1
|
Lassell RKF, Tamayo V, Pena TA, Kishi M, Zwerling J, Gitlin LN, Brody AA. "When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners. Front Aging Neurosci 2024; 16:1401255. [PMID: 38957542 PMCID: PMC11217360 DOI: 10.3389/fnagi.2024.1401255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers. Methods Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design. Results 21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care. Conclusion Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.
Collapse
Affiliation(s)
- Rebecca K. F. Lassell
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
- Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, IN, United States
- Hartford Institute for Geriatric Nursing (HIGN), NYU Rory Meyers College of Nursing, New York, NY, United States
| | - Valeria Tamayo
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
- Department of Art and Art Professions, NYU Steinhardt, New York, NY, United States
| | - Triana A. Pena
- Hartford Institute for Geriatric Nursing (HIGN), NYU Rory Meyers College of Nursing, New York, NY, United States
| | - Misa Kishi
- Arthur S. Abramson Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jessica Zwerling
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Laura N. Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing (HIGN), NYU Rory Meyers College of Nursing, New York, NY, United States
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
2
|
Browne B, Ali K, Ford E, Tabet N. Determinants of hospital readmissions in older people with dementia: a narrative review. BMC Geriatr 2024; 24:336. [PMID: 38609878 PMCID: PMC11015733 DOI: 10.1186/s12877-024-04905-6] [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: 10/27/2023] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Over 50% of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmissions within 30 days of their discharge. Between 20-40% of these readmissions may be preventable. Current research focuses on the physical causes of hospital readmissions. However, older people with dementia have additional psychosocial factors that are likely to increase their risk of readmissions. This narrative review aimed to identify psychosocial determinants of hospital readmissions, within the context of known physical factors. METHODS Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022 and followed up in February 2024. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated hospital readmissions. An inductive approach was adopted to map the determinants of readmissions. Identified themes were described as narrative categories. RESULTS Seventeen studies including 7,194,878 participants met our inclusion criteria from a total of 6369 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs, and one study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data on over 2 million patients in one American study. Physical determinants included reduced mobility and accumulation of long-term conditions. Psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, socioeconomic inequalities among ethnic minorities, and behavioural and psychological symptoms. Other important psychosocial factors such as loneliness, poverty and mental well-being, were not included in the studies. CONCLUSION Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions, increase the risk of readmission in older people with dementia. These identified psychosocial determinants are likely to significantly contribute to readmissions. However, future research should focus on the understanding of the interaction between a host of psychosocial and physical determinants, and multidisciplinary interventions across care settings to reduce hospital readmissions.
Collapse
Affiliation(s)
- Bria Browne
- Centre for Dementia Studies, Brighton and Sussex Medical School, The University of Sussex Brighton, Brighton, UK.
| | - Khalid Ali
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Elderly Care and Stroke Medicine, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Naji Tabet
- Centre for Dementia Studies, Brighton and Sussex Medical School, The University of Sussex Brighton, Brighton, UK
| |
Collapse
|
3
|
Kuzmik A, Boltz M, Resnick B, McPherson R, Rodriguez M, Drazich BF, Galik E. Delirium Severity and Physical Function in Hospitalized Persons Living With Dementia: Moderation by Age, Sex, and Race. Alzheimer Dis Assoc Disord 2024; 38:28-33. [PMID: 38277635 PMCID: PMC10922871 DOI: 10.1097/wad.0000000000000601] [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: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study investigated whether demographic characteristics (age, sex, and race) moderated delirium severity as a predictor of physical function in hospitalized persons living with dementia. METHODS The sample consisted of 351 patients enrolled in a randomized controlled trial (Function Focused Care for Acute Care Using the Evidence Integration Triangle). Preliminary analysis was conducted to assess the main effect, and multiple linear regression was used to examine the moderating effect of demographic characteristics between delirium severity and physical function. RESULTS Both age and sex were found to have significant moderating effects on the relationship between delirium severity and physical function (β = 2.22; P = 0.02 and β = 1.34; P = 0.04, respectively). Older adults aged 85 years or older with higher levels of delirium severity reported lower levels of physical function compared with older adults aged 65 to 84 years. Males with higher levels of delirium severity reported lower levels of physical function compared with females. Race did not significantly moderate the association between delirium severity and physical function (β = 0.22; P = 0.90). CONCLUSIONS Our findings suggest that age and sex may have differential effects on physical function across different levels of delirium severity in hospitalized persons living with dementia.
Collapse
Affiliation(s)
- Ashley Kuzmik
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA
| | - Marie Boltz
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA
| | | | | | - Marleny Rodriguez
- Department of Psychology and Counseling, Immaculata University, Immaculata, PA
| | | | | |
Collapse
|
4
|
Lassell RKF, Lin SY, Convery K, Fletcher J, Chippendale T, Jones T, Durga A, Galvin JE, Rupper RW, Brody AA. Neuropsychiatric symptoms in people living with dementia receiving home health services. J Am Geriatr Soc 2023; 71:3865-3873. [PMID: 37572061 PMCID: PMC10841370 DOI: 10.1111/jgs.18548] [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: 05/18/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND We sought to describe neuropsychiatric symptoms (NPS) among people living with dementia (PLWD) from diverse racial and ethnic groups receiving home health services while accounting for dementia severity, individual symptom prevalence, and neighborhood disadvantage. METHODS A prospective study using cross-sectional data from n = 192 PLWD receiving skilled home healthcare in New Jersey enrolled in the Dementia Symptom Management at Home Program trial. We prospectively measured symptom prevalence with the Neuropsychiatric Inventory Questionnaire and dementia severity using the Quick Dementia Rating System. A one-way ANOVA determined NPS prevalence by dementia severity (mild, moderate, severe). Fisher's exact tests were used to assess the association of individual symptom prevalence with race and ethnicity and cross tabs to descriptively stratify individual symptom prevalence by dementia severity among groups. A Pearson correlation was performed to determine if a correlation existed among neighborhood disadvantages measured by the Area Deprivation Index (ADI) state decile scores and NPS prevalence and severity. RESULTS Participants identified as non-Hispanic White (50%), non-Hispanic Black (30%), or Hispanic (13%). NPS were prevalent in 97% of participants who experienced 5.4 ± 2.6 symptoms with increased severity (10.8 ± 6.6) and care partner distress (13.8 ± 10.8). NPS increased with dementia severity (p = 0.004) with the greatest difference seen between individuals with mild dementia (4.3 ± 2.3) versus severe dementia (5.9 ± 2.3; p = 0.002). Few differences were found in symptom prevalence by racial and ethnic sub-groups. Nighttime behaviors were higher in non-Hispanic Black (78%), compared with non-Hispanic Whites (46%) with moderate dementia, p = 0.042. State ADI scores were not correlated with the number of NPS reported, or severity. CONCLUSIONS NPS were prevalent and increased with dementia severity with commonalities among racial and ethnic groups with varying levels of neighborhood disadvantage. There is a need for effective methods for improving NPS identification, assessment, and management broadly for homebound PLWD.
Collapse
Affiliation(s)
- Rebecca K F Lassell
- Department of Health & Wellness Design, School of Public Health, Indiana University, Bloomington, USA
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Shih-Yin Lin
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Kimberly Convery
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Jason Fletcher
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Tracy Chippendale
- Department of Occupational Therapy, New York University, New York, New York, USA
| | - Tessa Jones
- Silver School of Social Work, New York University, New York, New York, USA
| | - Aditi Durga
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
- Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
5
|
Drazich BF, Resnick B, Boltz M, Galik E, Kim N, McPherson R, Ellis J, Phun J, Kuzmik A. Factors Associated With Physical Activity in Hospitalized Patients With Dementia. J Aging Phys Act 2023; 31:658-665. [PMID: 36746152 PMCID: PMC10517697 DOI: 10.1123/japa.2022-0210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/11/2022] [Accepted: 11/12/2022] [Indexed: 02/08/2023]
Abstract
Older adults continue to spend little time engaged in physical activity when hospitalized. The purpose of this study was to (a) describe activity among hospitalized older adults with dementia and (b) identify the association between specific factors (gender, ambulation independence, comorbidities, race, and hospital setting) and their physical activity. This descriptive study utilized baseline data on the first 79 participants from the Function Focused Care for Acute Care using the Evidence Integration Triangle. Multiple linear regression models were run using accelerometry data from the first full day of hospitalization. The participants spent an average of 83.7% of their time being sedentary. Male gender, ambulation independence, and hospital setting (the hospital in which the patient was admitted) were associated with greater activity. This study reports on the limited time spent in activity for older adults with dementia when hospitalized and highlights patient profiles that are particularly vulnerable to sedentary behavior in the hospital setting.
Collapse
Affiliation(s)
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Marie Boltz
- School of Nursing, Penn State University, College State, PA,USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Nayeon Kim
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland Baltimore, Baltimore, MD,USA
| | - Jasmine Phun
- School of Medicine, Thomas Jefferson University, Philadelphia, PA,USA
| | - Ashley Kuzmik
- School of Nursing, Penn State University, College State, PA,USA
| |
Collapse
|
6
|
Gitlin LN, Marx K, Piersol CV, Hodgson NA, Parker LJ, Cidav T, Roth DL. Differential race effects of the tailored activity program (TAP) on dementia-related behaviors: A randomized controlled trial. J Am Geriatr Soc 2022; 70:3105-3115. [PMID: 35932186 PMCID: PMC10414755 DOI: 10.1111/jgs.17981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although nonpharmacological approaches are considered first-line treatments for dementia-related behaviors, it is unclear as to their effectiveness for different racial groups. We evaluated the effects of the Tailored Activity Program (TAP) on agitated and aggressive behaviors in Black and White families. METHODS We conducted a single-blind, two-arm randomized controlled trial involving Black (N = 90) and White (N = 145) families. TAP involved eight home sessions by occupational therapists who provided activities tailored to abilities and interests and instructed caregivers in their use over 3 months. An attention control group received eight sessions by research assistants who provided disease education and home safety tips. Measures included caregiver ratings of frequency by severity for the agitation and aggression subscales of the Neuropsychiatric Inventory-Clinician (NPI-C) at 3 months (main trial primary outcome), number of completed sessions and time spent, changes in behavioral subcomponents of the subscales (frequency, severity, caregiver distress), and percent improving/worsening. RESULTS Black and White families completed similar numbers of treatment sessions, but White dyads averaged nearly two contact hours more than Black dyads (p = 0.008). At 3 months, an interaction effect (treatment by race) indicated significantly greater reductions in frequency by severity scores for the agitation and aggression subscales for Black TAP dyads versus White TAP dyads and White and Black attention control dyads. Also, significant interaction effects favoring TAP Black dyads were observed for select behavioral components. For TAP dyads with elevated baseline agitation/aggression levels (N = 71), 34.5% of Black versus 11.9% of White dyads improved; whereas 2.6% of Black versus 16.7% of White dyads had worsened agitation/aggression scores. CONCLUSION Black families compared to White families derived greater behavioral benefits from TAP for PLWD at 3 months despite having less treatment exposure. Examining differential race effects may enhance precision in using nonpharmacological approaches and promote equity in dementia care for underserved populations.
Collapse
Affiliation(s)
- Laura N. Gitlin
- Drexel University, College of Nursing and Health Professions, Philadelphia, PA
| | - Katherine Marx
- Johns Hopkins University, School of Nursing, Baltimore, Maryland
| | | | | | - Lauren J. Parker
- Johns Hopkins University, School of Public Health, Baltimore, Maryland
| | - Tom Cidav
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - David L. Roth
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| |
Collapse
|
7
|
Resnick B, Boltz M, Kuzmik A, Galik E, Galvin JE. Reliability and Validity of the Neuropsychiatric Inventory-Questionnaire Using a Rasch Analysis. J Nurs Meas 2022; 31:JNM-2021-0008.R2. [PMID: 35882530 PMCID: PMC9877242 DOI: 10.1891/jnm-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to expand on the limited psychometric testing of the NPI-Q, and extend testing to include hospitalized older adults. METHOD This was a descriptive study using data from 318 dyads in an ongoing cluster randomized clinical trial. Rasch analysis and hypothesis testing were done. RESULTS The majority of the participants were female (62%), non-Hispanic (98%), and black (50%) with a mean age of 81.62 (SD = 8.43). There was evidence of internal consistency and invariance across race and gender. The items fit with each subscale. Hypothesis testing was supported with a significant association between the NPI-Q and dementia and caregiver distress. CONCLUSIONS The NPI-Q is short, easy to complete, and reliable and valid when used with hospitalized older adults.
Collapse
Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street Room 390, Baltimore, MD 21201
| | - Marie Boltz
- The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Ashley Kuzmik
- Project Director, The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street Room 390, Baltimore, MD 21201
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine
| |
Collapse
|
8
|
Galvin JE, Chrisphonte S, Chang LC. Medical and Social Determinants of Brain Health and Dementia in a Multicultural Community Cohort of Older Adults. J Alzheimers Dis 2021; 84:1563-1576. [PMID: 34690143 PMCID: PMC10731581 DOI: 10.3233/jad-215020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Socioeconomic status (SES), race, ethnicity, and medical comorbidities may contribute to Alzheimer's disease and related disorders (ADRD) health disparities. OBJECTIVE Analyze effects of social and medical determinants on cognition in 374 multicultural older adults participating in a community-based dementia screening program. METHODS We used the Montreal Cognitive Assessment (MoCA) and AD8 as measures of cognition, and a 3-way race/ethnicity variable (White, African American, Hispanic) and SES (Hollingshead index) as predictors. Potential contributors to health disparities included: age, sex, education, total medical comorbidities, health self-ratings, and depression. We applied K-means cluster analyses to study medical and social dimension effects on cognitive outcomes. RESULTS African Americans and Hispanics had lower SES status and cognitive performance compared with similarly aged Whites. We defined three clusters based on age and SES. Cluster #1 and #3 differed by SES but not age, while cluster #2 was younger with midlevel SES. Cluster #1 experienced the worse health outcomes while cluster #3 had the best health outcomes. Within each cluster, White participants had higher SES and better health outcomes, African Americans had the worst physical performance, and Hispanics had the most depressive symptoms. In cross-cluster comparisons, higher SES led to better health outcomes for all participants. CONCLUSION SES may contribute to disparities in access to healthcare services, while race and ethnicity may contribute to disparities in the quality and extent of services received. Our study highlights the need to critically address potential interactions between race, ethnicity, and SES which may better explain disparities in ADRD health outcomes.
Collapse
Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lun-Ching Chang
- Department of Mathematical Sciences, Florida Atlantic University, Boca Raton, FL, USA
| |
Collapse
|