 (0.3%) were American Indian or Alaska Native, 39 873 (1.9%) were Asian, 229 112 (10.9%) were Black or African American, 99 304 (4.7%) were Hispanic, 2785 (0.1%) were Native Hawaiian or Pacific Islander, 1 713 670 (81.7%) were White, and 6490 (0.3%) were multiracial; 1 355 143 (64.6%) were female; 128 997 (6.2%) were severely cognitively impaired; and the mean (SD) age was 81.8 (8.7) years. PAH incidence rate ratios (IRRs) were significantly greater for residents with severe cognitive impairment compared with those without. In unadjusted analyses comparing historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment, American Indian or Alaska Native residents had a 49% higher PAH incidence (IRR, 1.49 [95% CI, 1.10-2.01]), Black or African American residents had a 64% higher incidence (IRR, 1.64 [95% CI, 1.48-1.81]), and Hispanic residents had a 45% higher incidence (IRR, 1.45 [95% CI, 1.29-1.62]). Higher incidences persisted for historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment in adjusted analyses. Asian residents had a 24% higher PAH incidence (IRR, 1.24 [95% CI, 1.06-1.45]), Black or African American residents had a 48% higher incidence (IRR, 1.48 [95% CI, 1.36-1.60]), and Hispanic residents had a 27% higher incidence (IRR, 1.27 [95% CI, 1.16-1.39]). Conclusions and Relevance In this cross-sectional study of PAHs, compared with non-Hispanic White NH residents, historically marginalized residents had increased PAH incidence. In the presence of severe cognitive impairment, incidence rates increased significantly compared with rates for residents without severe cognitive impairment. These results suggest that identification of residents with severe cognitive impairment and proper NH care may help prevent further cognitive decline by avoiding PAHs.
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Affiliation(s)
- Leah V. Estrada
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center
| | | | - Laurent G. Glance
- RAND Corporation, Boston, Massachusetts
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
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Allick C. Perceptions of cognitive decline among American Indian and Alaska Native elders. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12611. [PMID: 38887535 PMCID: PMC11180990 DOI: 10.1002/dad2.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION American Indian and Alaska Native elders aged ≥ 65 years are experiencing increased life expectancy. Elders are critical to intergenerational knowledge, yet limited data exist on the health challenges faced by this group. METHODS This study engaged individuals attending the National Indian Council on Aging 2021 Annual Meeting in Reno, Nevada. A 19-question survey, designed to examine perceptions about cognitive decline and to identify comfort with potential risk and protective factors, was disseminated to 50 participants. RESULTS Participants indicated that they are concerned about cognitive decline, are willing to plan for their future care and cognitive testing, and articulated a desire for Tribally led long-term support services. DISCUSSION This study found similar results to studies on White individuals, which include a lack of knowledge, stigma around the aging process, and gaps in services available. More work is necessary to address the gap in literature and policy. Highlights American Indian and Alaska Natives (AI/ANs) are underrepresented in literature on Alzheimer's disease and related dementia (ADRD).AI/ANs believe that they will experience cognitive decline as they age.AI/ANs indicate a willingness to plan for future care and participate in future research on ADRD.
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Affiliation(s)
- Cole Allick
- Institute for Research and Education to Advance Community Health (IREACH)Washington State UniversitySeattleWashingtonUSA
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Kuo C, Jasczynski M, Yoo JH, Robinson JL, Reynolds K, Anoruo L, Bae K, Ka'opua LS, Chavez R, Tellei J, Aparicio EM. "I Need to Get My Culture Back": Youth and Provider Perspectives on Integrating Culturally Based Approaches into Sexual and Reproductive Health Programs for Native Hawaiian and Pacific Islander Youth Experiencing Homelessness. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:209-221. [PMID: 37566201 PMCID: PMC10764447 DOI: 10.1007/s11121-023-01573-7] [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] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
There is growing interest in decolonizing sexual and reproductive health (SRH) and embedding cultural practices into social and medical services in Hawai'i. Wahine ("woman") Talk is a multilevel, comprehensive SRH program for female youth experiencing homelessness (YEH) led by community health, social work, and medical providers. This study examines youth and program provider perspectives of culturally based approaches that may strengthen SRH programs. The study team conducted three focus groups and ten in-depth interviews with participating youth and program providers after the program's conclusion. Youth participants were aged 14 to 22 years (M = 18.1) and of Native Hawaiian or Pacific Islander ancestry. Interview transcripts were analyzed using structured thematic analysis. The youth described feeling estranged from their ancestral cultures and suggested incorporating multiple cultural practices to enhance their connection to community, body, and land into SRH programming for YEH. They identified several 'āina ("land")-based approaches, hands-on learning, hula, and language as possible practices to weave into the program. While youth felt estranged from their ancestral cultures, they discussed Native Hawaiian and Pacific Islander health perspectives where 'āina and relationships are considered life-sustaining. Youth and program staff stressed incorporating culture respectfully, caring for the whole person, and providing trauma-informed care. Future policy, practice, and research should consider protecting and integrating Native Hawaiian conceptions of health into SRH policy and practice and include youths' cultural identities in SRH intervention development.
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Affiliation(s)
- Charlene Kuo
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA.
| | - Michelle Jasczynski
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Jee Hun Yoo
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Jennifer L Robinson
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Katelyn Reynolds
- College of Computer, Mathematical, & Natural Sciences, Department of Biology, University of Maryland, College Park, MD, USA
| | - Lisa Anoruo
- School of Public Health, Department of Public Health Science, University of Maryland, College Park, MD, USA
| | - Kayla Bae
- School of Public Health, Department of Public Health Science, University of Maryland, College Park, MD, USA
| | - Lana Sue Ka'opua
- Thompson School of Social Work & Public Health (Retired), Department of Social Work, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Rebecca Chavez
- Waikiki Health, Honolulu, HI, USA
- PATH Clinic and Youth Outreach, Honolulu, HI, USA
| | - Jacqueline Tellei
- Waikiki Health, Honolulu, HI, USA
- PATH Clinic and Youth Outreach, Honolulu, HI, USA
| | - Elizabeth M Aparicio
- School of Public Health, Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
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Bryant J, Freund M, Ries N, Garvey G, McGhie A, Zucca A, Hoberg H, Passey M, Sanson-Fisher R. Volume, scope, and consideration of ethical issues in Indigenous cognitive impairment and dementia research: A systematic scoping review of studies published between 2000-2021. DEMENTIA 2022; 21:2647-2676. [PMID: 36054372 DOI: 10.1177/14713012221119594] [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: 11/17/2022]
Abstract
INTRODUCTION High quality research involving Indigenous people with cognitive impairment and dementia is critical for informing evidence-based policy and practice. We examined the volume, scope and ethical considerations of research related to dementia with Indigenous populations globally from January 2000-December 2021. METHODS Studies were included if they were published in English from 2000 to 2021 and provided original data that focused on cognitive impairment or dementia in any Indigenous population. RESULTS The search yielded 13,009 papers of which, 76 met inclusion criteria. The overall number of papers increased over time. Studies were mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 30; 39%). Twenty-six papers directly involved Indigenous participants with cognitive impairment or dementia. Of these studies, ethics approval was commonly required from two or more committees (n = 23, 88.5%). Ethical and legal governance frameworks were rarely discussed. DISCUSSION There is a clear need for further robust studies examining cognitive impairment and dementia with Indigenous populations. Future research should consider the ethical aspects of involving Indigenous participants with cognitive impairment in research.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nola Ries
- Faculty of Law, 1994University of Technology Sydney, Sydney, NSW, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, 10095Menzies School of Health Research, Causarina, Northern Territory, Australia
| | - Alexandra McGhie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alison Zucca
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Hana Hoberg
- Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, 10095Menzies School of Health Research, Causarina, Northern Territory, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, 5982University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, 5982University of Newcastle, Callaghan, NSW, Australia.,Equity in Health & Wellbeing Research Program, 454568Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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McCarthy MJ, Lee-Regalado Hustead M, Bacon R, Garcia YE, Dunn DJ, Williamson HJ, Baldwin J. Development and Validation of a Community Assessment Survey for Diverse Rural Family Caregivers of People With Alzheimer Disease and Related Dementias. FAMILY & COMMUNITY HEALTH 2021; 44:126-135. [PMID: 33646980 PMCID: PMC8131205 DOI: 10.1097/fch.0000000000000297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Many individuals with Alzheimer disease and related dementias receive care from family members and friends. Rurality adds increased complexity to care, especially for diverse caregivers. This study details the development and content validation process for a community assessment survey for rural white, Latinx, and American Indian/Alaska Native Alzheimer disease and related dementias caregivers. Foundational survey items were based upon instruments validated with diverse rural caregivers. A modified Delphi process (2 rounds) was used to refine items. The process concluded when 75%+ of experts agreed that the survey was (1) inclusive of different cultural groups; (2) respectful of cultural values and norms; (3) comprehensive with respect to needs, assets, and resources, and (4) relevant to the experiences of diverse rural caregivers. Round 1 of the process (N = 9 panelists) resulted in the elimination of 2 survey sections, a greater focus on issues including transportation and roles of extended family members, and the inclusion of open-ended questions. Round 2 (N = 6 panelists) resulted in further improvements, particularly to the sections about cultural customs, beliefs, and traditions and interactions with health care and other providers. Benefits of the process included raising awareness about rural caregiving issues and maximizing data quality. Challenges included honoring the diversity of respondents' opinions and balancing research rigor with community utility. This community assessment survey may help researchers better understand the needs and culturally-based strengths of diverse rural family caregivers.
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Affiliation(s)
- Michael J McCarthy
- Departments of Social Work, College of Social and Behavioral Sciences (Dr McCarthy), Educational Psychology, College of Education (Ms Lee-Regalado Hustead and Dr Garcia), and Occupational Therapy (Dr Williamson) and Health Sciences (Dr Baldwin), Center for Health Equity Research, Northern Arizona University, Flagstaff; Center for Health Equity Research (Dr Bacon), Northern Arizona University, Flagstaff; and School of Nursing, College of Health & Human Services (Dr Dunn), Northern Arizona University, Flagstaff
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Lewis JP, Manson SM, Jernigan VB, Noonan C. "Making Sense of a Disease That Makes No Sense": Understanding Alzheimer's Disease and Related Disorders Among Caregivers and Providers Within Alaska Native Communities. THE GERONTOLOGIST 2021; 61:363-373. [PMID: 32789474 PMCID: PMC8023374 DOI: 10.1093/geront/gnaa102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES With the rate of Alzheimer's disease and related dementias (ADRD) increasing among Alaska Indian/Alaska Native (AI/AN) people, the Alaska Native Health system is ill-prepared to meet the challenges associated with the growing population at risk of ADRD. The high cost of care, inadequate training of health care providers, and lack of supportive services for caregivers are especially concerning. RESEARCH DESIGN AND METHODS Interviews were conducted with 22 AN caregivers for ANs with ADRD and 12 ANs and non-Native health care providers in communities across Alaska. Interviews lasted approximately 60 min and were transcribed verbatim. We employed directed content analysis to examine the major agreements and disagreements between the participants' understandings of ADRD in each of the domains of Kleinman's Explanatory Model of Illness. RESULTS Caregivers and health care providers expressed concerns about the lack of understanding, resources, and awareness of ADRD among ANs in rural and urban communities. Both caregivers and providers recognized the need to obtain an early diagnosis, blend Western and traditional medicines, promote lifestyle and dietary changes, and foster training for caregivers. Health care providers acknowledged their limited exposure to AN understanding of ADRD and wish to receive culturally relevant training to better serve AN. DISCUSSION AND IMPLICATIONS As the older AN adult population grows, the need for culturally responsive training and support services will continue to increase. We recommend establishing rural outreach and support groups for caregivers, developing an understanding of how ANs view ADRD to train and educate health care providers, and implement screening early for memory loss during routine medical examinations.
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Affiliation(s)
- Jordan P Lewis
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth Campus, Aurora
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Valarie B Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Pullman
- Elson S. Floyd College of Medicine, Washington State University, Pullman
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Dilworth-Anderson P, Moon H, Aranda MP. Dementia Caregiving Research: Expanding and Reframing the Lens of Diversity, Inclusivity, and Intersectionality. THE GERONTOLOGIST 2020; 60:797-805. [PMID: 32667672 DOI: 10.1093/geront/gnaa050] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 02/04/2023] Open
Abstract
This forum expands and reframes the lens of dementia caregiving research among diverse racial and ethnic groups to better understand the unique needs, stressors, and strengths of multicultural and racial-ethnic family caregivers in the United States. By providing more diverse and inclusive knowledge on caregiving to older adults in the United States, we can create a new path forward with regards to caregiving research. Throughout the article, major questions and answers are supported by critiquing some of the caregiving literature. Discussions are provided to help create inclusive ways of conceptualizing caregiving research and using methodological approaches to reflect the diversity of caregivers and care recipients in the United States. Expanding and reframing the conceptual and methodological lens of diversity, inclusivity and intersectionality can provide evidence to support effective policy, practice, and care in addressing the needs of diverse groups of caregivers and older adults living with dementia.
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Affiliation(s)
- Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Heehyul Moon
- Kent School of Social Work, University of Louisville, Kentucky
| | - María P Aranda
- USC Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles.,USC Alzheimer's Disease Center, University of Southern California, Los Angeles
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Chen MC, Huang HL, Chiu YC, Yip PK, Wu SM, Hsu WC, Wang WS, Huang YF, Shyu YIL. Experiences of Living in the Community for Older Aboriginal Persons With Dementia Symptoms in Taiwan. THE GERONTOLOGIST 2020; 60:525-534. [PMID: 31091307 DOI: 10.1093/geront/gnz013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Improving quality of life for community-dwelling older persons with dementia symptoms (PWDS) and family caregivers requires promoting dementia-friendly communities (DFC). However, little is known regarding older Taiwanese Aboriginal PWDS' experiences of living in the community. We explored these experiences for older Atayal PWDS and their families in Taiwan. RESEARCH DESIGN AND METHODS This grounded theory research used in-depth interviews to explore the perspectives of older PWDS (n = 4), their family members (n = 3), and key persons (n = 10) in an Atayal community in northern Taiwan. Data were analyzed using constant comparative analysis. Participants were interviewed between January and May 2015. RESULTS Participants' experiences were captured by the overarching concept of "low dementia awareness, high family-like ambience in the community." Despite the low/absent community awareness of dementia, older Atayal PWDS functioned as freely in the community as at home due to a family-like supportive environment. Aboriginal PWDS and their families also faced environmental challenges, e.g., environmental constraints and barriers to transportation access. DISCUSSION AND IMPLICATIONS Our results suggest that this Aboriginal community and culture offer important DFC components, and these strengths could be further studied to enhance DFC models elsewhere. Despite these strengths in supporting PWDS, environmental challenges to transportation access still cause difficulties for PWDS and their families and need improvement. The Atayal community's low dementia awareness suggests that services introduced must be culturally appropriate and nondisruptive to existing supportive helping systems. Our study can be a model for future studies to understand and identify PWDS' needs in Indigenous communities.
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Affiliation(s)
- Mei-Chen Chen
- Department of Public Health, Taoyuan City Government, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Yi-Chen Chiu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Keung Yip
- Neurological Center, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Suh-Mian Wu
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Fang Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Schaefer KR, Noonan C, Mosley M, Smith J, Galbreath D, Fenn D, Robinson RF, Manson SM. Differences in service utilization at an urban tribal health organization before and after Alzheimer's disease or related dementia diagnosis: A cohort study. Alzheimers Dement 2019; 15:1412-1419. [PMID: 31563535 PMCID: PMC6874738 DOI: 10.1016/j.jalz.2019.06.4945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The prevalence, mortality, and healthcare impact of Alaska Native and American Indian (ANAI) people with Alzheimer's disease and related dementias (ADRD) are unknown. METHODS We conducted a cohort study of electronic health record data that compared healthcare service utilization in patients with and without an ADRD diagnosis. Zero-inflated negative binomial regression with robust standard errors was used to estimate utilization rates. RESULTS Compared with patients without ADRD, utilization rates were similar before but higher after ADRD diagnosis. For those with diagnosed ADRD, utilization increased gradually over time with sharp upward change during the year of diagnosis. DISCUSSION This is the only study quantifying changes in healthcare service utilization before and after ADRD diagnosis among ANAI people, which is crucial for tailoring geriatric care for ANAI populations.
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Affiliation(s)
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Michael Mosley
- Data Service Department, Southcentral Foundation, Anchorage, AK, USA
| | - Julia Smith
- Data Service Department, Southcentral Foundation, Anchorage, AK, USA
| | - Donna Galbreath
- Medical Service Administration, Southcentral Foundation, Anchorage, AK, USA
| | - David Fenn
- Organizational Development and Innovation, Southcentral Foundation, Anchorage, AK, USA
| | | | - Spero M Manson
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Gallardo-Peralta LP, Sánchez-Moreno E. Successful Aging and Personal Well-Being Among the Chilean Indigenous and Non-Indigenous Elderly. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this research was to analyse the association between successful aging (SA) and subjective well-being (SWB) in different domains. Method: The study is quantitative and cross-sectional, with a sample consisting of 800 older people, including 569 indigenous (Aymara and Mapuche) participants living in northern and southern Chile. Results: Domains associated with SA are satisfaction with health, satisfaction with social relationships, satisfaction with future security, and satisfaction with spiritual and religious experiences. SA is also positively associated with being a woman, being young, and not being indigenous. Conclusion: The research has two main practical implications. First, SWB domains may be incorporated into socio-health interventions as they relate to elements that can be changed or improved (health, social inclusion, security, and beliefs). Second, this study suggests a situation of risk among older indigenous Chileans, confirming the premise that the life paths of indigenous Chileans at social risk give rise to a more socially unequal old age with; therefore, it is important to analyse positive aspects that promote better old age.
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Martindale-Adams J, Tah T, Finke B, LaCounte C, Higgins BJ, Nichols LO. Implementation of the REACH model of dementia caregiver support in American Indian and Alaska Native communities. Transl Behav Med 2017; 7:427-434. [PMID: 28585164 PMCID: PMC5645288 DOI: 10.1007/s13142-017-0505-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The Resources for Enhancing Alzheimer's Caregivers Health in the VA (REACH VA) dementia caregiving intervention has been implemented in the VA, in community agencies, and internationally. As identified in the 2013 and 2015 National Plan to Address Alzheimer's Disease, REACH is being made available to American Indian and Alaska Native communities. Implementation activities are carried out by local Public Health Nursing programs operated by Indian Health Service and Tribal Health programs, and Administration for Community Living/Administration on Aging funded Tribal Aging program staff already working in each community. The implementation is described using the Fixsen and Blasé implementation process model. Cultural, community, health system, and tribe-specific adaptations occur during the six implementation stages of exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Adaptations are made by local staff delivering the program. Implementation challenges in serving AI/AN dementia caregivers include the need to adapt the program to fit the unique communities and the cultural perceptions of dementia and caregiving. Lessons learned highlight the importance of using a clinically successful intervention, the need for support and buy-in from leadership and staff, the fit of the intervention into ongoing routines and practices, the critical role of modifications based on caregiver, staff, and organization needs and feedback, the need for a simple and easily learned intervention, and the critical importance of community receptivity to the services offered.
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Affiliation(s)
- Jennifer Martindale-Adams
- Department of Preventive Medicine, University of Tennessee Health Science Center and Co-Director Caregiver Center, Veterans Affairs Medical Center Memphis, Memphis, USA
| | - Tina Tah
- Division of Nursing Services, Office of Clinical and Preventive Services, Indian Health Service, Rockville, USA
| | - Bruce Finke
- Nashville Area Indian Health Service and Learning and Diffusion Group, CMS Innovation Center, Nashville, USA
| | - Cynthia LaCounte
- Office for American Indian, Alaska Natives and Native Hawaiian Programs, Administration for Community Living, Administration on Aging, Washington, USA
| | - Barbara J Higgins
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Linda O Nichols
- Caregiver Center, Veterans Affairs Medical Center Memphis and Departments of Preventive Medicine and Internal Medicine, University of Tennessee Health Science Center, 1030 Jefferson Avenue (11h), Memphis, TN, 38104, USA.
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Braun KL, Nelson-Hurwitz DC, Ono M, Godinet M, Perkinson MA, Mokuau N, Hayes D. Insights in Public Health: From Hale to Kauhale: Public Health, Social Work, and Aging. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2017; 76:135-138. [PMID: 28484669 PMCID: PMC5418539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Kathryn L Braun
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (KLB, DN-H)
| | | | - Mari Ono
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (KLB, DN-H)
| | - Meripa Godinet
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (KLB, DN-H)
| | - Margaret A Perkinson
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (KLB, DN-H)
| | - Noreen Mokuau
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (KLB, DN-H)
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