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Robertson M, Colburn J, Gerber M. Applying a trauma-informed approach to home visits. J Am Geriatr Soc 2024; 72:1322-1328. [PMID: 38206878 DOI: 10.1111/jgs.18743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 01/13/2024]
Abstract
The concept of trauma and traumatic stress and its impact on health and mental health has been studied for nearly half a century. Trauma-informed care (TIC) is person-centered care designed and delivered based on knowledge of the ubiquity of trauma. It requires building an understanding of the role that trauma plays in the lives and health outcomes of survivors. In doing so, it helps promote physical, psychological, and emotional safety for both clinicians and patients. Trauma and traumatic events are cumulative over the lifespan, and individuals who have experienced trauma are at higher risk for re-traumatization and poorer health outcomes. TIC approaches have been applied in many healthcare settings successfully; however, to date, there have not been any recommendations made about applying these approaches to care of homebound older adults, even though it may be surmised that this population is at an especially high risk for prior trauma and entering a person's safe space could be especially sensitive for trauma survivors. This paper serves to provide specific recommendations for applying a trauma-informed approach to a home visit and provides recommendations to home-based primary care groups and health systems about implementing universal trauma-informed care to homebound older adults.
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Affiliation(s)
- Mariah Robertson
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Colburn
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Gerber
- Division of General Internal Medicine, Albany Medical College, Albany, New York, USA
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Mather H, Kleijwegt H, Bollens-Lund E, Liu B, Garrido MM, Kelley AS, Leff B, Ritchie CS, Ornstein KA. The heterogeneity of the homebound: A latent class analysis of a national sample of homebound older adults. J Am Geriatr Soc 2023; 71:2163-2171. [PMID: 36876755 DOI: 10.1111/jgs.18295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Homebound status is a final common pathway for people with a variety of diseases and conditions. There are 7 million homebound older adults in the United States. Despite concerns regarding their high healthcare costs and utilization and limited access to care, the unique subsets within the homebound population are understudied. Better understanding of distinct homebound groups may enable more targeted and tailored approaches to care delivery. Therefore, in a nationally representative sample of homebound older adults we used latent class analysis (LCA) to examine distinct homebound subgroups based on clinical and sociodemographic characteristics. MATERIALS AND METHODS Using data from the National Health and Aging Trends Study (NHATS) 2011-2019, we identified 901 newly homebound persons (defined as never/rarely leaving home or leaving home only with assistance and/or difficulty). Sociodemographic, caregiving context, health and function, and geographic covariates were derived from NHATS via self-report. LCA was used to identify the existence of distinct subgroups within the homebound population. Indices of model fit were compared for models testing 1-5 latent classes. Association between latent class membership and 1 year mortality was examined using a logistic regression. RESULTS We identified four classes of homebound individuals differentiated by their health, function, sociodemographic characteristics, and caregiving context: (i) Resource constrained (n = 264); (ii) Multimorbid/high symptom burden (n = 216); (iii) Dementia/functionally impaired (n = 307); (iv) Older/assisted living (n = 114). One year mortality was highest among the older/assisted living subgroup (32.4%) and lowest among the resource constrained (8.2%). CONCLUSIONS This study identifies subgroups of homebound older adults characterized by distinct sociodemographic and clinical characteristics. These findings will support policymakers, payers, and providers in targeting and tailoring care to the needs of this growing population.
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Affiliation(s)
- Harriet Mather
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Kleijwegt
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bian Liu
- Department of Population Health Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, Boston VA Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Transformative Geriatrics Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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Razbek J, Zhang Y, Xia WJ, Xu WT, Li DY, Yin Z, Cao MQ. Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model. Diabetes Metab Syndr Obes 2022; 15:2497-2510. [PMID: 35996564 PMCID: PMC9392490 DOI: 10.2147/dmso.s362071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
AIM Metabolic syndrome (MetS) coexists with the occurrence and even death of cardiovascular disease and diabetes mellitus. It is essential to study the factors in the dynamic progression of MetS in the interest of prevention and control. PURPOSE The aim of this study was to analyze the dynamic progression of Mets and explore the potential factors influencing the progression or reversal of MetS. PATIENTS AND METHODS This study involved 5581 individuals from two waves of the China Health and Retirement Longitudinal Study: 2011 and 2015. A multistate Markov model containing 4 states (free of metabolic disorder (FMD), mild metabolic disorder (MMD), severe metabolic disorder (SMD) and MetS) was adopted to study the dynamic progression of MetS and its influencing factors. RESULTS After follow-up, a total of 2862 cases (50.28% of the total number) had disease state transition. The intensity of transition from MetS to SMD is the same as that from SMD to MMD, and is greater than that from MMD to Mets (0.06 vs 0.05). For the MetS state, a mean of 1/0.08=12.5 years was spent in the MetS state before recovery. The exercise, smoke, drink, BMI level, hyperuricemia had statistically significant effects on progression of MetS status (P<0.05). The obesity or overweight, little exercise, smoke, drink and hyperuricemia increased the risk of forward progression of MetS disease status. There were significant nonmodifiable (age, gender) and modifiable factors (exercise, drink, BMI level, or high HbA1c) associated with reversion of MetS state. CONCLUSION The likelihood of progression from MMD to MetS is less likely than that of reversion from MetS to SMD and SMD to MMD. Old females were more resistant to recover from worse states than males. Prevention and intervention measures should be adopted early when MMD or SMD onset occurs.
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Affiliation(s)
- Jaina Razbek
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yan Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Wen-Jun Xia
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Wan-Ting Xu
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - De-Yang Li
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Zhe Yin
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Ming-Qin Cao
- Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, Urumqi, People’s Republic of China
- Correspondence: Ming-Qin Cao, Department of Epidemiology and Health Statistics, College of Public Health, Xinjiang Medical University, No. 393 Xinyi Road, Urumqi, 830011, People’s Republic of China, Tel +86-13319912419, Email
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