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Paladino J, Ritchie C. Meeting the Communication and Care Planning Needs of Patients and Caregivers Affected by Dementia from the Time of Diagnosis. J Palliat Med 2024; 27:716-719. [PMID: 38770630 DOI: 10.1089/jpm.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Joanna Paladino
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Ritchie
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Objectives: Patient trust in physicians is associated with patient satisfaction with healthcare, patients engaging in follow-up care, and positive health-related outcomes. The current study investigated whether age moderated the relation between trust in physicians and four health outcome variables, including patient satisfaction, doctor visits, emergency room visits, and hospital admissions. Methods: 398 English-speaking, community-dwelling adults completed measures of physician trust and important health outcome variables via Amazon Mechanical Turk. Results: Age significantly moderated relations between trust in physicians and hospital admissions, and trust in physicians and patient satisfaction, with both positive relations becoming stronger with increasing age. Discussion: The results highlight the need for a lifespan approach to the study of physician trust and related health outcomes. They offer an avenue for increasing physician trust, engagement with the healthcare system prior to the need for hospitalization, and the reduction of healthcare costs.
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Affiliation(s)
- Emma Katz
- Behavioral Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Barry Edelstein
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Kazanski ME, Dharanendra S, Rosenberg MC, Chen D, Brown ER, Emmery L, McKay JL, Kesar TM, Hackney ME. Life-long music and dance relationships inform impressions of music- and dance-based movement therapies in individuals with and without mild cognitive impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.09.24307114. [PMID: 38798436 PMCID: PMC11118554 DOI: 10.1101/2024.05.09.24307114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background No effective therapies exist to prevent degeneration from Mild Cognitive Impairment (MCI) to Alzheimer's disease. Therapies integrating music and/or dance are promising as effective, non-pharmacological options to mitigate cognitive decline. Objective To deepen our understanding of individuals' relationships (i.e., histories, experiences and attitudes) with music and dance that are not often incorporated into music- and dance-based therapeutic design, yet may affect therapeutic outcomes. Methods Eleven older adults with MCI and five of their care partners/ spouses participated (4M/12F; Black: n=4, White: n=10, Hispanic/ Latino: n=2; Age: 71.4±9.6). We conducted focus groups and administered questionnaires that captured aspects of participants' music and dance relationships. We extracted emergent themes from four major topics, including: (1) experience and history, (2) enjoyment and preferences, (3) confidence and barriers, and (4) impressions of music and dance as therapeutic tools. Results Thematic analysis revealed participants' positive impressions of music and dance as potential therapeutic tools, citing perceived neuropsychological, emotional, and physical benefits. Participants viewed music and dance as integral to their lives, histories, and identities within a culture, family, and/ or community. Participants also identified lifelong engagement barriers that, in conjunction with negative feedback, instilled persistent low self-efficacy regarding dancing and active music engagement. Questionnaires verified individuals' moderately-strong music and dance relationships, strongest in passive forms of music engagement (e.g., listening). Conclusions Our findings support that individuals' music and dance relationships and the associated perceptions toward music and dance therapy may be valuable considerations in enhancing therapy efficacy, participant engagement and satisfaction for individuals with MCI.
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Affiliation(s)
- Meghan E. Kazanski
- Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sahrudh Dharanendra
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael C. Rosenberg
- Department of Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta, GA, USA
| | - Danyang Chen
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Emma Rose Brown
- College of Arts and Sciences, Emory University, Atlanta, GA, USA
| | - Laura Emmery
- Department of Music, Emory University College of Arts and Sciences, Atlanta, GA, USA
| | - J. Lucas McKay
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Trisha M. Kesar
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Madeleine E. Hackney
- Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, USA
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, USA
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Natvik E, Lavik KO, Ogden J, Strømmen M, Moltu C. The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study. Disabil Rehabil 2023; 45:4440-4449. [PMID: 36484620 DOI: 10.1080/09638288.2022.2152876] [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: 06/10/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. MATERIALS AND METHODS We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. RESULTS We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other. CONCLUSIONS The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.
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Affiliation(s)
- Eli Natvik
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Kristina Osland Lavik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jane Ogden
- Department of Psychology, University of Surrey, Guildford, England
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
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Portacolone E, Torres JM, Johnson JK, Benton D, Rapp T, Tran T, Martinez P, Graham C. The Living Alone with Cognitive Impairment Project's Policy Advisory Group on Long-Term Services and Supports: Setting a Research Equity Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6021. [PMID: 35627558 PMCID: PMC9141001 DOI: 10.3390/ijerph19106021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022]
Abstract
(1) Background: A United States national policy advisory group (PAG) was convened to identify barriers and facilitators to expand formal long-term services and support (LTSS) for people living alone with cognitive impairment (PLACI), with a focus on equitable access among diverse older adults. The PAG's insights will inform the research activities of the Living Alone with Cognitive Impairment Project, which is aimed at ensuring the equitable treatment of PLACI. (2) Methods: The PAG identified barriers and facilitators of providing effective and culturally relevant LTSS to PLACI via one-on-one meetings with researchers, followed by professionally facilitated discussions among themselves. (3) Results: The PAG identified three factors that were relevant to providing effective and culturally relevant LTSS to PLACI: (i) better characterization of PLACI, (ii) leveraging the diagnosis of cognitive impairment, and (iii) expanding and enhancing services. For each factor, the PAG identified barriers and facilitators, as well as directions for future research. (4) Conclusions: The barriers and facilitators the PAG identified inform an equity research agenda that will help inform policy change.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
- Philip Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94158, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA;
| | - Julene K. Johnson
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
| | - Donna Benton
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA;
| | - Thomas Rapp
- LIRAES, Université Paris Cité, 75006 Paris, France;
- Sciences Po Paris, LIEPP, 75006 Paris, France
| | - Thi Tran
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
| | - Paula Martinez
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
| | - Carrie Graham
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
- Center for Health Care Strategies, Hamilton, NJ 08619, USA
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Merl H, Veronica Doherty K, Alty J, Salmon K. Truth, hope and the disclosure of a dementia diagnosis: A scoping review of the ethical considerations from the perspective of the person, carer and clinician. DEMENTIA 2022; 21:1050-1068. [PMID: 35134305 DOI: 10.1177/14713012211067882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper explores contemporary approaches to balancing truth with the provision of hope during the disclosure of a dementia diagnosis. We discuss the ethical significance of these practices as they relate to each member of the triad - the person, the carer and the clinician - at the point of diagnosis and beyond. The process of disclosing a diagnosis of dementia is complex. It encompasses breaking bad news while balancing hope, with truth about a progressive life-limiting condition. The process of receiving the diagnosis likewise challenges the person who may be unprepared for the diagnosis, while carers seek information and supports. The impact of receiving a diagnosis of dementia can be life-changing and harmful at the personal level - for both the person and carer. This risk of harm becomes a critical consideration for clinicians when deciding on the level of truth: what information should be relayed and to whom? That risk is also balanced against the ethical issue of patient autonomy, which includes the right to know (or not) and make informed decisions about therapeutic interventions. While the consensus is that the autonomy of the person living with dementia must be upheld, controversy exists regarding the extent to which this should occur. For instance, at diagnosis, it is common for clinicians to use euphemisms rather than the word dementia to maintain hope, even though people and carers prefer to know the diagnosis. This practice of therapeutic lying is a pervasive ethical issue in dementia care, made more acceptable by its roots in diagnosis disclosure.
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Affiliation(s)
- Helga Merl
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia
| | | | - Jane Alty
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia.,Neurology department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, 60119University of Tasmania, Hobart, TAS, Australia
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Edwards RD, Brenowitz WD, Portacolone E, Covinsky KE, Bindman A, Glymour MM, Torres JM. Difficulty and help with activities of daily living among older adults living alone with cognitive impairment. Alzheimers Dement 2020; 16:1125-1133. [PMID: 32588985 PMCID: PMC7416441 DOI: 10.1002/alz.12102] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/17/2019] [Accepted: 01/17/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. METHODS For U.S. Health and Retirement Study (2000-2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. RESULTS Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46% reported an I/ADL difficulty; 72% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22% more likely to report a difficulty without help, and Latina women were 36% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. DISCUSSION Findings call for targeted efforts to support older adults living alone with cognitive impairment.
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Affiliation(s)
- Ryan D. Edwards
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Willa D. Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Elena Portacolone
- Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Ken E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Andrew Bindman
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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