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Noh H, Suntai Z, Won C, Jeong H, Lee LH. A Qualitative Exploration of Rural Older Adults' Experiences With Pain From Chronic Illnesses and Its Treatment. Res Aging 2024:1640275241246279. [PMID: 38613140 DOI: 10.1177/01640275241246279] [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: 04/14/2024]
Abstract
Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.
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Affiliation(s)
- Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Chorong Won
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Haelim Jeong
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - Lewis H Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, USA
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Smalls BL, Kruse-Diehr A, Ortz CL, Douthitt K, McLouth C, Shelton R, Taylor Z, Williams E. Older adults using social support to improve self-care (OASIS): Adaptation, implementation and feasibility of peer support for older adults with T2D in appalachia: A feasibility study protocol. PLoS One 2024; 19:e0300196. [PMID: 38498512 PMCID: PMC10947915 DOI: 10.1371/journal.pone.0300196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes (T2D) is 17% higher in rural dwellers compared to their urban counterparts, and it increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. In rural Kentucky, up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are vital when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors and clinical and psychosocial outcomes related to T2D; however, literature also suggests self-selected social support can be obstructive when engaging in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used to prioritize older adults, especially those living in rural communities. METHOD To address this gap, we conducted formative research with stakeholders, and collaboratively identified an acceptable and feasible peer support EBI-peer health coaching (PHC)-that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. The goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. Testing the PHC components of the peer support intervention will be instrumental in promoting care for older adults in Appalachia, as it will allow for a larger scale intervention, which if effective, could be disseminated to community partners in Appalachia. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov (NCT06003634) in August 2023.
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Affiliation(s)
- Brittany L. Smalls
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Aaron Kruse-Diehr
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Courtney L. Ortz
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Key Douthitt
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Christopher McLouth
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States of America
| | - Rachel Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Zoe Taylor
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Edith Williams
- Center for Community Health and Prevention, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States of America
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Cousins S, McKechnie R, Jackman P, Middleton G, Rasekaba T, Blackberry I. Interventions to Increase Physical Activity in Community-Dwelling Older Adults in Regional and Rural Areas: A Realist Synthesis Review Protocol. Methods Protoc 2023; 6:mps6020029. [PMID: 36961049 PMCID: PMC10037574 DOI: 10.3390/mps6020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The importance of physical activity (PA) for the health and wellbeing of older adults is well documented, yet many older adults are insufficiently active. This issue is more salient in regional and rural areas, where evidence of the most critical components of interventions that explain PA participation and maintenance in older populations is sparse. This realist review will (1) systematically identify and synthesise literature on PA interventions in community-dwelling older adults in regional and rural areas, and (2) explore how and why those interventions increase PA in that population. Using a realist synthesis framework and the behaviour change wheel (BCW), context-mechanism-outcome (C-M-O) patterns of PA interventions for older adults in regional and rural areas will be synthesised. Thematic analysis will be employed to compare, contrast, and refine emerging C-M-O patterns to understand how contextual factors trigger mechanisms that influence regional and rural community-dwelling older adults' participation in PA interventions. This realist review will be the first to adopt a BCW analysis and a realist synthesis framework to explore PA interventions in community-dwelling older adults in regional and rural areas. This review will provide recommendations for evidence-based interventions to improve PA participation and adherence by revealing the important mechanisms apparent in this context. Systematic review registration: (PROSPERO CRD42023402499).
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Affiliation(s)
- Stephen Cousins
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Rebecca McKechnie
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Patricia Jackman
- School of Sport and Exercise Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Geoff Middleton
- School of Sport and Exercise Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Tshepo Rasekaba
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe University, Albury-Wodonga Campus, Wodonga, VIC 3689, Australia
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Fuller-Thomson E, Ferreirinha J, Ahlin KM. Temporal Trends (from 2008 to 2017) in Functional Limitations and Limitations in Activities of Daily Living: Findings from a Nationally Representative Sample of 5.4 Million Older Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2665. [PMID: 36768031 PMCID: PMC9915038 DOI: 10.3390/ijerph20032665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
This study's objectives are as follows: (1) to identify the temporal trends in the prevalence and the odds of activities of daily living (ADL) limitations and functional limitations (FLs) among Americans aged 65 and older; (2) to explore if these trends vary by gender and age cohort; (3) to determine if generational differences in educational attainment play a role in the observed temporal trends. A secondary analysis of the American Community Survey (ACS) was conducted for ten consecutive waves of the annual cross-sectional survey (2008-2017). The respondents were community-dwelling and institutionalized adults aged 65 and older (n = 5.4 million). The question on ADLs was "Does this person have difficulty dressing or bathing?". The question on FLs was "Does this person have serious difficulty walking or climbing stairs?". There was a substantial decline over the decade in the prevalence of ADL limitations, from 12.1% to 9.6%, and FLs, from 27.3% to 23.5%. If the 2017 prevalence rates had remained at the same level as the 2008 prevalence rates, there would have been an additional 1.27 million older Americans with ADL limitations and 1.89 million with FLs. Adjusting for educational attainment substantially attenuated the odds of the decline for both ADL limitations and FLs.
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Affiliation(s)
- Esme Fuller-Thomson
- Institute for Life Course & Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Jason Ferreirinha
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Katherine Marie Ahlin
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
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Jo A, Dai M, Peterson L, Mainous III AG. Trends of Geriatric Certification and Practice Patterns of Family Physicians: 1988-2019. Fam Med 2023; 55:95-102. [PMID: 36787517 PMCID: PMC10614548 DOI: 10.22454/fammed.2023.917437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Demand for geriatric care is increasing due to aging population. Trends in maintaining certification in geriatrics are unreported. Our objective was to describe the historic trend of family physicians who certified in geriatric medicine (FPs-GM) since 1988 and to assess differences in practice patterns between FPs-GM and family physicians (FPs). METHODS We performed a retrospective descriptive study using administrative data collected by the American Board of Family Medicine (ABFM). The study population was family physicians registering to continue their ABFM certification from 2017 to 2019. Medicare public use billing data was linked to ABFM administrative data on certification history. We used univariate analysis for descriptive analysis and logistic regression to identify contributors of recertification in geriatrics. RESULTS We identified a total of 3,207 FPs-GM between 1988 and 2019. More than half maintained GM certification since 2009 (57%), with male gender, White race, and urban practice associated with maintaining GM certification; 61% of their patients were older adults. FPs-GM were more likely to be in an academic practice setting with nearly half (53%) also practicing in hospitals or nursing homes. In the adjusted regression model, younger FPs or FPs who treat more older patients were significantly more likely to be recertified in geriatrics whereas other demographics and practice characteristics were not significant. CONCLUSIONS Most FPs who recently earned GM certification tended to retain certification since the required accredited fellowship started in 1995.
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Affiliation(s)
- Ara Jo
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
| | | | | | - Arch G. Mainous III
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
- Department of Community Health and Family Medicine, University of FloridaGainesville, FL
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Sun Y. Physical activity's impact on rural older adult health: The multiple mediating effects of education, income, and psychological capital. Front Public Health 2023; 11:1173217. [PMID: 37139375 PMCID: PMC10150060 DOI: 10.3389/fpubh.2023.1173217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction This study aims to explore the influence mechanism of rural older adult health. By examining the mediating roles of education, income, and psychological capital in physical activity's impact on health, this study provides a reference for lifestyle interventions to improve the health level of rural older adults. Methods The analysis was conducted on a sample of 1778 rural older adults from CGSS2017, and data were analyzed using PROCESS V4.2 for multiple mediating effects. Results The findings indicate that physical activity impacts rural older adult health through multiple mediating pathways. The mediating role includes seven paths, comprising the independent effects of three mediating variables of income, education, and psychological capital, and the chain mediating effects generated together. Discussion Based on the influence mechanism of health on rural older adults, optimizing policy focus and developing a precise, interconnected, and sustainable health security system for older adults is necessary. These research results are of practical significance for advancing healthy aging in rural areas.
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Valliant JC, Burris ME, Czebotar K, Stafford PB, Giroux SA, Babb A, Waldman K, Knudsen DC. Navigating Food Insecurity as a Rural Older Adult: The Importance of Congregate Meal Sites, Social Networks and Transportation Services. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2021.1977208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Mecca E. Burris
- Sustainable Food Systems Science, The Ostrom Workshop, Indiana University, Bloomington, Indiana USA
| | - Kamila Czebotar
- Food Institute, Indiana University, Bloomington, Indiana USA
| | - Philip B. Stafford
- Sustainable Food Systems Science, The Ostrom Workshop, Indiana University, Bloomington, Indiana USA
| | - Stacey A. Giroux
- Department of Anthropology, Indiana University, Bloomington, Indiana USA
- Sustainable Food Systems Science, The Ostrom Workshop, Indiana University, Bloomington, Indiana USA
| | - Angela Babb
- Department of Anthropology, Indiana University, Bloomington, Indiana USA
| | - Kurt Waldman
- Food Institute, Indiana University, Bloomington, Indiana USA
| | - Daniel C. Knudsen
- Food Institute, Indiana University, Bloomington, Indiana USA
- Department of Geography, Indiana University, Bloomington, Indiana USA
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Chaffee O, McGillivray A, Duizer L, Ross CF. Identifying elements of a ready-to-eat meal desired by older adults. Food Res Int 2022; 157:111353. [DOI: 10.1016/j.foodres.2022.111353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
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Miyazaki R, Abe T, Yano S, Okuyama K, Sakane N, Ando H, Isomura M, Yamasaki M, Nabika T. Associations between physical frailty and living arrangements in Japanese older adults living in a rural remote island: The Shimane
CoHRE
study. J Gen Fam Med 2022; 23:310-318. [PMID: 36093222 PMCID: PMC9444019 DOI: 10.1002/jgf2.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Ryo Miyazaki
- Faculty of Human Sciences Shimane University Matsue‐shi Japan
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
| | - Takafumi Abe
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
| | - Shozo Yano
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
| | - Kenta Okuyama
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
- Center for Primary Health Care Research Lund University Malmö Sweden
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute for Endocrine and Metabolic Disease, Kyoto Medical Center National Hospital Organization Kyoto Japan
| | - Hitoshi Ando
- Department of Cellular and Molecular Function Analysis Kanazawa University Graduate School of Medical Sciences Kanazawa Japan
| | - Minoru Isomura
- Faculty of Human Sciences Shimane University Matsue‐shi Japan
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
| | - Masayuki Yamasaki
- Faculty of Human Sciences Shimane University Matsue‐shi Japan
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
| | - Toru Nabika
- Center for Community‐Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information Shimane University Izumo‐shi Japan
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Chandel T, Alulaiyan M, Farraj M, Riedy CA, Barrow JR, Brennan L, Thompson L, Bass MB, Chamut S. Training and educational programs that support geriatric dental care in rural settings: A scoping review. J Dent Educ 2022; 86:792-803. [DOI: 10.1002/jdd.12885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/08/2022] [Indexed: 12/18/2022]
Affiliation(s)
- Tejasvita Chandel
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Mohammed Alulaiyan
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Malik Farraj
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Christine A. Riedy
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Jane R. Barrow
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Leonard Brennan
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Lisa Thompson
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Michelle B. Bass
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Steffany Chamut
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
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Jung SE, Shin YH, Cave L, Rockett J, Hermann J. Understanding Whole Grain Consumption among Low-Income Older Adults Using the Theory of Planned Behavior. J Nutr Gerontol Geriatr 2022; 41:46-64. [PMID: 34983322 DOI: 10.1080/21551197.2021.2024477] [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: 10/19/2022]
Abstract
Older adults have low whole grain (WG) intake. This qualitative study used the Theory of Planned Behavior (TPB) to identify low-income older adults' WG beliefs. A convenience sample of 25 low-income adults 60 years and older were interviewed using questions developed based on TPB constructs: behavioral, normative, and control beliefs. Interviews were audio-recorded, transcribed verbatim, cross-checked for consistency, and analyzed using content analysis. Study results revealed that regarding behavioral beliefs, health benefits, taste, and nutrition were WG advantages and sensory qualities, higher cost, and longer cooking time were disadvantages. Regarding normative beliefs, healthcare professionals and family members approved WG intake and those less informed about WGs disapproved. Regarding control beliefs, availability/accessibility, knowledge of WG benefits, and WG cooking skills facilitated WG intake and age-related changes, WG cost, decreased motivation to cook, and low knowledge (label reading) were barriers. Results provide insights for developing programs to increase older adults' WG intake.
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Affiliation(s)
- Seung Eun Jung
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Yeon Ho Shin
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Lauren Cave
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Julianne Rockett
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Janice Hermann
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
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Ridenhour BJ, Sarathchandra D, Seamon E, Brown H, Leung FY, Johnson-Leon M, Megheib M, Miller CR, Johnson-Leung J. Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey. PLoS One 2022; 17:e0268302. [PMID: 35594254 PMCID: PMC9122183 DOI: 10.1371/journal.pone.0268302] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.
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Affiliation(s)
- Benjamin J. Ridenhour
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, United States of America
- * E-mail:
| | - Dilshani Sarathchandra
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Culture, Society and Justice, University of Idaho, Moscow, ID, United States of America
| | - Erich Seamon
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
| | - Helen Brown
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Movement Science, University of Idaho, Moscow, ID, United States of America
| | - Fok-Yan Leung
- Department of Culture, Society and Justice, University of Idaho, Moscow, ID, United States of America
| | - Maureen Johnson-Leon
- Department of Integrative Biology, University of Texas–Austin, Austin, TX, United States of America
| | - Mohamed Megheib
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
| | - Craig R. Miller
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Biological Sciences, University of Idaho, Moscow, ID, United States of America
| | - Jennifer Johnson-Leung
- Institute for Modeling for Collaboration and Innovation, University of Idaho, Moscow, ID, United States of America
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, United States of America
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Kuo YL, Chou WT, Chu CH. Urban-rural differences in factors affecting mortality and causes of death among older adults. Geriatr Nurs 2021; 43:151-158. [PMID: 34896672 DOI: 10.1016/j.gerinurse.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
This study examined the differences in factors affecting mortality between urban and rural areas in Taiwan. A retrospective study design was adopted by using the older adult health examination data during 2013-2019 from Hualien, Taiwan. The overall mortality risk in rural areas was significantly higher than urban areas. However, there was no significant difference in the mortality risk between the urban and rural older adults with unhealthy behaviors. Betel nut chewing was a significant risk factor of mortality among the rural older adults, while alcohol consumption was a protective factor; smoking, hepatitis C, and mental illness were significant risk factors among the urban older adults. The rural older adults had a higher rate of death from heart disease and lower rate of death from sepsis than the urban older adults. This study highlights the importance of individualized health promotion strategies for urban and rural areas for reducing mortality from disease.
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Affiliation(s)
- Yu-Lun Kuo
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan, 880, Sec. 2, Chien-Kuo Rd. Hualien, 970, Taiwan (R.O.C.)
| | - Wei-Ting Chou
- Hualien County Health Bureau, Hualien, Taiwan, No.200, Xinxing Rd., Hualien City, Hualien County 970, Taiwan (R.O.C.)
| | - Chia-Hsiang Chu
- Hualien County Health Bureau, Hualien, Taiwan, No.200, Xinxing Rd., Hualien City, Hualien County 970, Taiwan (R.O.C.).
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Hefner JL, Nembhard IM, Litwin AS. Technological Change and Frontline Care Delivery Work: Toward the Quadruple Aim. Adv Health Care Manag 2021; 20. [PMID: 34779182 DOI: 10.1108/s1474-823120210000020005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic stressed the health care sector's longstanding pain points, including the poor quality of frontline work and the staffing challenges that result from it. This has renewed interest in technology-centered approaches to achieving not only the "Triple Aim" of reducing costs while raising access and quality but also the "Quadruple Aim" of doing so without further squeezing wages and abrading job quality for frontline workers. How can we leverage technology toward the achievement of the Quadruple Aim? I view this as a "grand challenge" for health care managers and policymakers. Those looking for guidance will find that most analyses of the workforce impact of technological change consider broad classes of technology such as computers or robots outside of any particular industry context. Further, they typically predict changes in work or labor market outcomes will come about at some ill-defined point in the medium to long run. This decontextualization and detemporization proves markedly problematic in the health care sector: the nonmarket, institutional factors driving technology adoption and implementation loom especially large in frontline care delivery, and managers and policymakers understandably must consider a well-defined, near-term, i.e., 5-10-year, time horizon. This study is predicated on interviews with hospital and home health agency administrators, union representatives, health care information technology (IT) experts and consultants, and technology developers. I detail the near-term drivers and anticipated workforce impact of technological changes in frontline care delivery. With my emergent prescriptions for managers and policymakers, I hope to guide sectoral actors in using technology to address the "grand challenge" inherent to achieving the Quadruple Aim.
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The Impact of Natural Hazards on Older Adult Health: Lessons Learned From Hurricane Maria in Puerto Rico. Disaster Med Public Health Prep 2021; 17:e52. [PMID: 34725020 DOI: 10.1017/dmp.2021.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE With natural hazards increasing in frequency and severity and global population aging, preparedness efforts must evolve to address older adults' risks in disasters. This study elucidates potential contributors to the elevated older adult mortality risk following Hurricane Maria in Puerto Rico through an examination of community stakeholder preparedness, response, and recovery experiences. METHODS In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities. Interview transcripts were deductively and inductively coded and analyzed to identify salient topics and themes representing participant response patterns. RESULTS The hurricane's detrimental impact on older adult health emerged as a prominent finding. Through 6 months post-hurricane, many older adults experienced unmet needs that contributed to declining physical and emotional health, inadequate non-communicable disease management, social isolation, financial strain, and excess morbidity and mortality. These needs were predominantly consequences of lengthy public service gaps, unsafe living conditions, interrupted health care, and the incongruence between preparedness and event severity. CONCLUSIONS In a landscape of increasing natural hazard frequency and magnitude, a pattern of older adult risk has become increasingly clear. Study findings compel practitioners to engage in natural hazard preparedness planning, research, and policy-making that considers the multiple facets of older adult well-being.
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17
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Kitayuguchi J, Abe T, Okuyama K, Gomi T, Okada S, Shiwaku K, Mutoh Y. Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study. J Rural Med 2021; 16:214-221. [PMID: 34707730 PMCID: PMC8527625 DOI: 10.2185/jrm.2021-028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Falls in older adults are a major public health issue, and it is
unclear whether the neighborhood environment is associated with falls among this group.
This cross-sectional study investigated whether hilly neighborhood environmental factors
were associated with fall status (falls or fear of falling) in rural Japanese older
adults. Materials and Methods: Data obtained from 965 participants aged 65 years and
older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status
was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of
falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental
factors, the mean elevation and land slope were assessed using a geographic information
system. The logistic regression model examined the odds ratios (OR) and 95% confidence
intervals (CIs) of fall status in quartiles for elevation and land slope, respectively,
and was adjusted for confounders. Results: Falls and fear of falling were observed in 16.8% and 43.2% of
participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI
1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74,
95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling
was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR
1.51, 95% CI 1.01–2.25 for Q4 vs. Q1). Conclusion: Our study found that elevation and land slope as hilly
neighborhood environment factors were positively associated with falls or fear of falling
among older adults living in rural Japan. Prospective observational studies that
investigate the effects of region-specific environmental factors on falls among older
adults should be conducted.
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Affiliation(s)
- Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN, Japan
| | - Takafumi Abe
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Japan
| | - Kenta Okuyama
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Japan.,Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | | | - Shinpei Okada
- Physical Education and Medicine Research Foundation, Japan
| | | | - Yoshiteru Mutoh
- The Research Institute of Health Rehabilitation of Tokyo, Japan
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18
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Li H, Wang C. The Relationships Among Structural Social Support, Functional Social Support, and Loneliness in Older Adults: Analysis of Regional Differences Based on a Multigroup Structural Equation Model. Front Psychol 2021; 12:732173. [PMID: 34650489 PMCID: PMC8507854 DOI: 10.3389/fpsyg.2021.732173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study investigated the relationship between structural social support and loneliness and explored whether functional social support had an intermediate role therein. It also employed a multigroup structural equation model to compare mediation models among older adults living in cities, towns, and rural areas. Methods: Using a self-made demographics questionnaire, the structural-functional social support scale, and the 3-item UCLA loneliness scale, this study collected information from 1,325 older adults identified via convenient sampling. Results: The results showed that as: (1) compared with older adults living in towns, older urban, and rural adults had higher structural social support and experienced less loneliness, while older adults' functional social support showed no difference among the three regions (2) An analysis of the models of regional differences indicated that functional social support served as a full mediator in the relationship between structural social support and loneliness in urban older adults, and a partial mediator for older adults living in towns and rural areas. Conclusion: The relationship between structural social support and loneliness is mediated by functional social support, and this mediation model varies between older adults in cities and towns/rural areas. This study helps us understand possible mechanisms through which structural social support impacts loneliness. It suggests that nursing strategies for older adults should be adjusted according to the region and direct greater focus on the function (or quality) of the social support network and older adults living in towns.
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Affiliation(s)
- Haifeng Li
- School of Psychology, Fujian Normal University, Fuzhou, China
| | - Cong Wang
- Fuzhou Hualun Middle School, Fuzhou, China
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19
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Schmidt T, Christiansen LB, Schipperijn J, Cerin E. Social network characteristics as correlates and moderators of older adults' quality of life-the SHARE study. Eur J Public Health 2021; 31:541-547. [PMID: 33547475 DOI: 10.1093/eurpub/ckab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The quality of life (QoL) of older adults is a key aspect of healthy ageing, and older adults' socioeconomic status (SES), the neighbourhood they live in and their social networks (SN) are known to impact QoL. However, little is known about the interaction between these concepts. The aim was to examine how SN, SES and neighbourhood type are associated with QoL in older adults. METHODS : Wave 4 (year 2011) and wave 6 (year 2015) data from the longitudinal Survey of Health, Ageing and Retirement in Europe were used for the analysis. Multilevel regression models estimated the associations including 34 792 participants from wave 4 and 67 334 participants from wave 6 from 16 countries (mean age = 66.45 years). The outcome variable was QoL, independent variables were SES (education and making end meet) and neighbourhood type (housing type and housing area), and SN variables (satisfaction and size) were the moderators. RESULTS : SES and SN variables were positively associated with QoL. Living in a house or duplex was positively associated with QoL compared with living in a farmhouse. SN moderated the association between education and QoL. The effect of area type on QoL was moderated by SN size. SN satisfaction was an independent correlate of QoL. CONCLUSION : Older adults' satisfaction with their SN may be more important than having a large SN. Low SES older adults may be more prone to having weak SN. Maintaining and creating supportive SN may attenuate the negative effects of low SES or less favourable neighbourhood characteristics.
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Affiliation(s)
- Tanja Schmidt
- Research Unit for Active Living, Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars B Christiansen
- Research Unit for Active Living, Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jasper Schipperijn
- Research Unit for Active Living, Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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20
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Han A, Carayannopoulos AG. Comprehensive Analysis of Trends in Medicare Utilization and Reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017. PM R 2021; 14:1188-1197. [PMID: 34392617 DOI: 10.1002/pmrj.12692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is an absence of literature describing Medicare utilization by physiatrists, despite their key role in treating Medicare enrollees with qualifying disabilities and common neuromusculoskeletal conditions. OBJECTIVE Analyze Medicare data regarding physiatrists and their beneficiaries, services, and reimbursement, as well as trends in utilization and geographic distribution. DESIGN AND SETTING Retrospective analysis of publicly available Center for Medicare & Medicaid Services data for Medicare beneficiaries receiving physiatric services from 2012-2017. MAIN OUTCOME MEASURES After adjustment for inflation, variables assessed for changes over time included provider and beneficiary demographics, total Medicare reimbursement, and number of services provided, subsequently separated by drug and medical service metrics. Lorenz curves and Gini coefficients were computed to study reimbursement inequality. Choropleth maps were generated to assess geographic differences in physician density and reimbursement, both by state and ZIP code. RESULTS The number of physiatrists utilizing Medicare increased from 7230 to 7895 from 2012-2017, while the average number of unique beneficiaries per clinician remained constant (307 vs 310; P = 0.51). Beneficiaries' mean hierarchical conditions category (HCC) health risk score, normalized to 1.0 for the average beneficiary, increased significantly from 2012-2017 (1.72 vs 1.80; P < 0.01). Mean Medicare reimbursement per physiatrist decreased significantly from 2012-2017 ($131 960 vs $117 623; P < 0.001), while mean number of services remained constant (3243 vs 3077; P = 0.132). Botulinum toxin and baclofen injections were the two most reimbursed drug-related services. Gini coefficients ranged from 0.52-0.53 for 2012-2017, suggesting moderate reimbursement inequality, with the 75th percentile receiving on average 2 times the median. Both physician density and top earners were concentrated in urban and metropolitan areas. CONCLUSIONS Despite rising healthcare costs and increasing medical complexity of physiatrists' beneficiaries, Medicare payments have decreased over time. These trends are relevant to both providers and policy makers, particularly in light of unequal geographic distribution of physiatrists across the country. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alex Han
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
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21
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Gibson N, Arends R, Voss J, Marckstadt S, Nissen MK. Reinforcing Telehealth Competence Through Nurse Practitioner Student Clinical Experiences. J Nurs Educ 2021; 59:413-417. [PMID: 32598014 DOI: 10.3928/01484834-20200617-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/26/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Telehealth is becoming increasingly integral in providing improved access to care, especially for patients who reside in frontier and rural areas. Nurse practitioner (NP) faculty are charged with preparing NP students through curriculum and clinical experiences that align with the health care environment and the health care access needs of the populations they serve. METHOD To meet this need, NP faculty at a land-grant university located in a frontier and rural midwestern state reinforced NP student telehealth curriculum and competency through application in a clinical environment. RESULTS Participants included 22 family NP (FNP) students and 19 clinical preceptors. According to the evaluations, the FNP students met seven of the eight competency criteria, and the preceptors met eight of the 13 evaluation criteria. CONCLUSION Outcomes indicate telehealth curriculum competency can be reinforced through application in a clinical setting to prepare NP students to meet the needs of patients and changing health care environments. [J Nurs Educ. 2020;59(7):413-417.].
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22
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Multi-Dimensional Accessibility Barriers in Care Services for the Rural Elderly with Disabilities: A Qualitative Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126373. [PMID: 34204657 PMCID: PMC8296197 DOI: 10.3390/ijerph18126373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
This research covers a multi-dimensional investigation into accessibility barriers in care services for older people with disabilities in rural China. In-depth interviews with 13 rural disabled older people in China were conducted using qualitative methods. Based on a welfare pluralism approach, the results showed that in comparison with urban areas, care services for disabled older populations in rural areas are more subject to social barriers. This can be seen in the limited state (lack of resources, rigorous eligibility qualifications, uneven distribution, and irregular implementation); the absent market (low levels of consumption, high cost pressures, self-exclusion, and traditional cultural constraints); absent NGOs and volunteers (difficulties in access for NGOs and volunteers outside the area and formation difficulties of local NGOs and volunteers); as well as low-quality care in households and communities (unprofessional care from the spouse, unsustainable care from children, and unavailable community-based care). A multi-subject support network should be established to remove accessibility barriers to care services for older people with disabilities in rural areas through active intervention and interaction. The results of the research provide insights that will aid in the formulation of future social care service plans and health policies for rural older people with disabilities.
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23
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Lee E, Williams JM. Examining Coping Skills as a Mediating Factor in Perceived Stress and Life Satisfaction: A Comparison Between Minority and Nonminority Older Adults. Int J Aging Hum Dev 2021; 95:72-90. [PMID: 34110921 DOI: 10.1177/00914150211024178] [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: 11/16/2022]
Abstract
Although stress due to racial and ethnic differences can negatively impact life satisfaction, there is a lack of focus on the differences between minority and nonminority older adults in how stress and coping skills impact life satisfaction. The objectives of this study are to explore (a) the differences between minority and nonminority older adults in their levels of life satisfaction, stress, and coping skills; and (b) the mediating effects of coping skills on the relationship between perceived stress and life satisfaction among both groups. Cross-sectional data from the Well Elderly 2 study (N = 460) were utilized in bivariate and mediation analyses. Minority older adults reported higher levels of stress and prioritized different coping skills. Mediation was not supported for either group. These findings enable practitioners to focus on the coping skills more frequently identified by clients' racial/ethnic grouping, as well as to target the primary stressors identified.
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Affiliation(s)
- Eunyoung Lee
- 34942 Department of Social Welfare, Dongguk University, Seoul, South Korea
| | - Jaclyn M Williams
- 7823 College of Social Work, Florida State University, Tallahassee, FL, USA
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24
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Jónsdóttir HL, Ruthig JC. A longitudinal study of the negative impact of falls on health, well-being, and survival in later life: the protective role of perceived control. Aging Ment Health 2021; 25:742-748. [PMID: 32081033 DOI: 10.1080/13607863.2020.1725736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Falls can have detrimental effects on older adults' psychological well-being, physical health, and survival rates. However, certain psychosocial mediators may lessen the negative impact of suffering a fall on health and well-being. Perceived control is a psychosocial factor that was examined as a mediator of the falls - health and well-being relationship in the current study.Method: Participants were 232 community-dwelling older adults, age 68 or older who took part in a longitudinal study in 2008 and 2010 and completed measures of perceived control, self-rated health, health-care utilization, number of falls, depressive symptomology, and perceived stress. Survival was also tracked for seven years from 2008 through 2015.Results: Older adults who suffered a fall had poorer health and well-being two years later compared to those who did not suffer a fall. Perceived control mediated the negative impact of falls on subsequent health and well-being outcomes two years later. Among older adults who experienced a fall, higher levels of perceived control predicted better subsequent health and well-being. Suffering one or more falls also predicted less likelihood of survival seven years later, beyond the effects of age, gender, marital status, and education.Conclusion: Findings highlight the importance of assessing risk of falling and levels of perceived control in later life.
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Affiliation(s)
- Harpa Lind Jónsdóttir
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Joelle C Ruthig
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
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25
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Behrman P, Fitzgibbon ML, Dulin A, Wang ML, Baskin M. Society of behavioral medicine statement on COVID-19 and rural health. Transl Behav Med 2021; 11:625-630. [PMID: 33289790 PMCID: PMC7798550 DOI: 10.1093/tbm/ibaa114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This position statement provides researchers, practitioners, and policymakers an overview of pre-existing and COVID-related rural health inequities in the United States (U.S.) and how they have been exacerbated by the COVID-19 pandemic. "Health deserts," defined as "large areas with inadequate or nonexistent medical and trauma facilities," are common in rural regions of the U.S. While telehealth could address some of these health-related inequities, significant gaps in broadband Internet availability are also common in these more remote areas. The Society of Behavioral Medicine urges Congress to authorize increased funding to rural healthcare facilities and staffing, along with the development of enhanced broadband Internet infrastructure. In addition, incentivizing rural healthcare systems to deliver value-based care could enhance their capacity to implement population health and behavioral health strategies. To stem the spread of COVID-19 in higher-risk rural-based industries (e.g., food processing plants), SBM urges Congress to require the Occupational Safety and Health Administration (OSHA) to routinely inspect for and enforce COVID-19 mitigation procedures, such as provision of effective Personal Protective Equipment (PPE) to all front-line workers and consistent implementation of standardized testing and social distancing advisories. The context of rural communities underscores the importance of tailored approaches to mitigate rural health inequities and promote the well-being of rural residents.
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Affiliation(s)
- Pamela Behrman
- Department of Psychology, College of Mt. St. Vincent, Bronx, NY
| | - Marian L Fitzgibbon
- Institute for Health Research and Policy, University of Illinois, Chicago, IL
| | - Akilah Dulin
- Center for Health Promotion and Health Equity, Brown University, Providence, RI
| | - Monica L Wang
- Boston University School of Public Health, Boston, MA
| | - Monica Baskin
- School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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26
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Bardach SH, Gibson A, Parsons K, Stauffer A, Jicha GA. Rural Caregivers: Identification of Informational Needs Through Telemedicine Questions. J Rural Health 2021; 37:406-411. [PMID: 32246530 PMCID: PMC7541628 DOI: 10.1111/jrh.12431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The prevalence of Alzheimer's disease and associated disorders is increasing. Rural residents in the United States have less access to memory care specialists and educational and community resources than in other areas of the country. Over a decade ago, we initiated an interdisciplinary rural caregiving telemedicine program to reach Kentucky residents in areas of the state where resources for supporting individuals with dementia are limited. Telemedicine programs involve a short informational presentation followed by a question and answer session; programs are offered 4 times a year. The purpose of this study was to explore questions asked over 1 year of the rural caregiving telemedicine program-encompassing 5 programs-to identify the scope of dementia-related knowledge gaps among attendees. METHODS Questions from the 5 programs were recorded and content analyzed to identify areas of frequent informational requests. RESULTS There were a total of 69 questions over the 5 sessions. For each program, questions ended due to time constraints rather than exhausting all inquiries. The most common topical areas of questions related to risk factors, behavioral management, diagnosis, and medications. DISCUSSION AND IMPLICATIONS This study highlights that rural caregivers in Kentucky have diverse dementia educational needs. Rural communities may benefit from additional, targeted resources addressing these common areas of unmet informational needs.
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Affiliation(s)
- Shoshana H. Bardach
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Graduate Center for Gerontology, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Allison Gibson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- College of Social Work, University of Kentucky, Lexington, Kentucky
| | - Kelly Parsons
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
| | | | - Gregory A. Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky
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27
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Bauer A, Amspoker AB, Fletcher TL, Jackson C, Jacobs A, Hogan J, Shammet R, Speicher S, Lindsay JA, Cloitre M. A Resource Building Virtual Care Programme: improving symptoms and social functioning among female and male rural veterans. Eur J Psychotraumatol 2021; 12:1860357. [PMID: 34025913 PMCID: PMC8128123 DOI: 10.1080/20008198.2020.1860357] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Veterans have higher rates of PTSD and depression compared to the general population and experience substantial functional impairment. Impairment in social functioning has been a significant concern among Veterans, particularly rural Veterans, who have limited access to mental health care and are at risk for social isolation. Objective: A mixed-method study was implemented to evaluate the feasibility and effectiveness of webSTAIR, a web-based skills training programme, paired with home-based telehealth sessions. It was hypothesized that the programme would lead not only to reductions in PTSD and depression but also to improvements in social functioning. Method: Participants were 80 trauma-exposed Veterans enrolled in rural-serving VHA facilities with clinically elevated symptoms of either PTSD or depression. The study directed substantial outreach efforts to rural women Veterans and those who have experienced military sexual trauma (MST). Results: Significant improvements were obtained with PTSD and depression symptoms as well as in social functioning, emotion regulation, and interpersonal problems at post-treatment and 3-month follow-up. Ratings of therapeutic alliance were high as were reports of overall satisfaction in the programme. There were no differences by gender or MST status in symptom outcomes or satisfaction. Conclusions: The results support the feasibility and effectiveness of this integrated telehealth web-based skills training programme for both male and female Veterans as well as for those with and without MST. The focus on resource building and improved functioning make this programme of particular interest. Further testing is warranted.
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Affiliation(s)
- Ashley Bauer
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Amber B Amspoker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Terri L Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | | | - Adam Jacobs
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Julianna Hogan
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Rayan Shammet
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sarah Speicher
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jan A Lindsay
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
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28
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A New Perspective of Urban-Rural Differences: The Impact of Social Support on the Mental Health of the Older Adults: A Case from Shaanxi Province, China. Healthcare (Basel) 2021; 9:healthcare9020112. [PMID: 33494490 PMCID: PMC7911548 DOI: 10.3390/healthcare9020112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
With the increase in aging in China, the health problems of older adults, especially mental health problems, have become a concern for the whole society. This article selected urban and rural older adults and analyzed the impact of social support on their mental health using a binary logistic model. It was found that under the current urban–rural dichotomy, the effects of social support on the mental health of urban and rural older adults are significantly different. In social support, first, the fairness and satisfaction with the social security system only had a significant effect on the mental health of urban older adults and had no significant effect on the rural older adults. Second, the closeness of contact with grassroots community workers had a significant impact on the mental health of older adults in urban and rural areas. From informal social support, the mental health of rural older adults was mainly influenced by the support of their children, reflecting the influence of the traditional culture of “filial piety”. Furthermore, the mental health of urban older adults was mainly influenced by neighborhood support, reflecting the importance of “close neighbors are better than distant relatives”. Based on the results of the empirical study, this article suggests that to promote the mental health of older adults, we should start by strengthening the formal social support system, establishing high-quality community service facilities, and emphasizing the role of informal social support.
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29
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Carnahan LR, Rauscher GH, Watson KS, Altfeld S, Zimmermann K, Ferrans CE, Molina Y. Comparing the roles of social context, networks, and perceived social functioning with health-related quality of life among self-reported rural female cancer survivors. Support Care Cancer 2021; 29:331-340. [PMID: 32361830 PMCID: PMC7606329 DOI: 10.1007/s00520-020-05497-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to (1) use latent class analysis to identify distinct classes of social context and social networks and (2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL. METHODS We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017-2018), via community-based sampling methods, and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor sas a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions. RESULTS For our first objective, there were three classes each of county-level contexts (1, highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2, mostly rural, moderately disadvantaged, and underserved; 3, mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1, no caregivers; 2, only spousal caregivers with whom they communicated daily; 3, multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL. CONCLUSIONS Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL.
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Affiliation(s)
- Leslie R Carnahan
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA.
- Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA.
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
| | - Karriem S Watson
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Susan Altfeld
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
| | - Kristine Zimmermann
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA
| | - Carol E Ferrans
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., Chicago, IL, 60612, USA
| | - Yamilé Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA
- Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA
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Okuyama K, Abe T, Yano S, Sundquist K, Nabika T. Neighborhood environment and muscle mass and function among rural older adults: a 3-year longitudinal study. Int J Health Geogr 2020; 19:51. [PMID: 33239058 PMCID: PMC7690178 DOI: 10.1186/s12942-020-00247-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sarcopenia, resulting from loss of muscle mass and function, is highly prevalent in the ageing societies and is associated with risk of falls, frailty, loss of independence, and mortality. It is important to identify environmental risk factors, so that evidence-based interventions to prevent sarcopenia can be implemented at the population level. This study aimed to examine the potential effect of several objectively measured neighborhood environmental factors on longitudinal change of muscle mass and function among older adults living in rural Japanese towns where the population is ageing. METHODS This study was based on data from the Shimane CoHRE Study conducted by the Center for Community-based Healthcare Research and Education (CoHRE) at Shimane University in 3 rural towns in the Shimane Prefecture, Japan. Subjects older than 60 years, who participated in an annual health examination in 2016 and any follow-up years until 2019, i.e., 4 possible time points in total, were included (n = 2526). The skeletal muscle mass index (SMI) and grip strength were assessed objectively for each year as a measure of muscle mass and function, respectively. Neighborhood environmental factors, i.e., hilliness, bus stop density, intersection density, residential density, and distance to a community center were measured by geographic information systems (GIS). Linear mixed models were applied to examine the potential effect of each neighborhood environmental factor on the change of SMI and grip strength over time. RESULTS Males living far from community centers had a less pronounced decline in SMI compared to those living close to community centers. Females living in areas with higher residential density had a less pronounced decline in grip strength compared to those living in areas with lower residential density. CONCLUSIONS Neighborhood environmental factors had limited effects on change of SMI and grip strength among rural older adults within the 3 years follow up. Further long-term follow up studies are necessary by also taking into account other modifiable neighborhood environmental factors.
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Affiliation(s)
- Kenta Okuyama
- Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.
| | - Takafumi Abe
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Shozo Yano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, 20502, Malmö, Sweden
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029-5674, USA
| | - Toru Nabika
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
- Department of Functional Pathology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
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Thangiah G, Said MA, Majid HA, Reidpath D, Su TT. Income Inequality in Quality of Life among Rural Communities in Malaysia: A Case for Immediate Policy Consideration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238731. [PMID: 33255397 PMCID: PMC7727827 DOI: 10.3390/ijerph17238731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
Abstract
Quality of life (QOL) is a proxy of health and social well-being. Hence, it is vital to assess QOL as it informs the strategies of policymakers to enhance the living conditions in communities. Rural areas in emerging economies are underserved in terms of modern facilities and technologies, which impact QOL. To address this, this study investigated whether income played a role in the QOL of rural residents within emerging economies using a large survey of Malaysian adults above 18 years old. The study extracted data from a sample of 18,607 respondents of a health and demographic surveillance system survey. A generalized linear model was used to estimate the impact of three income groups, the bottom 40%, middle 40% and top 20%, on perceived QOL, controlling for sociodemographic, chronic disease co-morbidities and mental health status. Results of the study showed a statistically significant association between income and the physical, psychological, social and environmental QOL domains. Using the bottom 40% as a reference category, the middle 40% and top 20% income groups showed a significant and positive association across the four domains of QOL. Hence, intervention programs are necessary to escalate the income levels of rural communities, especially the bottom 40%, to uplift perceived QOL among rural residents.
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Affiliation(s)
- Govindamal Thangiah
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (G.T.); (M.A.S.); (H.A.M.)
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia;
| | - Mas Ayu Said
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (G.T.); (M.A.S.); (H.A.M.)
| | - Hazreen Abdul Majid
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (G.T.); (M.A.S.); (H.A.M.)
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Jawa Timur 60115, Indonesia
| | - Daniel Reidpath
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia;
- International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh
| | - Tin Tin Su
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (G.T.); (M.A.S.); (H.A.M.)
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia;
- Correspondence: or
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Sobolewski P, Brola W, Wilczyński J, Szczuchniak W, Wójcik T, Wach-Klink A, Kos M, Kozera G. Cerebral Thrombolysis in Rural Residents Aged ≥ 80. Clin Interv Aging 2020; 15:1737-1751. [PMID: 33061326 PMCID: PMC7522422 DOI: 10.2147/cia.s256070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. Results The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients’ conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04–5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21–10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03–6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01–1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10–0.62, p = 0.003) were associated with mortality in rural patients over 80. Conclusion We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.
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Affiliation(s)
- Piotr Sobolewski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Saint Lukas Hospital in Końskie, Końskie, Poland
| | | | - Wiktor Szczuchniak
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Tomasz Wójcik
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aleksandra Wach-Klink
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Marek Kos
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.,Department of Public Health, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Kozera
- Medical Simulation Center, Medical University of Gdańsk, Gdańsk, Poland
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Perceived Barriers to Rural Elderly Women's Health-Promoting Behaviors: An Ecological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176107. [PMID: 32825801 PMCID: PMC7503892 DOI: 10.3390/ijerph17176107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
This study multidimensionally examines rural elderly women's subjective barriers to practicing health-promoting behaviors. Twenty-six rural elderly women participated in three focus group interviews. Content analysis and a qualitative research method were used. The results, based on an ecological model, show that the implementation of health-promoting behaviors in rural elderly women was comprehensively related to intrapersonal (functional decline, passive attitude, and lack of implementation), interpersonal (lack of social support), community (restrictive conditions, accessibility issues, and lack of infrastructure), and public policy (lack of policy support) factors. Interventions addressing each factor can help reduce or eliminate the perceived barriers to health-promoting behaviors through interactions. Our findings can contribute to the development of health-promoting programs focused specifically on the socialization of rural elderly women and community-centered health policies in the future.
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Choi J, Yang K, Chu SH, Youm Y, Kim HC, Park YR, Son YJ. Social Activities and Health-Related Quality of Life in Rural Older Adults in South Korea: A 4-Year Longitudinal Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155553. [PMID: 32752139 PMCID: PMC7432541 DOI: 10.3390/ijerph17155553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
During later life, inadequate social interactions may be associated with worse quality of life in older adults. Rural older adults are prone to developing unhealthy lifestyles related to social activities, which can lead to a poorer quality of life than that enjoyed by older adults living in urban areas. This study aimed to describe longitudinal changes in social activity participation and health-related quality of life among rural older adults, exploring potential associations with changes to in-person social activity over four years. We used prospective community-based cohort data from the Korean Social Life, Health, and Aging Project (KSHAP) collected between December 2011 and January 2016. The sample included 525 older adults who completed the measure of health-related quality of life. Our results showed a significant change in health-related quality of life according to changes in participation in meeting with friends. Even though an individual's participation in other social activities did not show significant differences in health-related quality of life, our findings imply that in-person social activities may be an important resource to encourage participation in physical activities and to develop other positive outcomes, such as a sense of belonging or satisfaction with later life, among rural older adults.
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Affiliation(s)
- JiYeon Choi
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea; (J.C.); (S.H.C.)
| | - Kyeongra Yang
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ 07107, USA;
| | - Sang Hui Chu
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea; (J.C.); (S.H.C.)
| | - Yoosik Youm
- College of Social Sciences, Department of Sociology, Yonsei University, Seoul 03722, Korea;
| | - Hyeon Chang Kim
- College of Medicine, Department of Preventive Medicine, Yonsei University, 03722 Seoul, Korea;
| | - Yeong-Ran Park
- Division of Silver Industry, Kangnam University, Gyeonggi-do 16979, Korea;
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea
- Correspondence: ; Tel.: +82-2-820-5198
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Zhang CH, Schwartz GG. Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020. J Rural Health 2020; 36:433-445. [PMID: 32543763 PMCID: PMC7323165 DOI: 10.1111/jrh.12476] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose This ecological analysis investigates the spatial patterns of the COVID‐19 epidemic in the United States in relation to socioeconomic variables that characterize US counties. Methods Data on confirmed cases and deaths from COVID‐19 for 2,814 US counties were obtained from Johns Hopkins University. We used Geographic Information Systems (GIS) to map the spatial aspects of this pandemic and investigate the disparities between metropolitan and nonmetropolitan communities. Multiple regression models were used to explore the contextual risk factors of infections and death across US counties. We included population density, percent of population aged 65+, percent population in poverty, percent minority population, and percent of the uninsured as independent variables. A state‐level measure of the percent of the population that has been tested for COVID‐19 was used to control for the impact of testing. Findings The impact of COVID‐19 in the United States has been extremely uneven. Although densely populated large cities and their surrounding metropolitan areas are hotspots of the pandemic, it is counterintuitive that incidence and mortality rates in some small cities and nonmetropolitan counties approximate those in epicenters such as New York City. Regression analyses support the hypotheses of positive correlations between COVID‐19 incidence and mortality rates and socioeconomic factors including population density, proportions of elderly residents, poverty, and percent population tested. Conclusions Knowledge about the spatial aspects of the COVID‐19 epidemic and its socioeconomic correlates can inform first responders and government efforts. Directives for social distancing and to “shelter‐in‐place” should continue to stem the spread of COVID‐19.
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Affiliation(s)
- Charlie H Zhang
- Department of Geography & Geosciences, University of Louisville, Louisville, Kentucky
| | - Gary G Schwartz
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota
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Poulin LIL, Skinner MW, Hanlon N. Rural gerontological health: Emergent questions for research, policy and practice. Soc Sci Med 2020; 258:113065. [PMID: 32480186 DOI: 10.1016/j.socscimed.2020.113065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/09/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
This article explores what can be learned from the evolution of rural gerontology as a field of study to inform a more critical approach to the health of rural older adults. To counter the prevailing essentialism of highlighting the rural health disparities faced by older adults, there is a need to expand rural gerontological health research beyond deficit and medicalized understandings of health in rural communities. We argue that appreciating the interplay between unique health experiences, the complexity of the rural context and the continuum of older adult care is an important next step to foster advances in the field. Emergent questions for research, policy and practice are discussed and new directions for rural gerontological health are proposed.
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Affiliation(s)
- Laura I L Poulin
- Trent University, 1600 West Bank Dr., Peterborough, Ontario, K9L 0G2, Canada.
| | - Mark W Skinner
- Trent University, 1600 West Bank Dr., Peterborough, Ontario, K9L 0G2, Canada.
| | - Neil Hanlon
- University of Northern British Columbia, 3333 University Way., Prince George, British Columbia, V2N 4Z9, Canada.
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Determinants of Subjective Health, Happiness, and Life Satisfaction among Young Adults (18-24 Years) in Guyana. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9063808. [PMID: 32047818 PMCID: PMC7003259 DOI: 10.1155/2020/9063808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/22/2019] [Accepted: 07/21/2019] [Indexed: 11/25/2022]
Abstract
Abstract. Persistent urban-rural disparity in subjective health and quality of life is a growing concern for healthcare systems across the world. In general, urban population performs better on most health indicators compared with their rural counterparts. However, research evidence on the urban-rural disparity on perceived health, happiness, and quality of life among the young adult population is scarce in South American countries like Guyana. Therefore, in the present study we aimed to investigate whether subjective health, happiness, and quality of life differ according to place of residence among the young adult population in Guyana.
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Pugliese M, Séguin AM, Fortier P. L’expérience des difficultés économiques
et les stratégies d’adaptation chez les personnes âgées canadiennes. Analyse
comparée avec d’autres groupes d’âge. ENFANCES, FAMILLES, GÉNÉRATIONS 2020. [DOI: 10.7202/1078009ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Liu Z, Tan Y, Liang H, Gu Y, Wang X, Hao Y, Gu J, Hao C. Factors Influencing Residents' Willingness to Contract With General Practitioners in Guangzhou, China, During the GP Policy Trial Phase: A Cross-Sectional Study Based on Andersen's Behavioral Model of Health Services Use. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019845484. [PMID: 31084420 PMCID: PMC6537300 DOI: 10.1177/0046958019845484] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate the current contract rate and residents’
willingness to contract with general practitioner (GP) services in Guangzhou,
China, during the policy trial phase, and also to explore the association of
behavior contract and contract willingness with variables based on Andersen’s
Behavioral Model of Health Services Use (ABM). In total, 160 residents from
community health centers (CHCs) and 202 residents from hospitals were recruited
in this study. The outcome variables were behavior contract and contract
willingness. Based on the framework of ABM, independent variables were
categorized as predisposing factors, enabling factors, need factors, and CHC
service utilization experiences. Univariate and multivariate logistic regression
analysis models were applied to explore the associated factors. Out of 362
participants, 14.4% had contracted with GP services. For those who had not
contracted with GP services, only 16.4% (51 out of 310) claimed they were
willing to do so. The contract rate for community-based participants was
significantly higher than that for hospital-based participants. Major reasons
for not choosing to contract were perceiving no benefit from the service and
concerns about the quality of CHCs. Community health center experiences and
satisfaction were significantly associated with contracting among hospital-based
participants. A need factor (diagnosed with hypertension or diabetes) and CHC
service utilization experiences (have gotten services from the same doctor in
CHCs) were significantly associated with contract willingness among CHC-based
participants. Intervention to improve awareness of GP services may help to
promote this service. Different intervention strategies should be used for
varying resident populations.
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Affiliation(s)
- Zhongqi Liu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yawen Tan
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,3 Peking University Sixth Hospital/Institute of Mental Health, China
| | - Haiqing Liang
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,4 Haizhu District Center for Disease Control and Prevention, Guangzhou, China
| | - Yijun Gu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,5 Institute of Clinical Epidemiology and Evidence - based Medicine, Tongji University School of Medicine, Shanghai, China
| | - Xiaowen Wang
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,6 Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yuantao Hao
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jing Gu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Chun Hao
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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Tetteh J, Kogi R, Yawson AO, Mensah G, Biritwum R, Yawson AE. Effect of self-rated health status on functioning difficulties among older adults in Ghana: Coarsened exact matching method of analysis of the World Health Organization's study on global AGEing and adult health, Wave 2. PLoS One 2019; 14:e0224327. [PMID: 31689325 PMCID: PMC6830754 DOI: 10.1371/journal.pone.0224327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Functional difficulty assessment has been proven as a key factor in the health evaluation of adults. Previous studies have shown a reduction in health and functional difficulties with increasing age. This analysis was conducted to quantify the effect of poor self-rated health on functional difficulty among older adults in Ghana. Method This analysis was based on the World Health Organization Study on Global AGEing and Adult Health in Ghana for older adults 50 years and above. Fifteen standard functioning difficulty tools were extracted and used for the analysis. Three predictive models with the Coarsened Exact Matching method involving Negative Binomial, Logistics and Ordered logistic regression were performed using Stata 14. Results Overall, the prevalence of poor Self-rated health was 34.9% and that of functional difficulties among older adults in Ghana was 69.4%. Female sex, increasing age, being separated, having no religious affiliation, not currently working and being underweight were associated with and significantly influence poor Self-rated health [AOR(95%CI)p-value = 1.41(1.08–1.83)0.011, 3.85(2.62–5.64)0.000, 1.45(1.08–1.94)0.013, 2.62(1.68–4.07)0.000, 2.4(1.85–3.12)0.000 and 1.39(1.06–1.81)0.017 respectively]. In addition, poor Self-rated health and geographical location (rural vs. urban)significantly influence functioning difficulties among older adults in Ghana as predicted by the three models [Negative Binomial: PR(95%CI) = 1.62(1.43–1.82), Binary logistic: AOR(95%CI) = 3.67(2.79–4.81) and ordered logistic: AOR(95%CI) = 2.53(1.14–2.03)]. Conclusion Poor SRH is more pronounced among older adult females in Ghana. Some determinants of poor SRH include; age, geographical location (urban vs. rural), marital status, religion, and employment status. This provides pointers to important socio-demographic determinants with implications on the social function of older adults in line with the theme of the national aging policy of 2010, ‘ageing with security and dignity’ and ultimately in the national quest to achieve the Sustainable Development Goals by 2030.
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Affiliation(s)
- John Tetteh
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kogi
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - George Mensah
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard Biritwum
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
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Bergen G, Stevens MR, Kakara R, Burns ER. Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies. Am J Lifestyle Med 2019; 15:580-589. [PMID: 34916876 DOI: 10.1177/1559827619880529] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients' modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.
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Affiliation(s)
- Gwen Bergen
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
| | - Mark R Stevens
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
| | - Ramakrishna Kakara
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
| | - Elizabeth R Burns
- Division of Unintentional Injury (GB, RK, ERB).,Division of Analysis, Research and Practice Integration (MRS).,National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee (RK)
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Roberson S, Dawit R, Moore J, Odoi A. An exploratory investigation of geographic disparities of stroke prevalence in Florida using circular and flexible spatial scan statistics. PLoS One 2019; 14:e0218708. [PMID: 31469839 PMCID: PMC6716650 DOI: 10.1371/journal.pone.0218708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 06/08/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Stroke is a major public health concern due to the morbidity and mortality associated with it. Identifying geographic areas with high stroke prevalence is important for informing public health interventions. Therefore, the objective of this study was to investigate geographic disparities and identify geographic hotspots of stroke prevalence in Florida. MATERIALS AND METHODS County-level stroke prevalence data for 2013 were obtained from the Florida Department of Health's Behavioral Risk Factor Surveillance System (BRFSS). Geographic clusters of stroke prevalence were investigated using the Kulldorff's circular spatial scan statistics (CSSS) and Tango's flexible spatial scan statistics (FSSS) under Poisson model assumption. Exact McNemar's test was used to compare the proportion of cluster counties identified by each of the two methods. Both Cohen's Kappa and bias adjusted Kappa were computed to assess the level of agreement between CSSS and FSSS methods of cluster detection. Goodness-of-fit of the models were compared using Cluster Information Criterion. Identified clusters and selected stroke risk factors were mapped. RESULTS Overall, 3.7% of adults in Florida reported that they had been told by a healthcare professional that they had suffered a stroke. Both CSSS and FSSS methods identified significant high prevalence stroke spatial clusters. However, clusters identified using CSSS tended to be larger than those identified using FSSS. The FSSS had a better fit than the CSSS. Most of the identified clusters are explainable by the prevalence distributions of the known risk factors assessed. CONCLUSIONS Geographic disparities of stroke risk exists in Florida with some counties having significant hotspots of high stroke prevalence. This information is important in guiding future research and control efforts to address the problem. Kulldorff's CSSS and Tango's FSSS are complementary to each other and should be used together to provide a more complete picture of the distributions of spatial clusters of health outcomes.
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Affiliation(s)
- Shamarial Roberson
- Bureau of Chronic Disease Prevention, Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Rahel Dawit
- Bureau of Chronic Disease Prevention, Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Jaleesa Moore
- Bureau of Chronic Disease Prevention, Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, United States of America
| | - Agricola Odoi
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tennessee, United States of America
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Hancock S, Wells Y. The change in quality of life for older Australians: A rural and urban comparison. Aust J Rural Health 2019; 27:322-327. [PMID: 31429139 DOI: 10.1111/ajr.12553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the quality of life of older Australians living in rural and urban communities over time. DESIGN Panel survey conducted in 2012-2013 and 2014-2015. SETTING Participants lived in metropolitan Melbourne (urban sample, N = 279), rural Victoria (N = 98) or Tasmania (N = 47). PARTICIPANTS All participants (N = 424) were clients of aged care providers or residents in retirement housing or residential care. MAIN OUTCOME MEASURES Quality of life. RESULT A repeated-measures analysis of variance showed a decrease in quality of life over time. There was no difference in change in quality of life over time by location of participants (urban vs rural). Multiple regression analysis showed that resilience predicted baseline quality of life in all three locations. CONCLUSION These findings generally did not support significant differences between geographic locations in trajectories of older adults' quality of life over time. Instead, individuals' resilience appears to be the strongest predictor of quality of life.
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Affiliation(s)
- Shaun Hancock
- Public Health: Stroke Division, The Florey Institute of Neuroscience & Mental Health, Heidelberg, Victoria, Australia
| | - Yvonne Wells
- College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
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Basic Disaster Preparedness of Rural Community Pharmacies in 5 States. Disaster Med Public Health Prep 2019; 14:329-334. [DOI: 10.1017/dmp.2019.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjectives:The aim of this study was to investigate the basic preparedness of rural community pharmacies to continue operations during and immediately following a disaster.Methods:In 2014, we conducted a telephone survey (N = 990) of community pharmacies in 3 rural areas: North Dakota/South Dakota, West Virginia, Southern Oregon/Northern California regarding whether they had a formal disaster/continuity plan, offsite data backup, emergency power generation, and/or had a certified pharmacy immunizer on staff. Logistic regression and chi square were performed using Stata 11.1.Findings:Community pharmacies in rural areas (≤50.0 persons/mile2) were less likely to have emergency power (odds ratio [OR] = 0.59; 95% confidence interval [CI]: 0.32-1.07) or certified pharmacy immunizer on staff (OR = 0.47; 95% CI: 0.34-0.64). Pharmacies in lower income areas were less likely to have emergency power and offsite data backup or a formal disaster plan (OR = 0.70; 95% CI: 0.49-0.99) compared with pharmacies in higher income areas. Community pharmacies in areas of higher percent elderly population were less likely to have emergency power (OR = 0.54; 95% CI: 0.39-0.73), or certified pharmacy immunizer on staff (OR = 0.65; 95% CI: 0.47-0.91) compared with chain pharmacies in areas with lower percent elderly population.Conclusions:Being in a rural, low-income, or high-elderly area was associated with lower likelihood of basic preparedness of community pharmacies.
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Gibson A, Holmes SD, Fields NL, Richardson VE. Providing Care for Persons with Dementia in Rural Communities: Informal Caregivers' Perceptions of Supports and Services. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:630-648. [PMID: 31250733 DOI: 10.1080/01634372.2019.1636332] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/22/2019] [Accepted: 06/22/2019] [Indexed: 06/09/2023]
Abstract
Dementia is one of the costliest and most time-consuming diseases among older persons. Although informal caregivers provide the majority of care for persons with dementia, little is known about the self-perceived need for social services of caregivers of persons with dementia within rural areas. This pilot study examined the knowledge, access and intent of the practice-oriented service model of caregivers of persons with dementia in rural communities in the Midwest U.S. After a systematic training, researchers interviewed 11 rural caregivers of persons with dementia (n = 11). Data were analyzed using thematic analysis. Although similarities with other caregivers of persons with dementia were found, important differences suggesting unique issues among these rural caregivers of persons with dementia. Many participants found strength in their community, which often served as a safety net of support. Consistent with existing literature, participants expressed financial concerns, geographic barriers and lack of dementia-specific services when using formal services. The need for more specialized formal services in rural areas to supplement existing informal care networks is discussed. Policies and services based on rural caregivers' unique concerns and challenges and that build upon their existing care networks are recommended.
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Affiliation(s)
- Allison Gibson
- College of Social Work, University of Kentucky , Lexington , USA
| | - Sarah D Holmes
- School of Medicine, University of Maryland , Baltimore, MD , USA
| | - Noelle L Fields
- School of Social Work, University of Texas , Arlington, TX , USA
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Carotid artery plaque detected on ultrasound is associated with impaired cognitive state in the elderly: A population-based study in Wakiso district, Uganda. J Clin Neurosci 2019; 68:194-200. [PMID: 31301929 DOI: 10.1016/j.jocn.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/01/2019] [Accepted: 06/09/2019] [Indexed: 12/24/2022]
Abstract
Carotid artery disease which includes carotid artery stenosis, plaques, clots and increased intima media thickness, have been reported by many studies to be associated with dementia. Dementia is an end stage of usually asymptomatic cognitive impairment. Risk factors of carotid artery disease include; age, atherosclerosis, arteriosclerosis, shorter years in school, history of hypertension, diabetes mellitus, stroke and depression. This study set out to determine the prevalence of abnormal carotid ultrasound findings and their association with cognitive function among the adults ≥60 years in Wakiso district, Uganda in 2018. A total of 210 participants were included. Carotid artery stenosis, presence of plaque, stenosis and intima-media thickness were assessed by ultrasound. Cognitive status was assessed using a Mini Mental State Exam (MMSE) test. The prevalence of plaque was 21.4%. Variables which included; presence of plaque, age, education, gender, marital status, whether participant stayed alone or with someone else, care for self, occupation status, division of staying and history of smoking. The presence of plaque was associated with an abnormal cognitive function at both univariate and multivariate analysis with respective OR = 3.8 (95% CI = 1.90-7.54, p-value = 0.0001) and OR = 3.4 (95% CI = 1.38-8.15, p-value = 0.007). The cognitive function distribution was 43.8%, 19%, 34.3% and 2.9% within the normal, mild, moderate, and severe cognitive function status respectively. This study showed that prevalence of carotid artery plaque was high in this elderly population in Wakiso district Uganda. Also, carotid artery plaque was associated with abnormal cognitive function.
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Peltzer K, Phaswana-Mafuya N, Pengpid S. Rural-urban health disparities among older adults in South Africa. Afr J Prim Health Care Fam Med 2019; 11:e1-e6. [PMID: 31296012 PMCID: PMC6620551 DOI: 10.4102/phcfm.v11i1.1890] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There are limited studies assessing rural-urban disparities among older adults in Africa including South Africa. AIM This study explores rural-urban health disparities among older adults in a population-based survey in South Africa. SETTING Data for this study emanated from the 2008 study on 'Global Ageing and Adult Health (SAGE) wave 1' (N = 3280) aged 50 years or older in South Africa. METHODS Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression. RESULTS Rural dwellers were more likely to be older, black African and had lower education and wealth than urban dwellers. Rural and urban dwellers reported a similar prevalence of self-rated health status, quality of life, severe functional disability, arthritis, asthma, lung disease, hypertension, obesity, underweight, stroke and/or angina, low vision, depression, anxiety and nocturnal sleep problems. Adjusting for socio-demographic and health risk behaviour variables, urban dwellers had a higher prevalence of diabetes (OR: 2.36, 95% CI: 1.37, 4.04), edentulism (OR: 2.79, 95% CI: 1.27, 6.09) and cognitive functioning (OR: 1.91, 95% CI: 1.27, 2.85) than rural dwellers. CONCLUSION There are some rural-urban health disparities in South Africa, that is, urban dwellers had a higher prevalence of diabetes, edentulism and cognitive functioning than rural ones. Understanding these rural-urban health variations may help in developing better strategies to improve health across geolocality in South Africa.
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Affiliation(s)
- Karl Peltzer
- Department of Research and Innovation, North West University, Potchefstroom, South Africa; and HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria.
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Shade MY, Herr K, Kupzyk K. Self-Reported Pain Interference and Analgesic Characteristics in Rural Older Adults. Pain Manag Nurs 2019; 20:232-238. [PMID: 31080145 DOI: 10.1016/j.pmn.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pain impacts the lives of millions of community-dwelling older adults. An important characteristic of pain is "pain interference" which describes the influence of pain on function. A description of pain interference is limited in rural settings where the number of older adults is expected to increase, and health disparities exist. AIMS The purpose of this study was to describe pain interference and analgesic medication use, highlighting those that may be potentially inappropriate in a sample of rural community-dwelling older adults. DESIGN This secondary analysis was from a cross sectional study. SAMPLE AND SETTINGS Data were analyzed from a sample of 138 rural community-dwelling older adults. METHODS Statistical analyses were performed on demographics, health characteristics, pain interference, and potentially inappropriate analgesic medication data. RESULTS Pain interference with work activity was reported by 76% of older adults overall, with 23% reporting moderate and 4% extreme interference, and 41% reported sleep difficulty due to pain. Higher pain interference was significantly associated with higher body mass index, more health providers, and the daily use of non-steroidal anti-inflammatory drugs (NSAIDs). Older women experienced more sleep difficulties due to pain. Over-the-counter analgesics were used most frequently by rural older adults to manage pain. Of most risk was the daily use of NSAIDs, in which only 30% used medications to protect the gastrointestinal system. CONCLUSIONS Older adults in rural settings experience pain interference and participate in independent-medicating behaviors that may impact safety.
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Affiliation(s)
- Marcia Y Shade
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska; University of Iowa College of Nursing, Iowa City, Iowa.
| | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Kevin Kupzyk
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska
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Okuyama K, Abe T, Hamano T, Takeda M, Sundquist K, Sundquist J, Nabika T. Hilly neighborhoods are associated with increased risk of weight gain among older adults in rural Japan: a 3-years follow-up study. Int J Health Geogr 2019; 18:10. [PMID: 31077213 PMCID: PMC6509780 DOI: 10.1186/s12942-019-0174-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/03/2019] [Indexed: 12/27/2022] Open
Abstract
Background Neighborhood environments have been regularly associated with the weight status. Although the evidence is mostly limited to adults residing in western urban settings, the weight status of older adults living in rural areas is also assumed to be significantly affected by their neighborhood environments. This study aimed to identify environmental attributes specific to rural areas that could affect the risk of longitudinal weight gain among older adults (≥ 65 years) in Japan. Methods We examined five environmental attributes, i.e., land slope, public transportation accessibility, residential density, intersection density, and the availability of parks and recreational centers, measured by the geographic information system. Our analysis was based on 714 subjects participated in Shimane Community-based Healthcare Research and Education study in 2012 and 2015. Multinomial logistic regression model was conducted to examine the association between each neighborhood environmental attribute and weight change status (gain, loss and unchanged). Results We observed a significant increase in the risk of weight gain as the steepness of the neighborhood land slope increased. There was no significant association between other environmental attributes and risk of weight gain as well as weight loss among older adults. Conclusion Living in hilly neighborhoods was associated with increased risk of weight gain among rural Japanese older adults. Future research should consider region-specific environmental attributes when investigating their effect on older adults’ weight status.
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Affiliation(s)
- Kenta Okuyama
- Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.
| | - Takafumi Abe
- Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Tsuyoshi Hamano
- Department of Sports Sociology and Health Sciences, Faculty of Sociology, Kyoto Sangyo University, Motoyama, Kamigamo Kita-ku, Kyoto, 603-8555, Japan
| | - Miwako Takeda
- Center for Community-based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms Gata 35, 205 02, Malmö, Sweden
| | - Toru Nabika
- Department of Functional Pathology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
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Felix HC, Ali M, Bird TM, Cottoms N, Stewart MK. Are community health workers more effective in identifying persons in need of home and community-based long-term services than standard-passive approaches. Home Health Care Serv Q 2019; 38:194-208. [PMID: 31060448 DOI: 10.1080/01621424.2019.1604461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Consumers prefer home and community-based long-term care (LTC) services (HCBS) but lack information on those services. We examined the use of community health workers (CHWs) to find and help Medicaid beneficiaries with unmet LTC needs access HCBS compared to standard HCBS outreach approaches. We found that CHWs were very effective at finding persons with greater needs and were better able to help them access a greater range of HCBS services. We also found that five times fewer HCBS beneficiaries helped by CHWs had to use nursing home care services than those not helped by the CHWs despite the fact that their health status was poorer than those not helped by the CHWs. Our study provides evidence of the effectiveness of CHWs for HCBS service awareness and navigation.
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Affiliation(s)
- Holly C Felix
- a Fay W. Boozman College of Public Health , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Mir Ali
- a Fay W. Boozman College of Public Health , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - T Mac Bird
- a Fay W. Boozman College of Public Health , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Naomi Cottoms
- b Tri County Rural Health Network , Helena-West Helena , AR , USA
| | - M Kate Stewart
- a Fay W. Boozman College of Public Health , University of Arkansas for Medical Sciences , Little Rock , AR , USA
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