1
|
Polick CS, Harris-Gersten ML, Dennis PA, Noonan D, Hastings SN, Calhoun PS, Rosemberg MA, Stoddard SA. Allostatic Load, Morbidity, and Mortality Among Older Adults: A Multi-Wave Analysis From the National Health and Aging Trends Study. J Appl Gerontol 2024; 43:1052-1059. [PMID: 38299792 PMCID: PMC11291700 DOI: 10.1177/07334648241230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
Although allostatic load (AL) is a key concept to reflect physiologic wear and tear from stress, older adults are underrepresented in AL-related research, especially the oldest old (≥80). Further, attenuative factors are often unaccounted for. This longitudinal analysis using data from National Health and Aging Trends Study investigated relationships of AL in 2017 and multi-wave (1) comorbidity accumulation using multilevel Poisson modeling and (2) mortality risk using survival analysis. By year five (2022), each incremental AL increase that older adults (n = 3614) experienced was associated with a 47% increase in comorbidity (p < .001), and a 33% increased mortality risk (p < .001). This research supports a shift to a more proactive, health promotion/risk mitigation paradigm through informing intervention research targeting AL, which is currently scarce. Identifying potentially modifiable and key driving factors influencing the relationship between AL and health among older adults is an important next step to inform intervention design.
Collapse
Affiliation(s)
- Carri S. Polick
- Center to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Melissa L. Harris-Gersten
- Center to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Paul A. Dennis
- Center to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Devon Noonan
- Duke University School of Nursing, Durham, NC, USA
| | - Susan N. Hastings
- Center to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Patrick S. Calhoun
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | |
Collapse
|
2
|
Coats H, Doyon K, Isaacson MJ, Tay D, Rosa WE, Mayahara M, Kates J, Frechman E, Wright PM, Boyden JY, Broden EG, Hinds PS, James R, Keller S, Thrane SE, Mooney-Doyle K, Sullivan SS, Xu J, Tanner J, Natal M. The 2023-2026 Hospice and Palliative Nurses Association Research Agenda. J Hosp Palliat Nurs 2023; 25:55-74. [PMID: 36843048 DOI: 10.1097/njh.0000000000000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.
Collapse
|
3
|
Provider-To-Provider Communication About Care Transitions: Considering Different Health Technology Tools. J Healthc Qual 2023; 45:133-139. [PMID: 36848603 DOI: 10.1097/jhq.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
ABSTRACT Transitions in patient care require exchanges of information between providers. This period of transition presents a range of challenges, and inadequate transitions can have serious consequences for patients. Our objective was to understand providers' perspectives about patient care transitions, especially around communication between providers and the role of health information technology in provider-to-provider communication. Semi-structured interviews were conducted. Deductive-dominant thematic analysis was used to allow categorization of data based on general themes derived from the interview guides, as well as identification of emergent themes. We characterized three main themes involving providers' perspectives about care transitions. Themes included communication challenges, communication preferences, and suggestions for improving the care transition processes. With respect to challenges around communication, providers highlighted four main concerns. These concerns included the existence of too many methods of communication, high volume of communication, challenges with involvement of multiple providers delivering longitudinal care, and difficulty communicating with providers outside the health system. Providers noted opportunities to improve transitions including improving standardization, enhancing the specialty to primary care transition process, and increasing communication back to the referring provider. Implementation and evaluation of these improvements could be considered by health systems to enhance care transitions.
Collapse
|
4
|
Goldman AS, Abbott KM, Huang L, Naylor MD, Hirschman KB. Changes in Tangible Social Support Over Time Among Older Adults Receiving Long-Term Services and Supports. J Appl Gerontol 2023; 42:981-991. [PMID: 36650926 PMCID: PMC10081952 DOI: 10.1177/07334648221150966] [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: 01/19/2023] Open
Abstract
The purpose of this study was to examine changes in and predictors of perceived tangible social support over a 2-year period among older adults new to LTSS. Linear mixed effects models were used to model repeated measures of tangible social support as a function of LTSS type [NH, AL, HCBS], personal, clinical, and health-related quality of life variables. AL residents reported greater initial tangible social support, but NH and HCBS residents improved more over time. Predictors of increased tangible social support over time included greater positive affect, sense of aesthetics, education, satisfaction with family relationships, and total number of close friends and family. Decreased tangible support over time was associated with greater depressive symptoms. Findings indicate the positive influence of NH and HCBS services on perception of tangible social support, and the importance of addressing depressive symptoms and assisting with the maintenance of important relationships.
Collapse
Affiliation(s)
| | - Katherine M Abbott
- Scripps Gerontology Center, Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Liming Huang
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Mary D Naylor
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Karen B Hirschman
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
5
|
Zhao B, Kong F, Shin DE, Nam EW. Gender Disparity and the Association Between Socioeconomic Status, Mental Health, and the Need for Long-Term Services and Support Among the Older Koreans. Front Public Health 2022; 10:888011. [PMID: 35719606 PMCID: PMC9203953 DOI: 10.3389/fpubh.2022.888011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Background Population aging-the inevitable increase in the percentage of older adults-is occurring all around the world as the fertility rate declines and life expectancy rises. This study examined the relationship between socioeconomic status (SES), mental health, and the need for long-term services and support (LTSS) among Korean older adults. It also aimed to provide evidence-based information for South Korea's long-term support services and programs. Methods This study used the data on older adults aged over 60 years from the 2018 Korean Longitudinal Study of Aging (KLoSA). Ultimately, 5,527 older adults were included in the database (42.6% men, 57.4% women). To clarify the association between SES, mental health, and the need for LTSS among older Korean men and women, chi-squared test, t-test, and structural equation modeling (SEM) were performed. Results The SEM analysis showed that a significant, negative association was observed between SES and the need for LTSS among these older adults-the higher SES groups would generally have less need for LTSS. Mental health had a strong, negative impact on the need for LTSS-better mental health status of the older individuals would indicate a lower need for LTSS, and the effect was stronger among older men. Meanwhile, the positive relationship between SES and mental health was verified-the higher the SES of these older adults the better their mental health. Conclusions Gender- and social class-sensitive impacts of mental health on the need for LTSS were observed in this study. These findings could provide an evidence-based reference for interventions targeting different genders and social classes in Korea's long-term care system, such as the enhancement of social welfare and mental health status of the older adults.
Collapse
Affiliation(s)
- Bo Zhao
- Department of Health Administration, Graduate School, Yonsei University, Wonju, South Korea
- Yonsei Global Health Center, Yonsei University, Wonju, South Korea
| | - Fanlei Kong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dong Eun Shin
- Yonsei Global Health Center, Yonsei University, Wonju, South Korea
| | - Eun Woo Nam
- Department of Health Administration, Graduate School, Yonsei University, Wonju, South Korea
- Yonsei Global Health Center, Yonsei University, Wonju, South Korea
| |
Collapse
|
6
|
Roma M, Sullivan SS, Casucci S. TILE-12 index: an interpretable instrument for identifying older adults at risk for transitions in living environment within the next 12-months. Home Health Care Serv Q 2022; 41:236-254. [PMID: 35392771 DOI: 10.1080/01621424.2022.2052220] [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: 10/18/2022]
Abstract
Few evidence-based tools exist to support identification of older community dwelling adults at risk for unwanted transitions in living environment leading to missed opportunities to modify care plans to support aging-in-place and/or establish end-of-life care goals. An interpretable and actionable tool for assessing a person's risk of experiencing a transition is introduced. Logistic regression analysis of 14,772 transition opportunities (i.e. 12-month periods) for 4,431 respondents to the National Health and Aging Trends Study (NHATS) rounds 1-7. Results were visualized in a nomogram. Unmarried males of increasing age with chronic disease, greater functional dependence, overnight hospitalizations, not living in a single-family home, and limited social network, have elevated risk of experiencing a transition in living environment in a 12-month period. Homecare nurses are uniquely qualified to identify social determinants of health and can use this evidence-based tool to identify individuals who may benefit from transitional care assistance.
Collapse
Affiliation(s)
- Makayla Roma
- Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Sabrina Casucci
- Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| |
Collapse
|
7
|
Quinn CC, Knopp KL, Marsiglia CA, Bearch RC, LeFever A, Barr EA, Liang Y, Gruber-Baldini AL. Mobile Technology Care Coordination of Long-Term Services and Support: Cluster Randomized Clinical Trial. J Appl Gerontol 2020; 40:529-535. [PMID: 32705913 DOI: 10.1177/0733464820944043] [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: 11/15/2022] Open
Abstract
The purpose of the study was to assess whether the effects of a mobile predictive intervention used by Service Coordinators (SCs) reduce hospital utilization in a Medicaid Long-Term Services and Supports (LTSS) population in Baltimore city during a 5-month intervention. SC participants (n = 11) were recruited to treatment or control groups. LTSS clients (n = 420) followed their SC randomization assignment. Utilization data were obtained from the Maryland Chesapeake Regional Information System for our Patients (CRISP) Health Information Exchange (HIE) system and linked to service coordination records. Study groups were similar in age, gender, race, and years receiving LTSS. SCs' satisfaction with use of the mobile tool was surveyed. SC perceptions were neutral (mean scores ranged from 2.3 to 3.3 on a 5-point scale). No significant differences between groups were observed for all utilization metrics. The mobile technology software system used in this study did not improve health care utilization for a LTSS population needing ongoing clinical and social services coordinated care.
Collapse
Affiliation(s)
| | - Kasey L Knopp
- University of Maryland School of Medicine, Baltimore, USA
| | | | | | | | - Erik A Barr
- University of Maryland School of Nursing, Baltimore, USA
| | - Yuanyuan Liang
- University of Maryland School of Medicine, Baltimore, USA
| | | |
Collapse
|
8
|
Rivera E, Hirschman KB, Naylor MD. Reported Needs and Depressive Symptoms Among Older Adults Entering Long-Term Services and Supports. Innov Aging 2020; 4:igaa021. [PMID: 32685704 PMCID: PMC7334621 DOI: 10.1093/geroni/igaa021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Long-term services and supports (LTSS) are vital for older adults with physical and cognitive disabilities. LTSS can be provided in settings such as nursing homes, assisted living, or via community-based services. During the transition to LTSS, older adults are at risk of increased depressive symptoms. In addition, older adults may identify unmet needs despite having access to new LTSS resources. The goal of this study was to examine the factors associated with increased depressive symptoms among a pool of older adults, with a focus on change in reported needs after starting LTSS. RESEARCH DESIGN AND METHODS This cross-sectional analysis of a cohort study included 352 older adults new to LTSS (R01AG025524). The outcome of depressive symptoms was measured using the Geriatric Depression Scale-Short Form. Reported needs included supportive equipment, devices, transportation, and social activities. Bivariate and linear regression modeling using change in needs 3 months later were performed. RESULTS Depressive symptoms were present among 40% of the LTSS recipients at enrollment and 3 months. At baseline, 29% of LTSS recipients reported a need for supportive equipment, 30% for transportation, and 23% for social activities. After 3 months, an average of 12% of LTSS recipients' needs were met, 13% of LTSS recipients' needs persisted, and 11% of LTSS recipients reported new needs. Depressive symptoms 3 months later were higher for those who reported persistent unmet needs compared with those who reported no needs at all, controlling for functional status and LTSS type. DISCUSSION AND IMPLICATIONS The transition to LTSS is a vulnerable time for older adults. Assessing the need for equipment, transportation, and social activities during this period may identify opportunities to improve the lives and emotional status of this population.
Collapse
Affiliation(s)
- Eleanor Rivera
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Mary D Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia
| |
Collapse
|