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Choi H, Reblin M, Litzelman K. Conceptualizing Family Caregivers' Use of Community Support Services: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad039. [PMID: 37022354 DOI: 10.1093/geront/gnad039] [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: 10/06/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Only a fraction of the 53 million caregivers in the United States use available formal community services. This scoping review synthesized the literature on the barriers and facilitators of community support service utilization by adult caregivers of a family member or friend with an illness, disability, or other limitation. RESEARCH DESIGN AND METHODS We searched PubMed, CINAHL, PsycInfo, and Web of Science for quantitative and qualitative articles assessing barriers and facilitators of caregivers' access to and utilization of resources, following Preferred Reporting Items for Systematic Review and Meta-Analysis scoping review guidelines. Thematic analysis, drawing on an initial conceptualization, informed key insights around caregivers' resource navigation process. RESULTS The review provides support for individual factors affecting service use. Notably, some factors-such as time restrictions and increased caregiving demands-appear to function as barriers to accessing services even as they increase caregivers' need for support. Additionally, contextual barriers including cultural factors and support of friends/family can affect caregivers' access to resources. Finally, experience with health systems and structures and the intersection with other factors can affect service utilization. DISCUSSION AND IMPLICATIONS Suboptimal access to and utilization of community support services can be addressed at both the person and system level to mitigate potential inequities. Ensuring that caregivers are aware of, eligible for, and have the capacity and support to access the appropriate resources at the right time is essential for improving caregiver outcomes, reducing burnout, and supporting continued care.
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Affiliation(s)
- Hyojin Choi
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Maija Reblin
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Kristin Litzelman
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Dimtsu Assfaw A, Reinschmidt KM, Teasdale TA, Stephens L, Kleszynski KL, Dwyer K. Describing providers' perspectives on the needs and challenges of family caregivers of African American people living with dementia. Home Health Care Serv Q 2024; 43:133-153. [PMID: 38147405 DOI: 10.1080/01621424.2023.2299486] [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] [Indexed: 12/28/2023]
Abstract
The primary purpose of this study was to explore the needs and challenges of African American family caregivers of People living with dementia (PLWD) from the perspective of service providers including healthcare and social service providers. The study conducted three online semi-structured focus group interviews with service providers (n = 15). Data were analyzed using Braun & Clarke's guide to thematic analysis approach. Five themes emerged from the analysis of the focus group data: (i) Inadequate information about resources; (ii) Dementia education; (iii) Burden of dementia on families; (iv) Limited financial support and funding; and (v) Suggestions for needed resources. Service providers expressed the lack of community-based dementia service and support programs in African American communities. Findings from the study indicated the need to provide culturally appropriate information on dementia caregiving. This study adds to the scope of knowledge by exploring the processes of seeking help and using services.
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Affiliation(s)
- Araya Dimtsu Assfaw
- Department of Neurology- Knight Alzheimer Disease Research Center, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Kerstin M Reinschmidt
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center- Hudson College of Public Health, Oklahoma, USA
| | - Thomas A Teasdale
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center- Hudson College of Public Health, Oklahoma, USA
| | - Lancer Stephens
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center- Hudson College of Public Health, Oklahoma, USA
- Department of Health Promotion Sciences, Oklahoma Shared Clinical and Translational Research Center, Oklahoma, USA
| | - Keith L Kleszynski
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Kathleen Dwyer
- Population Health and Health Systems Science, University of Oklahoma Health Sciences Center- Fran and Earl Ziegler College of Nursing, Oklahoma, USA
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3
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Misiura MB, Butts B, Hammerschlag B, Munkombwe C, Bird A, Fyffe M, Hemphill A, Dotson VM, Wharton W. Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease. Neurotherapeutics 2023; 20:1019-1036. [PMID: 37490246 PMCID: PMC10457280 DOI: 10.1007/s13311-023-01408-x] [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] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
It is well known that vascular factors and specific social determinants of health contribute to dementia risk and that the prevalence of these risk factors differs according to race and sex. In this review, we discuss the intersection of sex and race, particularly female sex and Black American race. Women, particularly Black women, have been underrepresented in Alzheimer's disease clinical trials and research. However, in recent years, the number of women participating in clinical research has steadily increased. A greater prevalence of vascular risk factors such as hypertension and type 2 diabetes, coupled with unique social and environmental pressures, puts Black American women particularly at risk for the development of Alzheimer's disease and related dementias. Female sex hormones and the use of hormonal birth control may offer some protective benefits, but results are mixed, and studies do not consistently report the demographics of their samples. We argue that as a research community, greater efforts should be made to not only recruit this vulnerable population, but also report the demographic makeup of samples in research to better target those at greatest risk for the disease.
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Affiliation(s)
- Maria B Misiura
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Bruno Hammerschlag
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Chinkuli Munkombwe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Arianna Bird
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Mercedes Fyffe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Asia Hemphill
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
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Sloan DH, Johnston D, Reuland M, Spliedt M, Samus QM, Fabius C, Pyatt T, Antonsdottir I. Transcending inequities in dementia care in Black communities: Lessons from the maximizing independence at home care coordination program. DEMENTIA 2022; 21:1653-1668. [DOI: 10.1177/14713012221085808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose We examine care partners’ experience of the Maximizing Independence at Home (MIND) intervention, a multicomponent, home-based dementia care coordination program designed to provide high quality, wholistic care coordination for people and families living with dementia. The goal of the study was to understand 1. the unique dementia-related needs of Black care partners and barriers and challenges to caregiving experienced within the Black community, 2. perceived benefits of the MIND program, and 3. ways to improve the program and make it more culturally responsive to the Black community. Method We conducted three focus groups totaling 20 care partners of people living with dementia; who participated in the MIND intervention (2014–2019); all Black/African American and English speaking. Verbatim transcriptions were independently analyzed line-by-line by two coders using inductive approaches. Findings Participants noted three overarching themes related to dementia care needs and challenges in the Black community: difficulty finding and accessing dementia information and relevant services and supports; familial conflict/lack of sibling and familial support; and lack of effective communication about dementia within Black Communities. Regarding MIND at home program benefits, four themes emerged: 1. perceived to help locate resources (formal and informal); 2. provided care partners an opportunity for socialization and interaction; 3. included comprehensive assessments and helpful linked information; and 4. resulted in a “much needed break for care partners.” Increased diversity of the MIND program personnel, greater clarity and consistency in MIND program promotion, and better communications were themes for how the program could be improved. Conclusion Care partners participating in the MIND program perceived common benefits in aspects related to care for the persons living with dementia as well as benefits to themselves, believed the program addressed important challenges and gaps in education, services, and social support, and could be enhanced in its delivery and cultural responsiveness.
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Affiliation(s)
- Danetta H Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Melissa Reuland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Morgan Spliedt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chanee Fabius
- Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tabitha Pyatt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Inga Antonsdottir
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins School of Nursing, Baltimore, MD, USA
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Keller AO, Norris NC, Easter B, Garr A, Morgan G, Dicks-Williams R, Galambos C. A time for me: A virtual program to engage African American caregivers. J Women Aging 2022:1-14. [PMID: 35446750 DOI: 10.1080/08952841.2022.2064175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To address the self-care needs of African American family caregivers, a community-engaged approach was used to develop and implement a half-day virtual self-care program. This study evaluates experiences of program attendees. All attendees were emailed an electronic survey containing Likert-type and open-ended questions. Responses were examined for patterns and key content-related categories using inductive content analysis. Eleven attendees responded to the survey. All 11 strongly agreed (64%) or agreed (36%) that the event met their expectations and/or needs. In addition to providing opportunity to take time to engage in self-care, the event created a virtual space for women to focus on themselves. Women spoke about three distinct ways the event met their needs: (1) learning and trying new things, (2) access to resources, and (3) having a shared experience. These findings suggest that virtual programs may be used as an additional resource to support the health of African American women caregivers.
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Affiliation(s)
- Abiola O Keller
- College of Nursing, Marquette University, Milwaukee, WI, USA
| | - Nia C Norris
- Wisconsin Alzheimer's Institute Regional Milwaukee Office, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bashir Easter
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Gail Morgan
- Wisconsin Alzheimer's Institute Regional Milwaukee Office, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Colleen Galambos
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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6
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Alexander K, Oliver S, Bennett SG, Henry J, Hepburn K, Clevenger C, Epps F. "Falling between the cracks": Experiences of Black dementia caregivers navigating U.S. health systems. J Am Geriatr Soc 2022; 70:592-600. [PMID: 35015300 PMCID: PMC8892588 DOI: 10.1111/jgs.17636] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/22/2021] [Accepted: 12/05/2021] [Indexed: 02/03/2023]
Abstract
In addition to numerous care responsibilities, family caregivers are expected to navigate health systems and engage in healthcare management tasks on behalf of their persons living with dementia (PLWD). These challenging tasks pose additional difficulties for Black dementia caregivers. Due to the centuries-old, disadvantaged social history of Black Americans, several unique stressors, vulnerabilities, and resources have emerged which inform and affect Black dementia caregivers' experiences and well-being. Focus groups were held with Black caregivers (N = 19) from the United States to explore the unique experiences and perspectives of this population navigating the U.S. health system on behalf of their PLWD. Five overarching themes were constructed during thematic analysis: Forced Advocacy, Poor Provider Interaction, Payor Source Dictates Care, Discrimination, and Broken Health System. Black dementia caregivers unanimously concurred that the health system that they experience in America is "broken." Gaps in the health system can lead to people [as one caregiver passionately expressed] "falling between the cracks," in terms of care, services, and resources needed. Caregivers agreed that class, sex, utilizing public health insurance, and being a "person of color" contribute to their difficulties navigating the health system. Caregivers perceived being dismissed by providers, forcing them to advocate for both themselves and their PLWD. Healthcare providers and researchers can utilize these findings to improve the experiences and healthcare outcomes of Black persons living with dementia and their caregivers. Additionally, these findings can lead to the development of culturally tailored caregiver education programs.
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Affiliation(s)
- Karah Alexander
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sloan Oliver
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Jenyl Henry
- Public Health Department, Grand Canyon University, Phoenix, Arizona, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Carolyn Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Epps F, Moore MA, Chester M, Gore J, Sainz M, Adkins A, Clevenger C, Aycock DM. The Alter Program: A Nurse-Led, Dementia-Friendly Program for African American Faith Communities and Families Living With Dementia. Nurs Adm Q 2022; 46:72-80. [PMID: 34860803 PMCID: PMC8647771 DOI: 10.1097/naq.0000000000000506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dementia is a stigmatizing condition requiring enhanced awareness and understanding. Churches are a trusted source of support for African Americans, a demographic disproportionately affected by dementia. However, many African American churches are not equipped with the knowledge and means to provide safe environments, resources, and spiritual and social support for their parishioners living with dementia and their families. This protocol is written to detail the design and implementation of a nurse-led, dementia-friendly congregation program, Alter. The Alter program was developed to increase dementia awareness, develop a supportive, faith-based dementia-friendly infrastructure, and create a community supporting the well-being of African Americans living with dementia and their families. Engagement in this program aims to improve brain health status of older adults, improve physical and mental health outcomes, reduce dementia stigma, and enhance personal agency. Improved outcomes for persons living with dementia translate into lower use of acute and emergency services due to more stability in community care. It is expected that the churches participating in this program will be recognized by their community as a great resource for dementia information and support. The long-term goal of the Alter program is to be widely adapted in various health systems to reduce health disparities associated with dementia in the African American community.
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Affiliation(s)
- Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University
| | - Miranda A. Moore
- Department of Family and Preventive Medicine, School of Medicine, Emory University
| | | | - Janelle Gore
- Nell Hodgson Woodruff School of Nursing, Emory University
| | - Mayra Sainz
- Nell Hodgson Woodruff School of Nursing, Emory University
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8
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Murchison CF, Kennedy RE, McConathy JE, Roberson ED. Racial Differences in Alzheimer's Disease Specialist Encounters Are Associated with Usage of Molecular Imaging and Dementia Medications: An Enterprise-Wide Analysis Using i2b2. J Alzheimers Dis 2021; 79:543-557. [PMID: 33337364 PMCID: PMC7902957 DOI: 10.3233/jad-200796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: African Americans are at increased risk for Alzheimer’s disease (AD) but barriers to optimal clinical care are unclear. Objective: To comprehensively evaluate potential racial differences in the diagnosis and treatment of AD in an academic medical center. Methods: We used the clinical informatics tool, i2b2, to analyze all patient encounters for AD or mild cognitive impairment (MCI) in the University of Alabama at Birmingham Health System over a three-year period, examining neuroimaging rates and dementia-related medication use by race and clinic site using ratio tests on contingency tables of stratified patient counts. Results: Enterprise-wide, African Americans were not underrepresented among outpatients seen for AD/MCI. However, there were differences in the clinic setting where visits occurred, with African Americans overrepresented in Geriatrics and primary care clinics and underrepresented in Memory Disorders specialty clinics. There were no racial differences in the rates at which any clinic ordered PET neuroimaging tests or dementia-related medications. However, unsurprisingly, specialty clinics ordered both PET neuroimaging and dementia-related medications at a higher rate than primary care clinics, and overall across the medical enterprise, African Americans were statistically less likely to have PET neuroimaging or dementia-related medications ordered. Conclusion: African Americans with AD/MCI were not underrepresented at this academic medical center but were somewhat less likely to have PET neuroimaging or to be on dementia-related medications, potentially in part from underrepresentation in the specialty clinics where these orders are more likely. The reasons for this underrepresentation in specialty clinics are likely multifactorial and important to better understand.
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Affiliation(s)
- Charles F Murchison
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Integrative Center for Aging Research, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jonathan E McConathy
- Molecular Imaging and Therapeutics, Department of Radiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erik D Roberson
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Neurodegeneration and Experimental Therapeutics, Department of Neurobiology, School of Medicine, Birmingham, AL, USA
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9
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Fischer A, Conigliaro J, Allicock S, Kim EJ. Examination of social determinants of health among patients with limited English proficiency. BMC Res Notes 2021; 14:299. [PMID: 34353369 PMCID: PMC8340469 DOI: 10.1186/s13104-021-05720-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study is to examine the prevalence of social needs by English proficiency using data from Northwell Health’s social determinants of health screening program. The screening program evaluates 12 domains of social needs: material need, employment, medical-legal assistance, health insurance, public benefits, health literacy, transportation, medical care, utilities, housing quality, food security, and housing insecurity. We have identified patients to have limited English proficiency if they have selected a language other than English as their primary language. Results The study population includes 92,958 individuals; of these, 83,445 (89.8%) patients are English proficient, and 9513 (10.2%) patients have limited English proficiency. A higher percentage of patients with limited English proficiency has social needs, including material need, employment, medical-legal assistance, health insurance, public benefit, health literacy, medical care, utility bill, poor housing quality, and food insecurity (all p-values < 0.05). In multivariable logistic regression models adjusting for sociodemographic information, LEP status (odds ratio = 1.36 [1.25–1.49]) has been associated with having social needs. These findings suggest that system-wide SDH screening and referral programs should identify ways to ensure capturing social needs among patients with limited English proficiency. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05720-7.
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Affiliation(s)
- Austin Fischer
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Joseph Conigliaro
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.,Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, 600 Community Drive Suite 403, Manhasset, NY, 11030, USA
| | - Shaun Allicock
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.,Northwell Health, 5 Dakota Dr, New Hyde Park, NY, 11042, USA
| | - Eun Ji Kim
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA. .,Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, 600 Community Drive Suite 403, Manhasset, NY, 11030, USA.
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10
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Abramsohn EM, Paradise KM, Glover CM, Benjamins M, Douglas L, Jerome J, Kim ML, Kostas T, Mata D, Padron F, Shah RC, Lindau ST. CommunityRx: Optimizing a Community Resource Referral Intervention for Minority Dementia Caregivers. J Appl Gerontol 2021; 41:113-123. [PMID: 33834890 DOI: 10.1177/07334648211005594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community resource referral systems have been implemented into care settings that serve persons with dementia but with little input from caregivers. Focus groups were conducted with African American, Hispanic, and Asian caregivers to describe their preferences for community resource referral information. Caregivers discussed the significance of a community resource list for dementia caregiving and self-care and articulated strategies for effective information delivery during a medical visit. Most caregivers acknowledged that resource needs change with progression of dementia, but no patterns emerged with regard to preference for information delivered incrementally based on disease stage or all at once. Hispanic and Asian caregivers felt that resource information should specify service providers' language and cultural capabilities. All caregivers agreed that delivery by a member of the care team with knowledge of dementia-specific resources would be most effective. Optimal delivery of community resource referrals is caregiver-centered and customizable to individual and subgroup preferences.
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Affiliation(s)
| | | | - Crystal M Glover
- Rush University Medical Center, Chicago, IL, USA.,Rush Alzheimer's Disease Center, Chicago, IL, USA
| | | | | | | | | | | | - David Mata
- Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Raj C Shah
- Rush University Medical Center, Chicago, IL, USA.,Rush Alzheimer's Disease Center, Chicago, IL, USA
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11
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Boltz M, BeLue R, Resnick B, Kuzmik A, Galik E, Jones JR, Arendacs R, Sinvani L, Mogle J, Galvin JE. Disparities in Physical and Psychological Symptoms in Hospitalized African American and White Persons with Dementia. J Aging Health 2020; 33:340-349. [PMID: 33371763 DOI: 10.1177/0898264320983210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This study examined differences in physical function, delirium, depressive symptoms, and behavioral and psychological symptoms of dementia (BPSD) in hospitalized African American and white older adults with dementia. Methods: This secondary data analysis using baseline data from an ongoing trial testing family-centered function-focused care included African American (n = 159) and white persons (n =135) with dementia. Results: A multivariate analysis of covariance showed that controlling for relevant demographic and health characteristics, African Americans with dementia had lower physical function, more delirium, and more depressive symptoms upon admission than white participants. There were no significant differences in BPSD between African American and white persons. Discussion: To our knowledge, this is the first study to examine racial differences in admission symptoms of hospitalized persons with dementia. While the findings are preliminary, they can be used to inform the design of future research, including identifying the causes of disparities.
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Affiliation(s)
- Marie Boltz
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | | | - Barbara Resnick
- School of Nursing, 12265University of Maryland, Baltimore, MD, USA
| | - Ashley Kuzmik
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | - Elizabeth Galik
- School of Nursing, 12265University of Maryland, Baltimore, MD, USA
| | - Joanne R Jones
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | - Rachel Arendacs
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | - Liron Sinvani
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jacqueline Mogle
- Center for Healthy Aging, 311285The Pennsylvania State University, University Park, PA, USA
| | - James E Galvin
- Cognitive Disorder Division, 5452University of Miami, Coral Gables, FL, USA
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12
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Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults. Palliat Support Care 2020; 19:515-523. [PMID: 33234188 DOI: 10.1017/s1478951520001200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. METHOD Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann-Whitney U test. RESULTS There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). SIGNIFICANCE OF RESULTS This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.
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