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Chan KT, Marsack-Topolewski CN, Ratnayake M, Kaplan DB, Voet KA, Riemenschneider M, Graves J. The Impact of an Intergenerational Service Learning Program on Psychological Distress for Homebound Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-18. [PMID: 38934724 DOI: 10.1080/01634372.2024.2373290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/24/2024] [Indexed: 06/28/2024]
Abstract
This study examined the benefits of an intergenerational home-based service learning program to reduce psychological distress for homebound older adults. Multivariate regression analyses were conducted with a sample of 182 to examine the association of length of service from the program and presence of caregivers with psychological distress. Findings indicated length of service (β = -0.15, p < .05) and having a child as a caregiver (β = -0.14, p < .05) were associated with a reduction in psychological distress. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers, and students.
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Affiliation(s)
- Keith T Chan
- Hunter College, Silberman School of Social Work, New York, New York, USA
| | | | | | - Daniel B Kaplan
- School of Social Work, Adelphi University, Garden City, New York, USA
| | - K Alida Voet
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jillian Graves
- School of Social Work, Eastern Michigan University, Ypsilanti, Michigan, USA
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2
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Jindal SK, Lee T, Agrawal A, Demers L, Schwartz AW. A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities. J Am Med Dir Assoc 2024; 25:104930. [PMID: 38336356 DOI: 10.1016/j.jamda.2023.12.018] [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: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
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Affiliation(s)
- Shivani K Jindal
- Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
| | | | - Arushi Agrawal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lindsay Demers
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Miao C, Fang X, Sun H, Yin Y, Li B, Shen W, Chen J, Huang X. The relationship between individual-level socioeconomic status and preference for medical service in primary health institutions: a cross-sectional study in Jiangsu, China. Front Public Health 2024; 11:1302523. [PMID: 38274517 PMCID: PMC10809986 DOI: 10.3389/fpubh.2023.1302523] [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: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Background While China's primary health care (PHC) system covers all citizens, the use of medical services supplied by primary health institutions (PHIs) is not at ideal levels. This study explored the impact of socioeconomic status (SES) on residents' first choice of medical services provided by PHIs. Methods This community-based, cross-sectional study was conducted in Jiangsu Province, China, from October 2021 to March 2022. A custom-designed questionnaire was used to evaluate 4,257 adults, of whom 1,417 chose to visit a doctor when they were sick. Logistic regression was used to test the relationships among SES, other variables and the choice of medical services, and interaction effects were explored. Results A total of 1,417 subjects were included in this study (48.7% female; mean age 44.41 ± 17.1 years). The results showed that older age (p < 0.01), rural residence (p < 0.01), a preference for part-time medical experts in PHIs (p < 0.01), and lack of coverage by basic medical insurance (p < 0.05) were associated with the first choice to use PHIs. In the multiple logistic regression model, SES was not associated with the first choice of medical services supplied by PHIs (p > 0.05), but it interacted with three variables from the Commission on Social Determinants of Health Framework (material circumstances, behaviors and biological factors, and psychosocial factors). Conclusion Vulnerable individuals who are the target visitors to PHIs are older, live in rural areas, and suffer from chronic diseases. SES, as a single factor, did not impact whether medical services at PHIs were preferred, but it mediated relationships with other factors.
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Affiliation(s)
- Chunxia Miao
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xin Fang
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hong Sun
- School of Economics and Management, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Yani Yin
- Personnel Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Bo Li
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenxing Shen
- School of Economics and Management, Nanjing Forestry University, Nanjing, Jiangsu, China
| | - Jie Chen
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaojing Huang
- School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Kim HJ, Lim JY, Jang SN. Korean primary health care program for people with disabilities: do they really want home-based primary care? BMC Health Serv Res 2023; 23:1086. [PMID: 37821901 PMCID: PMC10568830 DOI: 10.1186/s12913-023-10102-9] [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: 05/20/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Despite many studies on home-based primary care (HBPC)-related benefits and challenges, little is known about the perspectives of potential target groups of the care and their intention or preference for using it. This study aimed to explore the demand for HBPC from the perspective of people with disabilities (PWDs) and caregivers and identify relevant determinants for that demand. METHODS Data from the population-based survey conducted in the Gyeonggi Regional Health & Medical Center for People with Disabilities in South Korea were analyzed. Logistic regression analysis was performed to identify relevant determinants for the demand on HBPC. RESULTS Overall, 22% of respondents required HBPC, and 34.7% of persons aged ≥ 65 years demanded it. Older adults with disability, homebound status, and a need for assistance with daily living activities were associated with a demand for HBPC. Though having severe disability, only 19.49% of self-reported respondents demanded for HBPC, while 39.57% of proxy-reported respondents demanded for HBPC. Among self-reported group, only marital status was a predictor associated with a demand for HBPC. In contrast, among proxy-reported groups, PWDs with external physical disabilities, or with unmet medical needs due to availability barriers reported a higher demand for HBPC. CONCLUSIONS The demand for HBPC does not derive from the medical demands of the users themselves, but rather the care deficit by difficulty in getting out of the house or in outpatient care. Beyond an alternative to office-based care, HBPC needs to be considered to solve the care deficit and as well as to deal with PWDs' medical problems.
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Affiliation(s)
- Hye-Jin Kim
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, South Korea
| | - Jae-Young Lim
- Department of Gyeonggi Regional Health & Medical Center for Persons with Disabilities, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, South Korea.
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Lech S, Mümken S, Kessler EM, Gellert P. Life-space mobility among home-living older adults with care needs and clinical depression-A cross-sectional analysis. Int J Geriatr Psychiatry 2023; 38:e5875. [PMID: 36647245 DOI: 10.1002/gps.5875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVES While life-space mobility is key for wellbeing, social participation and access to health care, vulnerable older adults face physical and mental barriers that may restrict mobility. The present exploratory study examined associations between physical functional limitations, depressive symptoms, life-space mobility and outpatient health care utilization. METHODS Cross-sectional data from 197 community-dwelling older adults with care needs and clinical depression was collected. Life-space assessment composite score (LS-C), instrumental activities of daily living scale (iADL), Geriatric Depression Scale (GDS-12) and outpatient health care utilization have been assessed. Multiple regression analyses were conducted. RESULTS Mean LS-C score was 31.8 (SD = 17.7, range: 0-92), indicating low mobility levels. Depressive symptoms (β = -0.21, p = 0.001) and iADL (β = 0.54, p < 0.001) were significantly related with life-space mobility, over and above age and living alone. An interaction effect between depressive symptoms and iADL was not significant (β = -0.07, 0.17, p = 0.26). Moreover, life-space mobility was positively associated with primary care (β = 0.19, p = 0.02) and mental health care utilization (β = 0.33, p < 0.001). CONCLUSIONS Life-space mobility appears to be largely restricted in home-living vulnerable older adults with clinically significant depression; and factors associated with these restrictions appear to be physical and mental. The interplay of depression, mobility and health care utilization and its potential for interventional approaches need further investigations. Present findings underline an urgent need for new health care services that allow mobility-impaired older patients to receive mental health outpatient treatment in their own home. CLINICAL TRIAL REGISTRATION The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, registered February 15, 2019).
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Affiliation(s)
- Sonia Lech
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Mümken
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva-Marie Kessler
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Brooke J, Dunford S, Clark M. Older adult's longitudinal experiences of household isolation and social distancing during the COVID-19 pandemic. Int J Older People Nurs 2022; 17:e12459. [PMID: 35322541 PMCID: PMC9115298 DOI: 10.1111/opn.12459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 01/08/2023]
Abstract
Background Due to the global pandemic, governments have enforced household isolation and social distancing to reduce infection and mortality rate. However, the impact of prolonged enforced isolation for older people who are prone to social isolation and loneliness has yet to be understood. Objectives A longitudinal study to understand the lived experience of people aged 70 and older, living in England during COVID‐19 restrictions. Methods All participants completed five qualitative telephone interviews from 20 April to 7 July 2020. The majority completed individual interviews (n = 13), whilst two participants completed these interviews as a couple. Interviews were audio‐recorded, transcribed verbatim and thematic analysis completed from the perspective of hermeneutic phenomenology. Results Three themes included (1) engagement and confusion with government restrictions; (2) socialisation through virtual platforms and opportunistic physical social contact; and (3) accessing health care during COVID‐19 restrictions. Conclusion Older people are committed to following government restrictions, and government campaigns need to consider the potential impact of placing an emphasis on avoiding healthcare services. Virtual platforms are supportive but not sufficient to reduce social isolation and loneliness of older people. Thus, nurses supporting older people living in the community need to understand these concepts to provide holistic care and support older people's mental and physical health. Implications for practice Nurses are ideally placed to support older people to understand the current government restrictions, when to attend acute healthcare services or to engage virtually with healthcare appointments, and to discuss the risks of physically socialising with others.
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Affiliation(s)
- Joanne Brooke
- Centre of Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Sandra Dunford
- Centre of Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Maria Clark
- Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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Perngmark P, Waebuesa N, Holroyd E. Collaborative Approaches to Promote Family Caregiving for Thai-Muslim Older Adults. J Holist Nurs 2022; 41:17-29. [PMID: 35195479 DOI: 10.1177/08980101221081228] [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
This action research study aimed to develop, implement and evaluate the feasibility of an Islamic-based intervention program that included three main Islamic tenets and concept of family collaboration to promote comprehensive homebound care for Thai-Muslim older adults in southern Thailand. Using action research cycles, interviews with five dyads of healthcare recipients (Thai-Muslim older adults and their family primary caregivers) and with seven Thai-Muslim healthcare professionals (five clinical nurses, a physician and a pharmacist) were undertaken alongside participant observations. Inadequate knowledge, insufficient skills, low family involvement, poor negotiation skills, and the need for better integration of Islamic doctrines were identified. Satisfaction was expressed with the program components and activities, with a qualitative audit data revealed that family primary caregivers felt that they had gained more self-confidence, increased their caregiving knowledge and improved their skills. All stakeholders expressed a desire to further engage and maintain this collaborative program. Engaging with Islamic doctrines and concepts of family collaboration support improvements in homebound care for Muslim older adults. Using on core values of Islamic moral belief systems provides an important and culturally sensitized framework for engaging healthcare providers and family members in the Muslim older adults' comprehensive homebound care.
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Wong AKC, Bayuo J, Wong FKY. Investigating predictors of self-care behavior among homebound older adults: The role of self-efficacy, eHealth literacy, and perceived social support. J Nurs Scholarsh 2021; 54:278-285. [PMID: 34766694 DOI: 10.1111/jnu.12730] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aimed to investigate the predictors of self-care behavior among homebound older adults using the Health Empowerment theory as a framework. DESIGN This was a cross-sectional, predictive correlational study. METHODS Sixty-eight participants were randomly selected from five Hong Kong community centers from May 21, 2020 through July 20, 2020. Self-care behaviors were assessed using the Chinese version of Partners in Health. Self-efficacy, eHealth literacy, and perceived social support were assessed as potential predictors of self-care behaviors. A multiple linear regression analysis was adopted to examine the predictive effects. RESULTS The age of the sample ranged from 61 to 85 years (mean = 71.7, SD = 6.0). Participants who reported having sufficient or more than sufficient financial resources had better self-care behaviors than those who claimed to have insufficient financial resources (F = 5.08, p = 0.009). Statistically significant correlations were found between the participants' eHealth literacy (r = 0.54, p < 0.001), perceived social support (r = 0.60, p < 0.001), and self-care behaviors. eHealth literacy (β = 0.13, p = 0.007) and perceived social support (β = 0.13, p < 0.001) were significant predictors of self-care behaviors. Collectively, the three variables accounted for 41% of the variances in self-care behaviors. CONCLUSIONS The findings in this study suggest that eHealth literacy and perceived social support are two key factors that predicted the self-care behaviors of this vulnerable population. CLINICAL RELEVANCE In this technological era, the use of eHealth, together with enhanced social support, can lead to better self-care among older adults, particularly those who are homebound.
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Affiliation(s)
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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9
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Hills WE, Murphy MS, Hills KT. Assessment of virtual healthcare: predictors of access and utilization before, during,
and after the COVID-19 pandemic. MEDICAL SCIENCE PULSE 2021. [DOI: 10.5604/01.3001.0015.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Societal needs highlighted by the ongoing COVID-19 pandemic have resulted in rapid telehealth development and implementation. The broadening of guidelines for practice by regulatory bodies have
allowed providers to employ video-capable devices in the virtual delivery of services to physical- and mentalhealth clients located across a broad range of settings.
Aim of the study: This study examined use of synchronous, video-based, virtual healthcare before and during the COVID-19 pandemic. This included a comparison of: access for physical and mental health needs;
differential assessment of service provision by professionals; consumer satisfaction; and, anticipated future
use of virtual healthcare.
Material and Methods: An online survey link was sent to three participant groups: college-aged students,
adults, and retirement-aged persons. A total of 685 participants, varying in age, gender, ethnicity, and experience using tele-healthcare provided usable data for this study.
Results: Half of participants (49.2%; n=337) used virtual healthcare; more people used it during the pandemic (87.2%; n=294) than before (26.4%; n=89). Physical services (86.8%; n=291; primarily physicians) were
more common than mental health services (25.6%; n=86; primarily counselors). Access was most common
through laptop computers (60.7%; n=204). Participants were satisfied with virtual healthcare experiences
(Mdn=5). Almost all participants (94.2%; n=645) believed that virtual healthcare would continue after the
pandemic, but only two-thirds (61.3%; n=420) reported they would use virtual healthcare if available in the
future. Both previous experience with (p<0.001) and satisfaction with (p<0.001) virtual healthcare positively
predicted anticipated future use.
Conclusions: Tele-healthcare has experienced significant growth in the COVID-19 era. Emergency policy
changes have resulted in services being developed and offered in the medical and mental health realms in
conjunction with ongoing empirical evaluations of what does and does not work.
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Affiliation(s)
| | | | - Karen T. Hills
- Beaufort Jasper Hampton Comprehensive Health Services Ridgeland, SC, USA
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10
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Cheng JM, Batten GP, Yao NA. A Qualitative Study of the Social and Lived Experiences of Homebound Older Adults. J Appl Gerontol 2021; 41:744-753. [PMID: 34459256 DOI: 10.1177/07334648211040383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The number of homebound older adults is increasing in the United States. We aimed to examine their social and lived experiences and to understand their perspectives on their situation, feelings, and coping mechanisms. METHODS We conducted a cross-sectional qualitative study using semi-structured interviews with 18 older homebound individuals in Central Virginia. RESULTS Homebound older adults experienced both physical and mental health challenges that restricted their ability to participate in activities of daily living, recreation, and social interactions. Participants often felt dependent, helpless, lonely, and socially isolated. Those who communicated regularly with friends, family, and health care providers reported positive benefits from these interactions. DISCUSSION Participants faced challenges to their physical, emotional, and mental well-being. Our findings might help clinicians, policymakers, and community organizations understand how to better support homebound older adults. We should provide educational opportunities, respect their autonomy, and implement initiatives to address their isolation and loneliness.
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Affiliation(s)
- Joyce M Cheng
- University of Virginia, Charlottesville, USA.,Johns Hopkins University, Baltimore, MD, USA
| | | | - Nengliang Aaron Yao
- University of Virginia, Charlottesville, USA.,Home Centered Care Institute, Schaumburg, IL, USA.,Shandong University, Jinan, China
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11
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Rosen JM, Adams LV, Geiling J, Curtis KM, Mosher RE, Ball PA, Grigg EB, Hebert KA, Grodan JR, Jurmain JC, Loucks C, Macedonia CR, Kun L. Telehealth's New Horizon: Providing Smart Hospital-Level Care in the Home. Telemed J E Health 2021; 27:1215-1224. [PMID: 33656918 DOI: 10.1089/tmj.2020.0448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During the COVID-19 pandemic, medical providers have expanded telehealth into daily practice, with many medical and behavioral health care visits provided remotely over video or through phone. The telehealth market was already facilitating home health care with increasing levels of sophistication before COVID-19. Among the emerging telehealth practices, telephysical therapy; teleneurology; telemental health; chronic care management of congestive heart failure, chronic obstructive pulmonary disease, diabetes; home hospice; home mechanical ventilation; and home dialysis are some of the most prominent. Home telehealth helps streamline hospital/clinic operations and ensure the safety of health care workers and patients. The authors recommend that we expand home telehealth to a comprehensive delivery of medical care across a distributed network of hospitals and homes, linking patients to health care workers through the Internet of Medical Things using in-home equipment, including smart medical monitoring devices to create a "medical smart home." This expanded telehealth capability will help doctors care for patients flexibly, remotely, and safely as a part of standard operations and during emergencies such as a pandemic. This model of "telehomecare" is already being implemented, as shown herein with examples. The authors envision a future in which providers and hospitals transition medical care delivery to the home just as, during the COVID-19 pandemic, students adapted to distance learning and adults transitioned to remote work from home. Many of our homes in the future may have a "smart medical suite" as well as a "smart home office."
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Affiliation(s)
- Joseph M Rosen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Thayer School of Engineering, Hanover, New Hampshire, USA
| | - Lisa V Adams
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - James Geiling
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kevin M Curtis
- Connected Care/Center for Telehealth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robyn E Mosher
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Perry A Ball
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eliot B Grigg
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Kendra A Hebert
- Geisel School of Medicine at Dartmouth, Biomedical Research, Hanover, New Hampshire, USA
| | | | | | - Charles Loucks
- John Picard & Associates, Orem, Utah, USA.,Taurean Holdings, LLC, Orem, Utah, USA
| | - Christian R Macedonia
- Lancaster Maternal-Fetal Medicine, Lancaster General Hospital, Lancaster, Pennsylvania, USA
| | - Luis Kun
- William Perry Center for Hemispheric Defense Studies, National Defense University, Washington, District of Columbia, USA
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12
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Dassieu L, Sourial N. Tailoring interventions for social isolation among older persons during the COVID-19 pandemic: challenges and pathways to healthcare equity. Int J Equity Health 2021; 20:26. [PMID: 33419420 PMCID: PMC7791535 DOI: 10.1186/s12939-020-01360-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social isolation among older adults raises major issues for equity in healthcare in the context of the COVID-19 pandemic. MAIN TEXT This commentary describes current challenges in preventing social isolation among older adults and proposes pathways to develop inclusive approaches to intervention in this vulnerable population. Building interventions that take account of structural inequities among older persons, as well as their subjective experiences, expectations and perspectives, appears fundamental to improve their health and quality of life in pandemic and post-pandemic contexts. CONCLUSIONS We argue that equity-based and person-centered approaches are critical to counter the negative outcomes of social isolation in the vulnerable older population.
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Affiliation(s)
- Lise Dassieu
- Research Center of the Centre Hospitalier de l'Université de Montréal, 850 St Denis Street, Saint Antoine Tower, Office S01.135, H2X 0A9, Montréal, Quebec, Canada.
| | - Nadia Sourial
- Research Center of the Centre Hospitalier de l'Université de Montréal, 850 St Denis Street, Saint Antoine Tower, Office S01.135, H2X 0A9, Montréal, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
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13
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Robinson JM, Cameron R. The Holobiont Blindspot: Relating Host-Microbiome Interactions to Cognitive Biases and the Concept of the " Umwelt". Front Psychol 2020; 11:591071. [PMID: 33281689 PMCID: PMC7705375 DOI: 10.3389/fpsyg.2020.591071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/29/2020] [Indexed: 01/13/2023] Open
Abstract
Cognitive biases can lead to misinterpretations of human and non-human biology and behavior. The concept of the Umwelt describes phylogenetic contrasts in the sensory realms of different species and has important implications for evolutionary studies of cognition (including biases) and social behavior. It has recently been suggested that the microbiome (the diverse network of microorganisms in a given environment, including those within a host organism such as humans) has an influential role in host behavior and health. In this paper, we discuss the host’s microbiome in relation to cognitive biases and the concept of the Umwelt. Failing to consider the role of host–microbiome (collectively termed a “holobiont”) interactions in a given behavior, may underpin a potentially important cognitive bias – which we refer to as the Holobiont Blindspot. We also suggest that microbially mediated behavioral responses could augment our understanding of the Umwelt. For example, the potential role of the microbiome in perception and action could be an important component of the system that gives rise to the Umwelt. We also discuss whether microbial symbionts could be considered in System 1 thinking – that is, decisions driven by perception, intuition and associative memory. Recognizing Holobiont Blindspots and considering the microbiome as a key factor in the Umwelt and System 1 thinking has the potential to advance studies of cognition. Furthermore, investigating Holobiont Blindspots could have important implications for our understanding of social behaviors and mental health. Indeed, the way we think about how we think may need to be revisited.
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Affiliation(s)
- Jake M Robinson
- Department of Landscape Architecture, The University of Sheffield, Sheffield, United Kingdom.,In vivo Planetary Health, Worldwide Universities Network (WUN), West New York, NJ, United States.,The Healthy Urban Microbiome Initiative (HUMI), Australia
| | - Ross Cameron
- Department of Landscape Architecture, The University of Sheffield, Sheffield, United Kingdom
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14
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LeMaster JW. 23.4 Briefing. Health Expect 2020; 23:719-721. [PMID: 32939947 PMCID: PMC7495074 DOI: 10.1111/hex.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joseph W LeMaster
- Department of Family Medicine and Community Health School of Medicine University of Kansas Kansas City KS USA
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15
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Cheng JM, Batten GP, Cornwell T, Yao N. A qualitative study of health-care experiences and challenges faced by ageing homebound adults. Health Expect 2020; 23:934-942. [PMID: 32476232 PMCID: PMC7495080 DOI: 10.1111/hex.13072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The ageing of the global population is associated with an increasing prevalence of chronic diseases and functional impairments, resulting in a greater proportion of homebound individuals. OBJECTIVE To examine the health-care experiences of older homebound adults who have not previously received home-based primary care (HBPC). To explore their impressions of this method of care. DESIGN Cross-sectional qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS 18 older homebound individuals in Central Virginia. RESULTS Our findings revealed that homebound individuals faced significant health challenges, including pain resulting from various comorbidities. They felt that their mobility was restricted by their physical conditions and transportation challenges. These were major barriers to social outings and health-care access. Participants left their homes infrequently and typically with assistance. Regarding office-based care, participants were concerned about long wait times and making timely appointments. Some thought that HBPC would be convenient and could result in better quality care; however, others believed that the structure of the health-care system and its focus on efficiency would not permit routine HBPC. DISCUSSION AND CONCLUSIONS Older homebound adults in this study faced high burdens of disease, a lack of mobility and difficulty accessing quality health care. Our observations may help researchers and clinicians better understand the health-care experiences and personal opinions of older homebound individuals, informing the development of effective and empathetic home-based care. Participant responses illuminated a need for education about HBPC. We must improve health-care delivery and develop comprehensive, patient-centered HBPC to meet the needs of homebound individuals.
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Affiliation(s)
- Joyce M. Cheng
- University of Virginia College of Arts and SciencesCharlottesvilleVAUnited States
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
| | - George P. Batten
- University of Virginia Cancer CenterCharlottesvilleVAUnited States
| | | | - Nengliang Yao
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
- Home Centered Care InstituteSchaumburgILUnited States
- University of Virginia School of MedicineCharlottesvilleVAUnited States
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