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Park J, Wiese LAK, Holt J. Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias. Clin Gerontol 2023:1-17. [PMID: 37941382 DOI: 10.1080/07317115.2023.2277333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults. METHODS We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up. RESULTS A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups. CONCLUSIONS Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies. CLINICAL IMPLICATIONS This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
| | - Lisa Ann Kirk Wiese
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Janet Holt
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Arsenault-Lapierre G, Bui TX, Le Berre M, Bergman H, Vedel I. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 2023; 23:102. [PMID: 36721162 PMCID: PMC9887943 DOI: 10.1186/s12913-023-09100-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. METHODS We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. RESULTS From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. CONCLUSIONS This comprehensive portrait of rural-urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.
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Affiliation(s)
- Geneviève Arsenault-Lapierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Tammy X. Bui
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada
| | - Mélanie Le Berre
- grid.14848.310000 0001 2292 3357Université de Montréal, Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montreal, H3W 1W5 Canada
| | - Howard Bergman
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Isabelle Vedel
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada ,grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
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Fukuda H, Kanzaki H, Murata F, Maeda M, Ikeda M. Disease Burden and Progression in Patients with New-Onset Mild Cognitive Impairment and Alzheimer's Disease Identified from Japanese Claims Data: Evidence from the LIFE Study. J Alzheimers Dis 2023; 95:1559-1572. [PMID: 37718811 PMCID: PMC10578250 DOI: 10.3233/jad-230471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Accurate epidemiological data on mild cognitive impairment (MCI) and Alzheimer's disease (AD) can inform the development of prevention and control measures, but there is a lack of such data in Japan. OBJECTIVE To investigate the disease burden and progression in patients with new-onset MCI or AD in Japan. METHODS Using claims data, this multi-region cohort study was conducted on new-onset MCI and AD patients in 17 municipalities from 2014 to 2021. To characterize the patients, we investigated their age, comorbidities, and long-term care (LTC) needs levels at disease onset according to region type (urban, suburban, or rural). Disease burden was examined using health care expenditures and LTC expenditures, which were estimated for 1, 2, and 3 years after disease onset. Kaplan-Meier curves were plotted for AD progression in new-onset MCI patients and death in new-onset AD patients. RESULTS We analyzed 3,391 MCI patients and 58,922 AD patients. In MCI and AD patients, health care expenditures were high in the first year ($13,035 and $15,858, respectively), but had declined by the third year ($8,278 and $10,414, respectively). In contrast, LTC expenditures (daily living support) steadily increased over the 3-year period (MCI patients: $1,767 to $3,712, AD patients: $6,932 to $9,484). In the third year after disease onset, 30.9% of MCI patients developed AD and 23.3% of AD patients had died. CONCLUSIONS This provides an important first look at the disease burden and progression of MCI and AD in Japan, which are high-priority diseases for a rapidly aging population.
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Affiliation(s)
- Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroshi Kanzaki
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Megumi Maeda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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Axenhus M, Frederiksen KS, Zhou RZ, Waldemar G, Winblad B. The impact of the COVID-19 pandemic on mortality in people with dementia without COVID-19: a systematic review and meta-analysis. BMC Geriatr 2022; 22:878. [PMCID: PMC9675075 DOI: 10.1186/s12877-022-03602-6] [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: 07/01/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Significant mortality amongst vulnerable populations, such as people living with dementia, might go undetected during pandemic conditions due to refocus of care efforts. There is an urgent need to fully evaluate the pandemic impact on mortality amongst people living with dementia in order to facilitate future healthcare reforms and prevent deaths. The purpose of this study was to determine whether there was any significant difference in mortality amongst people with dementia without COVID-19 during the COVID-19 pandemic compared to previous years. Methods A literature search was conducted in 5 databases. The relative risk ratio and confidence interval was used to estimate the change in mortality rates amongst people with dementia during the COVID-19 pandemic. The I2 value was used to assess heterogeneity, publication bias, and sensitivity analyses were performed. Results Pooled analysis of 11 studies showed that mortality amongst people living with dementia was significantly increased during the COVID-19 pandemic for people with dementia without COVID-19. Mortality risk increased by 25% during the time period studied. Subgroup analysis was not performed due the low number of included studies. Conclusions The results of this study suggest that people with dementia had a significant increased mortality during the pandemic even if they did not have COVID-19. People with dementia should participate in efforts that reduce general social spread and pandemic impact on healthcare system such as vaccinations, mask mandates, and testing. These results have clinical implications as preventing direct COVID-19 infection is not enough to adequately protect people living with dementia from increased mortality. Measures to limit social spread of infections and help support patients should also be a focus for clinicians. Further research should focus on the identification of mechanisms and other explanations for increased mortality as well as contributing factors such as living in care homes and differences between countries with various pandemic strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03602-6.
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Affiliation(s)
- Michael Axenhus
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
| | - Kristian Steen Frederiksen
- grid.5254.60000 0001 0674 042XDanish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robin Ziyue Zhou
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Gunhild Waldemar
- grid.5254.60000 0001 0674 042XDanish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDept. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bengt Winblad
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
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Sharma A, Basu S. Does Primary Care Availability Mediate the Relationship Between Rurality and Lower Life Expectancy in the United States? J Prim Care Community Health 2022; 13:21501319221125471. [PMID: 36222656 PMCID: PMC9561680 DOI: 10.1177/21501319221125471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Rural counties in the United States have lower life expectancy than their urban counterparts and comprise the majority of primary care provider (PCP) shortage areas. We evaluated whether PCP availability mediates the relationship between rurality and lower life expectancy. METHODS We performed a mediation analysis on a panel dataset which included county-level estimates (N = 3103) for the years 2010, 2015, and 2017, and on a subset containing only rural counties (N = 1973), with life expectancy as the outcome variable, urbanity as the independent variable, and PCP density as the mediating variable. County-level socio-demographic data were included as covariates. RESULTS AND CONCLUSIONS PCP density mediated 10.1% of the relationship between urbanity and life expectancy in rural counties. Increasing PCP density in rural counties with PCP shortages to the threshold of being a non-shortage county (>1 physician/3500 population, as defined by the Health Resources and Services Administration) would be expected to increase mean life expectancy in the county by 26.1 days (95% confidence interval [CI]: 11.4, 49.3) and increasing it to the standards recommended by a Secretarial Negotiated Rulemaking Committee would be expected to increase mean life expectancy by 65.3 days (95% CI: 42.6, 87.5). PCP density is a meaningful mediator of the relationship between urbanity and life expectancy. The mediation effect observed was higher in rural counties compared to all counties. Understanding how PCP density may be increased in rural areas may be of benefit to rural life expectancy.
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Affiliation(s)
- Arjun Sharma
- Columbia Grammar & Preparatory
School, New York, NY, USA,Arjun Sharma, Columbia Grammar &
Preparatory School, 5 West 93rd Street, New York, NY 10128, USA.
| | - Sanjay Basu
- Research and Development, Waymark Care,
San Francisco, CA, USA
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Glauber R. Rural depopulation and the rural-urban gap in cognitive functioning among older adults. J Rural Health 2022; 38:696-704. [PMID: 35257439 PMCID: PMC10268026 DOI: 10.1111/jrh.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
PURPOSE As the population ages, the number of people with cognitive impairment will rapidly increase. Although previous research has explored the rural-urban gap in physical health, few studies have analyzed cognitive health. The purpose of this study was to examine rural-urban differences in cognitive health, with a focus on the moderating effect of population decline. METHODS The study used individual-level nationally representative data from the 2000-2016 waves of the Health and Retirement Study (N = 152,444) merged to county-level contextual characteristics. Hierarchical linear models were used to predict the cognitive functioning of US adults aged 50 and over by rural-urban residence, county depopulation, and their interactions while controlling for individual-level and county-level demographic and contextual factors. FINDINGS Older adults living in rural counties had lower cognitive functioning than urban adults. The interaction between living in a rural and depopulated county was statistically significant (P < .001). The rural penalty in cognitive functioning was 40% larger for those who lived in counties that lost population between 1980 and 2010 compared to those who lived in stable or growing rural counties. These results were independent of race-ethnicity, gender, age, education, income, region, employment status, marital status, physical health, and depression as well as the county's racial-ethnic composition, age structure, economic and educational disadvantage, and health care shortages. CONCLUSIONS The results have important implications for those seeking to reduce health disparities both between rural and urban older adults and among different groups of rural people. Interventions targeting those living in rural depopulating areas are particularly warranted.
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Affiliation(s)
- Rebecca Glauber
- Department of Sociology, University of New Hampshire, Durham, New Hampshire, USA
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Rhew SH, Jacklin K, Bright P, McCarty C, Henning‐Smith C, Warry W. Rural health disparities in health care utilization for dementia in Minnesota. J Rural Health 2022. [DOI: 10.1111/jrh.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sung Han Rhew
- Memory Keepers Medical Discovery Team University of Minnesota Medical School Duluth Minnesota USA
| | - Kristen Jacklin
- Memory Keepers Medical Discovery Team University of Minnesota Medical School Duluth Minnesota USA
| | - Patrick Bright
- Memory Keepers Medical Discovery Team University of Minnesota Medical School Duluth Minnesota USA
| | - Catherine McCarty
- Department of Family Medicine & Biobehavioral Health University of Minnesota Medical School Duluth Minnesota USA
| | - Carrie Henning‐Smith
- Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis Minnesota USA
| | - Wayne Warry
- Memory Keepers Medical Discovery Team University of Minnesota Medical School Duluth Minnesota USA
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