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Bender AA, Pier E, Moore M, Jungerman J, Davis A, Perkins MM. Barriers to Community Service Use Among Persons With Dementia and Their Care Partners: A Focus on Consumers of a Novel Statewide Dementia Care Program. J Appl Gerontol 2024; 43:612-622. [PMID: 38171532 DOI: 10.1177/07334648231223295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Although the importance of access to, and utilization of, home and community-based services (HCBS) is a well-documented aspect of informal care and the ability to age in place among people living with dementia, these resources are underutilized, especially in the initial stages of the disease. In 2017, the Georgia Memory Net was established as a novel private-public partnership to extend dementia screening, diagnosis, care planning, and direct HCBS connections for people with memory concerns throughout the State of Georgia. We aimed to identify barriers and facilitators to HCBS utilization following a dementia diagnosis and subsequent referral for services. Data were collected through in-depth interviews with 7 Georgia Memory Net patients and 19 care partners (unconnected dyads) and analyzed using thematic analysis. We found that even with a direct handoff, many people do not use HCBS and face barriers to accessing services. We offer several recommendations based on these findings.
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Affiliation(s)
| | - Ellyn Pier
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA
- Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center, Atlanta, GA, USA
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Johnson TM, Freiji J, Moore MA, Bender AA, Munroe D, Geresu H, Baxter GG, Epps F, Taylor LF, Bussey-Jones J, Sharp T, Suggs A. Engaging partners, lay persons, and learners through effective marketing and messaging. J Am Geriatr Soc 2024. [PMID: 38599611 DOI: 10.1111/jgs.18914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Affiliation(s)
| | - Jason Freiji
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | - Hayat Geresu
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Fayron Epps
- The University of Texas Health Science Center San Antonio School of Nursing, San Antonio, Texas, USA
| | - Leslie F Taylor
- Mercer University College of Health Professions, Atlanta, Georgia, USA
| | | | - Travis Sharp
- Reckon Branding, Peachtree Corners, Georgia, USA
| | - Andy Suggs
- Reckon Branding, Peachtree Corners, Georgia, USA
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Plantinga LC, Bender AA, Urbanski M, Douglas-Ajayi C, Morgan JC, Woo K, Jaar BG. Patient Care Technician Staffing and Outcomes Among US Patients Receiving In-Center Hemodialysis. JAMA Netw Open 2024; 7:e241722. [PMID: 38457178 PMCID: PMC10924248 DOI: 10.1001/jamanetworkopen.2024.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
Importance Dialysis patient care technicians (PCTs) play a critical role in US in-center hemodialysis (HD) care, but little is known about the association of PCT staffing with patient outcomes at US HD facilities. Objective To estimate the associations of in-center HD patient outcomes with facility-level PCT staffing. Design, Setting, and Participants This was a retrospective cohort study, with data analysis performed from March 2023 to January 2024. Data on US patients with end-stage kidney disease and their treatment facilities were obtained from the US Renal Data System. Participants included patients (aged 18-100 years) initiating in-center HD between January 1, 2016, and December 31, 2018, who continued receiving in-center HD for 90 days or more and had data on PCT staffing at their initial treating HD facility. Exposure Facility-level patient-to-PCT ratios (number of HD patients divided by the number of PCTs reported by the treating facility in the prior year), categorized into quartiles (highest quartile denotes the highest PCT burden). Main Outcomes and Measures Patient-level outcomes included 1-year patient mortality, hospitalization, and transplantation. Associations of outcomes with quartile of patient-to-PCT ratio were estimated using incidence rate ratios (IRRs) from mixed-effects Poisson regression, with adjustment for patient demographics and clinical and facility factors. Results A total of 236 126 patients (mean [SD] age, 63.1 [14.4] years; 135 952 [57.6%] male; 65 945 [27.9%] Black; 37 777 [16.0%] Hispanic; 153 637 [65.1%] White; 16 544 [7.0%] other race; 146 107 [61.9%] with diabetes) were included. After full adjustment, the highest vs lowest quartile of facility-level patient-to-PCT ratio was associated with a 7% higher rate of patient mortality (IRR, 1.07; 95% CI, 1.02-1.12), a 5% higher rate of hospitalization (IRR, 1.05; 95% CI, 1.02-1.08), an 8% lower rate of waitlisting (IRR, 0.92; 95% CI, 0.85-0.98), and a 20% lower rate of transplant (IRR, 0.80; 95% CI, 0.71-0.91). The highest vs lowest quartile of patient-to-PCT ratio was also associated with an 8% higher rate of sepsis-related hospitalization (IRR, 1.08; 95% CI, 1.03-1.14) and a 15% higher rate of vascular access-related hospitalization (IRR, 1.15; 95% CI, 1.03-1.28). Conclusions and Relevance These findings suggest that initiation of treatment in facilities with the highest patient-to-PCT ratios may be associated with worse early mortality, hospitalization, and transplantation outcomes. These results support further investigation of the impact of US PCT staffing on patient safety and quality of US in-center HD care.
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Affiliation(s)
- Laura C. Plantinga
- Division of Rheumatology, Department of Medicine, University of California, San Francisco
- Division of Nephrology, Department of Medicine, University of California, San Francisco
| | - Alexis A. Bender
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Megan Urbanski
- Division of Transplantation, Department of Surgery, Emory University, Atlanta, Georgia
| | | | | | - Karen Woo
- Department of Surgery, University of California, Los Angeles
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Plantinga LC, Urbanski M, Hoge C, Rickenbach F, Douglas-Ajayi C, Morgan JC, Bender AA, Jaar BG. Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study. Kidney Med 2024; 6:100782. [PMID: 38419788 PMCID: PMC10900094 DOI: 10.1016/j.xkme.2023.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Rationale & Objective Technicians caring for patients receiving dialysis play a critical, frontline role in the care of patients receiving dialysis in the United States. We sought to provide a comprehensive description and identify correlates of US in-center hemodialysis facility patient care technician staffing patterns. Study Design This was an ecological study. Setting & Participants US facilities providing hemodialysis and reporting patient care technician staffing, identified using the US Renal Data System. Exposures Geography, year, and facility characteristics, including aggregated patient characteristics. Outcomes The study outcome was facility-reported patient-to-patient care technician ratio. Analytical Approach We examined patient-to-patient care technician ratios by US state and over time and also estimated the differences in patient-to-patient care technician ratios associated with facility characteristics, using robust regression with adjustment for facility-level covariates. Results The median patient-to-patient care technician ratio among 6,862 US facilities in 2019 was 9.9 (25th-75th percentiles, 8.2-12.0). Median 2019 patient-to-patient care technician ratios varied substantially by US state and region. There was an overall decline (from 10.6 to 9.9) in median patient-to-patient care technician ratios from 2004 to 2019, whereas the percentage of positions that were unfilled increased (from 2.8% to 3.5%). After adjustment, large dialysis organization status (β, -0.42; 95% CI, -0.61 to -0.23) and larger facility size (β, -0.51; 95% CI, -0.68 to -0.33) were associated with lower patient-to-patient care technician ratios. Higher patient-to-registered nurse (β, 0.80; 95% CI, 0.65-0.94) and patient-to-social worker (β, 0.53; 95% CI, 0.37-0.70) ratios, presence of licensed vocational nurses or licensed practical nurses at the clinic (β, 0.83; 95% CI, 0.53-1.12), and location in a poverty area (β, 0.29; 95% CI, 0.13-0.44) were all associated with higher patient-to-patient care technician ratios. Aggregated patient characteristics of patients treated at the facilities were generally not associated with patient-to-patient care technician ratio after adjustment. Limitations Limited causal inference and potential shifts in staffing after 2019. Conclusions US dialysis facilities vary considerably in their patient care technician staffing by geography, over time, and by various facility characteristics. Further investigation of US patient care technician staffing is warranted and could lead to better, more stable dialysis staffing, improved staff and patient satisfaction, and higher quality of care.
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Affiliation(s)
- Laura C. Plantinga
- Divisions of Rheumatology and Nephrology, University of California, San Francisco, San Francisco, California
| | - Megan Urbanski
- Departments of Surgery, Emory University, Atlanta, Georgia
| | | | - Fran Rickenbach
- National Association of Nephrology Technicians/Technologists, Dayton, Ohio
| | | | | | | | - Bernard G. Jaar
- Departments of Medicine and Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Kemp CL, Craft Morgan J, Bender AA, Hill AM, Anglin E, Burgess EO, Epps F, Perkins MM. "Just Join Them": Improv and Dementia Care. J Appl Gerontol 2024; 43:302-309. [PMID: 37933156 DOI: 10.1177/07334648231203195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Improvisational (improv) theatre skill development holds promise for improving the dementia capability of care partners. In this report, we present analysis of data from an ongoing study on meaningful engagement and quality of life among assisted living (AL) residents with dementia. Using ethnographic methods, we collected data from persons with dementia (n = 59) and their care partners (n = 165) in six diverse AL communities each studied for one year. Building cumulatively on past work and existing literature, we demonstrate the potential benefits of training care partners to use improv skills. We discuss implications, including the need for intervention research.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
- Department of Sociology, Georgia State University, Atlanta, GA, USA
| | - Jennifer Craft Morgan
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
- Department of Sociology, Georgia State University, Atlanta, GA, USA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Andrea M Hill
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Emerald Anglin
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Elisabeth O Burgess
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
- Department of Sociology, Georgia State University, Atlanta, GA, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Molly M Perkins
- Division of Geriatrics & Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA
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Chan K, Mitchell MM, Casselle E, Bender AA. Facilitators and Barriers to PrEP Acceptability and Initiation Among Opioid Treatment Program Patients and Staff. AIDS Educ Prev 2024; 36:60-72. [PMID: 38349350 DOI: 10.1521/aeap.2024.36.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The Centers for Disease Control and Prevention recommends PrEP (pre-exposure prophylaxis) for people who use drugs, yet uptake remains low. This study explores the acceptability and potential uptake of PrEP among participants in an opioid treatment program (OTP). We conducted 26 in-depth, semistructured interviews with staff and patients at an OTP in Baltimore, Maryland. Overall, participants felt that providing PrEP within the program would be beneficial, but they noted competing priorities among populations engaging in high-risk behaviors and lack of willingness among groups with lower risk behaviors. Participants reported several barriers to PrEP use among people who use drugs and who use medications for opioid use, including cost, competing priorities, stigma, and misconceptions about who should use PrEP. Facilitators to PrEP use were described as health benefits, trusted relationships with providers, and existing resources in the opioid treatment program. Practitioners should consider addressing barriers to access and stigma within an OTP setting for HIV prevention tools.
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Affiliation(s)
- Kiera Chan
- Department of Medicine, Emory University, Atlanta, Georgia
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Vandenberg AE, Bender AA, Kemp CL, Perkins MM. Resident and Caregiver Dyads Talk About Death and Dying in Assisted Living: A Typology of Communication Behaviors. Am J Hosp Palliat Care 2024:10499091231225960. [PMID: 38242860 DOI: 10.1177/10499091231225960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In the U.S., assisted living (AL) is increasingly a site of death, and anxiety about dying has been identified in long-term care residents and their caregivers. Communication about death and dying is associated with better quality of life and care at end of life (EOL). OBJECTIVE To understand communication behaviors used by AL residents and their informal caregivers (i.e., family members or friends) related to death and dying, and address communication needs or opportunities applicable to EOL care in AL. DESIGN A thematic analysis of in-depth interviews and fieldnotes from a subsample of data from a 5-year NIA-funded study. SETTING/SUBJECTS Participants included 15 resident-caregiver dyads from three diverse AL communities in Atlanta, Georgia in the U.S. MEASUREMENTS Interview transcripts were coded for communication behavior. Concordances and discordances within dyads were examined. RESULTS We identified a typology of four dyadic communication behaviors: Talking (i.e., both partners were talking with each other about death), Blocking (i.e., one partner wanted to talk about death but the other did not), Avoiding (i.e., each partner perceived that the other did not want to communicate about death), and Unable (i.e., dyads could not communicate about death because of interpersonal barriers). CONCLUSIONS Older residents in AL often want to talk about death but are blocked from doing so by an informal caregiver. Caregivers and AL residents may benefit from training in death communication. Recommendations for improving advance care planning and promoting better EOL communication includes timing these conversations before the opportunity is lost.
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Affiliation(s)
| | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA
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Mitchell MM, Angelo S, Akinwolere OG, Perkins MM, Bender AA. Latent class analysis of perceived stigma among older adults receiving medications for opioid use disorder. J Subst Use Addict Treat 2024; 156:209187. [PMID: 37858796 PMCID: PMC10843650 DOI: 10.1016/j.josat.2023.209187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
RATIONALE Public stigma surrounds individuals who use medication for their recovery from a substance use disorder. However, we know little about subgroups of individuals with varying levels of perceived stigma and how these levels may be associated with physical and mental health-related quality of life (HRQOL) and social support. METHODS We used latent class analysis to define subgroups of people aged 50-72 years of age (N = 104) who were enrolled in eight medication for opioid use disorder (MOUD) programs to explore subgroupings and correlates of group membership. RESULTS We found evidence for three distinct classes of individuals and named the classes 1) the high stigma class, 2) the embarrassed class, and 3) the low stigma class. We found that people in the high-stigma class reported more rejection, more abstinence-based support group involvement, and reduced mental HRQOL. CONCLUSIONS Results suggest reducing stigma among people on MOUD may help to boost mental HRQOL and improve social support receipt. The results are consistent with iatrogenic effects of AA/NA support groups such that these treatment modalities may increase stigma due to their focus on abstinence-only treatment for substance use disorders.
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Affiliation(s)
| | - Sahil Angelo
- Georgetown University Hospital, United States of America
| | | | - Molly M Perkins
- Emory University School of Medicine, United States of America; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, United States of America
| | - Alexis A Bender
- Emory University School of Medicine, United States of America.
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Kemp CL, Skipper AD, Bender AA, Perkins MM. Turning It Over to God: African American Assisted Living Residents' End-of-Life Preferences and Advance Care Planning. J Gerontol B Psychol Sci Soc Sci 2023; 78:1747-1755. [PMID: 37466307 PMCID: PMC10561881 DOI: 10.1093/geronb/gbad100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Assisted living (AL), a popular long-term care setting for older Americans, increasingly is a site for end-of-life care. Although most residents prefer AL to be their final home, relatively little is known about end-of-life preferences and advance care planning, especially among African American residents. Our research addresses this knowledge gap. METHODS Informed by grounded theory, we present an analysis of qualitative data collected over 2 years in a 100-bed AL community catering to African American residents. Data consisted of field notes from participant observation conducted during 310 site visits and 818 observation hours, in-depth interviews with 25 residents, and a review of their AL records. RESULTS Residents varied in their end-of-life preferences and advance care planning, but united in the belief that God was in control. We identified "Turning it over to God" as an explanatory framework for understanding how this group negotiated end-of-life preferences and advance care planning. Individual-level resident factors (e.g., age, pain, and function) and factors reflecting broader cultural and societal influences, including health literacy and care experiences, were influential. DISCUSSION Contradictions arose from turning it over to God, including those between care preferences, planning, and anticipated or actual end-of-life outcomes.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
- Department of Sociology, Georgia State University, Atlanta, Georgia, USA
| | - Antonius D Skipper
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Molly M Perkins
- Division of Geriatrics & Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Department of Sociology, Emory University, Atlanta, Georgia, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta, Georgia, USA
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Plantinga LC, Rickenbach F, Urbanski M, Hoge C, Douglas-Ajayi C, Morgan JC, Bender AA, Jaar BG. Professional Fulfillment, Burnout, and Turnover Intention Among US Dialysis Patient Care Technicians: A National Survey. Am J Kidney Dis 2023; 82:22-32.e1. [PMID: 36906216 PMCID: PMC10293091 DOI: 10.1053/j.ajkd.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/27/2022] [Indexed: 03/12/2023]
Abstract
RATIONALE & OBJECTIVE High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs). STUDY DESIGN Cross-sectional national survey. SETTING & PARTICIPANTS National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N=228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic). EXPOSURE Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention. ANALYTICAL APPROACH Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of≥1.3 and professional fulfillment by a score≥3.0. RESULTS Most respondents (72.8%) worked ≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect. LIMITATIONS Limited generalizability to all US dialysis PCTs. CONCLUSIONS More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.
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Affiliation(s)
| | - Fran Rickenbach
- National Association of Nephrology Technicians/Technologists, Dayton, Ohio
| | - Megan Urbanski
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Courtney Hoge
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | | | | | - Bernard G Jaar
- Department of Medicine, Department of Epidemiology, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Kemp CL, Bender AA, Morgan JC, Burgess EO, Epps FR, Hill AM, Perkins MM. Understanding Capacity and Optimizing Meaningful Engagement among Persons Living with Dementia. Dementia (London) 2023; 22:854-874. [PMID: 36913646 PMCID: PMC10789114 DOI: 10.1177/14713012231162713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Meaningful engagement is a key dimension of quality of life among persons living with dementia, yet little is known about how to best to promote it. Guided by grounded theory methods, we present analysis of data collected over a 1-year period in four diverse assisted living (AL) communities as part of the study, "Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia." Our aims are to: (a) learn how meaningful engagement is negotiated among AL residents with dementia and their care partners; and (b) identify how to create these positive encounters. Researchers followed 33 residents and 100 care partners (formal and informal) and used participant observation, resident record review, and semi-structured interviews. Data analysis identified "engagement capacity" as central to the negotiation of meaningful engagement. We conclude that understanding and optimizing the engagement capacities of residents, care partners, care convoys, and settings, are essential to creating and enhancing meaningful engagement among persons living with dementia.
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Affiliation(s)
- Candace L. Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
| | - Alexis A. Bender
- Division of Geriatric & Gerontology, Emory School of Medicine, Atlanta, GA
| | - Jennifer Craft Morgan
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Elisabeth O. Burgess
- The Gerontology Institute, Georgia State University, Atlanta, GA
- Department of Sociology, Georgia State University, Atlanta, GA
| | - Fayron R. Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Molly M. Perkins
- Division of Geriatric & Gerontology, Emory School of Medicine, Atlanta, GA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC)
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Plantinga LC, Bender AA, Urbanski M, Hoge C, Joseph J, Damron K, Douglas-Ajayi CJ, Rickenbach F, Morgan JC, Jaar BG. Work Experiences of the Interdisciplinary Dialysis Workforce in the United States: A Cross-Sectional Survey. Am J Nephrol 2023:000530553. [PMID: 37031676 DOI: 10.1159/000530553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Suboptimal dialysis care may be in part due to staff issues such as job dissatisfaction, burnout, work overload, high staff turnover, and inconsistent training. Here, we leveraged data collected in a recent national survey to provide an initial, comprehensive description of current work experiences of U.S. dialysis care providers. METHODS We conducted a cross-sectional survey of 1240 active U.S. dialysis clinic staff members (physicians, advanced practice providers, nurse managers/clinic coordinators, nurses, social workers, dietitians, and patient care technicians), who were recruited via emails to society membership lists. Respondents were asked about a wide variety of work experiences, including job satisfaction, professional fulfillment and burnout (Stanford Professional Fulfillment Index), work culture, experiences of hostility and violence, and self-reported medical errors. Responses were summarized overall and compared by clinic role. RESULTS Most of the survey respondents, representing all 50 U.S. states, were aged 35-49 (58.3%) or ≥50 (23.5%), female (60.7%), and white (59.8%; 23.1% Black and 10.0% Asian); 82.1% had been in their current role for at least 1 year. Most U.S. dialysis staff responding to our survey reported being generally satisfied with their jobs (mean rating of 7.9 on 0-10 scale), but only 54.4% met criteria for professional fulfillment, and 32.8% met criteria for burnout, driven by high scores in the work exhaustion domain. Related issues, including high workloads, lack of respect (including experiences of violence and hostility), lack of autonomy, and suboptimal patient environments (in terms of both safety and patient-centeredness), were commonly reported among dialysis care providers, although their prevalence often differed by provider type. CONCLUSION Our results suggest that the dialysis workforce may be at a critical point. Preventing further staff burn out, which could lead to even greater staffing shortages and worse working conditions among those who continue to provide dialysis care, is essential.
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Brody LA, Kamalyan L, Karcher K, Guarena LA, Bender AA, McKenna BS, Umlauf A, Franklin D, Marquine MJ, Heaton RK. NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations. Patient Relat Outcome Meas 2023; 14:15-30. [PMID: 36814680 PMCID: PMC9939807 DOI: 10.2147/prom.s391113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH. Patients and Methods Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH. Results PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence. Conclusion The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.
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Affiliation(s)
- Lilla A Brody
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Kayle Karcher
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lesley A Guarena
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Benjamin S McKenna
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Donald Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maria J Marquine
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert K Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
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Bender AA, Kemp CL, Vandenberg AE, Burgess EO, Perkins MM. "You gotta have your cry": Administrator and direct care worker experiences of death in assisted living. J Aging Stud 2022; 63:101072. [PMID: 36462917 PMCID: PMC9769282 DOI: 10.1016/j.jaging.2022.101072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022]
Abstract
Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and 38 direct care workers (DCWs) in 7 diverse settings. As assisted living administrators and DCWs experienced resident death, they engaged in a dynamic and individualized process of "managing the normalization of death," which refers to the balance of self-identity and workplace identity. The process of reconciling these opposing contexts in AL involved several individual- and community-level conditions. Administrators and DCWs would benefit from additional resources and training around death. Increasing collaboration with hospice and clarifying policies about death communication would better prepare the workforce to acknowledge the end of life in assisted living.
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Affiliation(s)
| | | | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, USA
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15
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Bender AA, Chozom T, Saiyed SA. Concern About Past Trauma Among Nursing Home Admissions: Report From Screening 722 Admissions. J Am Med Dir Assoc 2022; 23:1499-1502. [PMID: 36087958 DOI: 10.1016/j.jamda.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Major life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care. DESIGN Observational, cross-sectional. SETTING AND PARTICIPANTS A total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July 2021. METHODS We developed a "TRAUMA" framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48 hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ2 tests. All data were analyzed using SPSS v. 28. RESULTS Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ2 (1) = 5.206, P = .022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (β = -0.037; SE = 0.11; P < .001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions. CONCLUSIONS AND IMPLICATIONS Our experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions.
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Affiliation(s)
- Alexis A Bender
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Sahebi A Saiyed
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Emory Healthcare, Atlanta, GA, USA
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16
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Kunz A, Moodley A, Colby DJ, Soltis M, Robb-McGrath W, Fairchok A, Faestel P, Jungels A, Bender AA, Kamau E, Wingood G, DiClemente R, Scott P. Feasibility, acceptability, and short-term impact of a brief sexually transmitted infection intervention targeting U.S. Military personnel and family members. BMC Public Health 2022; 22:640. [PMID: 35366848 PMCID: PMC8977033 DOI: 10.1186/s12889-022-13096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Over the past 10 years, incidence of sexually transmitted infections (STIs) has increased to record numbers in the United States, with the most significant increases observed among adolescents and young adults. The US military, where the majority of active duty personnel are 18–30 years old, has seen similar increases. However, the US military does not yet have a standardized, service-wide program for STI education and prevention. Methods The KISS intervention (Knocking out Infections through Safer-sex and Screening) was adapted from an evidence-based intervention endorsed by the US Centers for Disease Control and Prevention and consisted of a one-time, small group session. Content included STI/HIV knowledge and prevention, condom use skills, and interpersonal communication techniques. The intervention was pilot tested for feasibility and acceptability among a population of service members and medical beneficiaries at Joint Base Lewis-McChord in Washington state. Results A total of 79 participants aged 18–30 years were consented to participate in the pilot study and met entry criteria, 66/79 (82.5%) attended the intervention session, and 46/66 (69.7%) returned at 3 months for the final follow-up assessment. The intervention sessions included 31 male (47.0%) and 35 female (53.0%) participants. Almost all participants felt comfortable discussing sexual issues in the group sessions, reported that they intended to practice safer sex after the intervention, and would also recommend the intervention to friends. Knowledge about STI/HIV prevention significantly increased after the intervention, and intervention effects were maintained at 3 months. About one-fifth of participants tested positive for N. gonorrhea or C. trachomatis infection at enrollment, while none had recurrent STIs at the final visit. Use of both male and female condoms increased after the intervention. Conclusions The KISS intervention was feasible to implement in the military setting and was acceptable to the active duty service members and other medical beneficiaries who participated in the pilot project. Further studies are needed to determine if the KISS intervention, or others, effectively decrease STI incidence in active duty personnel and would be appropriate for more widespread implementation. Trial Registration Retrospectively registered as the pilot phase of clinicaltrials.gov NCT04547413, “Prospective Cohort Trial to Assess Acceptability and Efficacy of an Adapted STI/HIV Intervention Behavioral Intervention Program in a Population of US Army Personnel and Their Medical Beneficiaries—Execution Phase.” Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13096-x.
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Bender AA, McIntosh RL, Sudduth S, Harris M, Tuckey K, Morgan JC, Jungerman JM, Cox A, Moore MA, Ingram B, Pier E, Johnson TM, Loring DW, Hepburn K, Medders L, Levey AI, Lah JJ, Hales CM. The Georgia Memory Net: Implementation of a statewide program to diagnose and treat Alzheimer's disease and related dementias. J Am Geriatr Soc 2022; 70:1257-1267. [PMID: 35133003 PMCID: PMC9306650 DOI: 10.1111/jgs.17690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/07/2022] [Accepted: 01/16/2022] [Indexed: 12/04/2022]
Abstract
Objectives The number of people living with dementia is growing and most patients go years without receiving a specific diagnosis or support services, leading to suboptimal care, negative impacts on the quality of life, and increased costs of care. To address these gaps, the State of Georgia Department of Human Services collaborated with academic and community partners to create the Georgia Memory Net (GMN). Design GMN is a hub and spoke model partnered with Emory University's Cognitive Neurology Clinic and Emory Goizueta Alzheimer's Disease Research Center to provide training and support for best practices in diagnosis and management to Memory Assessment Clinics (MACs) throughout the state. Setting Communities across the State of Georgia. Participants GMN is a mix of academic and community providers, hospital systems, state and community agencies. Patients and families are evaluated at the MACs and connected to community services. Intervention A dedicated clinic workflow: primary care providers (PCPs) identify a memory problem and refer to the MACs for diagnostic evaluation; meeting with a community services educator, and development of a care plan. The patient is reconnected with the PCP for continuity of care. Measurements Initial metrics include numbers of unique patients, total patient visits, and referrals to state agency partners for community services. Results GMN established five MACs across Georgia with annual state funding. Partners at Emory University provided initial training; refined patient workflows for best practices; and provide ongoing support, guidance, and continuing education for MAC teams. Local PCPs and community services partners demonstrated strong engagement with the new model. Conclusions GMN is an innovative care model to improve access to accurate and timely diagnosis in patients with memory loss. GMN may help improve the quality of life for patients and families through preventive and early care.
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Affiliation(s)
- Alexis A Bender
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rebecca L McIntosh
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Michaela Harris
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kathy Tuckey
- Department of Neurology, Augusta University, Medical College of Georgia, Atlanta, Georgia, USA
| | - John C Morgan
- Department of Neurology, Augusta University, Medical College of Georgia, Atlanta, Georgia, USA
| | - Joanna M Jungerman
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abby Cox
- Georgia Department of Human Services, Division of Aging Services, Atlanta, Georgia, USA
| | - Miranda A Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bryshia Ingram
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ellyn Pier
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theodore M Johnson
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Laura Medders
- Integrated Memory Care Clinic, Emory Healthcare, Atlanta, Georgia, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James J Lah
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chadwick M Hales
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Abstract
OBJECTIVES This project examined administrator processes, barriers, and facilitators for conducting advance care planning in assisted living. METHOD Data from qualitative interviews with 27 administrators from seven diverse assisted living communities in the metropolitan Atlanta area were linked with descriptive and administrative data collected from each site and analyzed using thematic analysis. RESULTS Although administrators generally contended with a lack of staff training and stakeholders' reluctance to discuss advance care planning and end-of-life care, important facilitators of advance care planning in some assisted living communities included periodic follow-up discussions of residents' wishes and successfully educating consumers about the importance of planning. Three study communities whose administrators discussed planning with residents and informal caregivers during regular care plan meetings had more advance care planning documents on file. DISCUSSION These findings demonstrate the potential for nonmedical organizations, such as assisted living, to successfully promote advance care planning among their members.
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Affiliation(s)
| | - Molly M. Perkins
- Emory University
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center
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19
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Burgess EO, Kemp CL, Bender AA. "It's Going to be Different for Everyone": Negotiating Quality of Life and Care Priorities Within Care Convoys. J Aging Health 2021; 34:602-613. [PMID: 34866447 DOI: 10.1177/08982643211052367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The overall goal of this analysis was to learn about residents' quality of life and quality of care in assisted living over time and from multiple viewpoints within support networks. Method: This grounded theory analysis examined qualitative data collected from 50 residents and 169 of their care network members followed over two consecutive 2-year periods in 8 diverse settings. Results: Quality involved a dynamic process of "negotiating priorities," which refers to working out what is most important for residents' quality of life and care. Resident and care partner priorities were not always consistent or shared, in part because quality is personal, subjective, dynamic, and situational. Discussion: Communication and collaboration among formal and informal care partners are vital to residents' ability to age in place with a high quality of life and quality care.
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Affiliation(s)
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Alexis A Bender
- Emory University School of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, USA
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20
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Ciofi JM, Kemp CL, Bender AA. Assisted Living Residents with Dementia: Being Out in the World and Negotiating Connections. Gerontologist 2021; 62:200-211. [PMID: 34370003 DOI: 10.1093/geront/gnab113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to: 1) identify residents' opportunities for, and experiences with, getting out; 2) understand the significance of getting out; and 3) explain influential factors. RESEARCH DESIGN AND METHODS Guided by grounded theory methods, we analyzed qualitative data collected over a one-year period in four diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review. RESULTS We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of 'working out' engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, convoy-, AL community-, and neighborhood-level factors. DISCUSSION AND IMPLICATIONS We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.
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Affiliation(s)
- Joy M Ciofi
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA.,Department of Sociology, Georgia State University, Atlanta, Georgia, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Emory School of Medicine, Atlanta, Georgia, USA
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21
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Kemp CL, Bender AA, Ciofi J, Craft Morgan J, Burgess EO, Duong S, Epps FR, Hill AM, Manley PR, Sease J, Perkins MM. Meaningful Engagement Among Assisted Living Residents With Dementia: Successful Approaches. J Appl Gerontol 2021; 40:1751-1757. [PMID: 33655775 DOI: 10.1177/0733464821996866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Meaningful engagement is an important dimension of quality of life and care for persons living with dementia, including the growing number who reside in assisted living communities. This report presents preliminary findings from an ongoing qualitative study aimed at identifying best care practices to create and maintain meaningful engagement among persons with dementia. Over a 1-year period, we conducted interviews, residents' record review, and participant observations in four diverse care communities. Our analysis identified four approaches that successfully promote meaningful engagement: (a) knowing the person, (b) connecting with and meeting people where they are, (c) being in the moment, and (d) viewing all encounters as opportunity. Incorporation of these approaches in care routines and adoption by all care partners can promote meaningful engagement, including during crises such as COVID-19.
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Affiliation(s)
| | | | - Joy Ciofi
- Georgia State University, Atlanta, USA
| | | | | | | | | | | | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), AL/GA, USA
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22
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Shiau S, Bender AA, O'Halloran JA, Sundermann E, Aggarwal J, Althoff KN, Baker JV, Deeks S, Fried LP, Karpiak S, Karris MY, Marcotte TD, Nachega JB, Margolick JB, Erlandson KM, Moore DJ. The Current State of HIV and Aging: Findings Presented at the 10th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses 2020; 36:973-981. [PMID: 32847368 PMCID: PMC7703090 DOI: 10.1089/aid.2020.0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With increasing effectiveness of antiretroviral therapy, people with HIV (PWH) are living longer and the prevalence of older PWH continues to increase. Accordingly, PWH are experiencing an increased burden of age-related comorbidities. With this shifting demographics, clinicians and researchers face additional challenges in how to identify, address, and manage the complex intersections of HIV- and aging-related conditions. Established in 2009, the International Workshop on HIV and Aging brings together clinicians and researchers in cross-disciplinary fields along with community advocates and PWH to address the multidisciplinary nature of HIV and aging. This article summarizes plenary talks from the 10th Annual International Workshop on HIV and Aging, which took place in New York City on October 10 and 11, 2019. Presentation topics included the following: the burdens of HIV-associated comorbidities, aging phenotypes, community engagement, and loneliness; these issues are especially important for older PWH, considering the current COVID-19 pandemic. We also discuss broad questions and potential directions for future research necessary to better understand the interaction between HIV and aging.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Alexis A. Bender
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jane A. O'Halloran
- Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Juhi Aggarwal
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Keri N. Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jason V. Baker
- Division of Infectious Diseases, Hennepin Health Care, Minneapolis, Minnesota, USA
| | - Steven Deeks
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Linda P. Fried
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Stephen Karpiak
- ACRIA Center on HIV & Aging at Gay Men's Health Crisis (GMHC) and College of Nursing, New York University, New York, New York, USA
| | - Maile Y. Karris
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Thomas D. Marcotte
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jean B. Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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23
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Kemp CL, Epps F, Bender AA, Hill AM, Ciofi J, Duong S, Manley PR. Optimizing meaningful engagement among persons living with dementia through sensitivity to differing situations and realities. Alzheimers Dement 2020. [DOI: 10.1002/alz.038629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Joy Ciofi
- Georgia State University Atlanta GA USA
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24
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Arneson L, Bender AA, Robert MN, Perkins MM. Optimizing Quality of Life With Cognitive Impairment: A Study of End-of-Life Care in Assisted Living. J Am Med Dir Assoc 2020; 21:692-696. [PMID: 31784190 PMCID: PMC7186142 DOI: 10.1016/j.jamda.2019.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/05/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Assisted living (AL) is an expanding site of end-of-life (EOL) care in the United States. Understanding determinants of quality of life (QoL) for AL residents near EOL is vital to optimize care for this growing population, most of whom have some degree of cognitive impairment (CI). This analysis aimed to identify factors associated with QoL in a diverse sample of AL residents with CI approaching EOL. DESIGN Observational cross-section design. SETTING AND PARTICIPANTS Data are from a 5-year study funded by the National Institute on Aging examining EOL care of residents in 7 diverse AL communities in metropolitan Atlanta (n = 67). METHODS CI was assessed with the Montreal Cognitive Assessment (scores ≤ 26) and QoL was determined with the self-reported QoL in Alzheimer's disease survey adapted for use in AL. Psychological distress was assessed using the Patient Health Questionnaire-4 and fatigue was assessed using the 13-item Functional Assessment of Chronic Illness Therapy Fatigue Scale. Initial descriptive analyses were followed by backward stepwise regression analyses to select a best-fitting model of QoL. RESULTS The final model predicted 27% of the variance in QoL. CI was not significantly correlated with QoL and was not retained in the final model. Pain and functional limitation also did not meet inclusion criteria (P ≤ .10) and were sequentially removed, producing a final model of QoL in terms of psychological distress (β = -0.28, P = .032), fatigue (β = -0.26, P = .048), and race (β = 0.21, P = .063). CONCLUSIONS AND IMPLICATIONS The lack of a significant correlation between degree of CI and self-reported QoL suggests that AL residents have the potential to experience high QoL, despite CI. Interventions to reduce psychological distress and manage fatigue could be implemented during EOL care to attempt to improve QoL for AL residents with CI. The correlation between race and QoL warrants investigation into possible racial disparities in AL and EOL care.
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Affiliation(s)
- Laura Arneson
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexis A Bender
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Maggi N Robert
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA; Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA.
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Bender AA, Halpin SN, Kemp CL, Perkins MM. Barriers and Facilitators to Exercise Participation Among Frail Older African American Assisted Living Residents. J Appl Gerontol 2019; 40:268-277. [PMID: 31833788 DOI: 10.1177/0733464819893923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite the well-known health benefits of physical activity, older adults are more sedentary than any other age group. This issue is particularly true for assisted living (AL) residents, which also represents an important and often overlooked aspect of palliative care. Here, we analyze ethnographic and interview data from a longitudinal study aimed at identifying best practices for palliative care in one African American AL community. The aim was to identify the factors that facilitate and constrain resident participation in instructor-led group exercise. Thematic analysis identified several main themes including the quality and location of the exercise program, AL staffing limitations, residents' health and function, values about exercise, and residents' interest in recreation and social engagement. We identified facilitators and barriers that shaped residents' opportunity, desire, and commitment related to attending group exercise. Findings have implications for interventions aimed at increasing resident participation in group exercise, leading to multiple health benefits.
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Affiliation(s)
| | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, GA, USA
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Abstract
Over the last decade, the number of older adults (people over the age of 50) who misuse opioids doubled and continues to increase. People over the age of 50 also represent one of the fastest growing groups entering into and sustaining medication assisted treatment (MAT) (i.e., methadone and buprenorphine) for opioid use disorder (OUD). Despite increasing awareness of this growing at-risk population, significant knowledge gaps regarding their support and care needs persist. To begin to address these gaps, we conducted interviews with 20 treatment staff, focus groups with 18 patients and surveys with 100 patients over the age of 50 at eight diverse Opioid Treatment Programs (OTPs) participating in a 1-year pilot study (Bender, PI) funded by the Georgia Clinical and Translation Science Alliance supported by the National Center Advancing Translational Sciences. Patients in this study do not always disclose their use of MAT to non-OTP providers. When they do, participants reported numerous negative experiences with non-OTP providers, including perceived discrimination, stigma, and misunderstanding by providers about MAT. These negative experiences potentially contribute to an over reliance on OTP providers to manage age-related health conditions (e.g., COPD, hypertension). Providers report minimal training about aging and varied levels of confidence to manage these conditions. We present the experiences of patients and providers with suggestions for improving care coordination. We conclude with recommendations to improve communication among providers working with older adults in recovery from OUD.
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Affiliation(s)
| | | | | | - Emma M Klein
- Emory University, Atlanta, Georgia, United States
| | - Molly M Perkins
- Emory University School of Medicine, Atlanta, Georgia, United States
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Kemp CL, Bender AA, Quest T, Coyle MH, Perkins MM. THAT’S MY CREATOR’S REALM: UNDERSTANDING AFRICAN AMERICAN ASSISTED LIVING RESIDENTS’ END-OF-LIFE PREFERENCES. Innov Aging 2019. [PMCID: PMC6841558 DOI: 10.1093/geroni/igz038.2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Assisted living, one of the fastest growing formal long-term care options for older adults in the U.S., increasingly is a site for end-of-life care.. Most residents are non-Hispanic and white, yet African Americans reside in these settings and relatively little is known about their end-of-life preferences. In this paper, we present an analysis of data collected as part of a larger five-year mixed-methods NIA-funded study (R01AG047048) examining end of life in assisted living. We analyze longitudinal qualitative data collected over two years in a large (>90 beds) care community catering to African American older adults. Drawing on 850 hours of participant observation, in-depth interviews with 25 residents, and record review data, we seek to: (a) understand residents’ end-of-life preferences; and b) identify how and why preferences vary. Guided by principles of grounded theory, our analysis shows that most preferred a death where “you go to sleep and never wake up.” Yet, residents varied in their preferences for the timing and location of death, nature of end-of-life care, and use of advanced directives. Age, health, health literacy, perceived quality of life, and not wanting to be a burden all influenced preferences. For most, religious beliefs were a key factor shaping these preferences. Perceiving that end of life, including how, when, where one dies, and the nature of suffering and care, ultimately is their “creator’s realm,” led to the near universal conclusion: “I got no control over it.” We discuss implications of these findings for improving end-of-life care for African American residents.
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Affiliation(s)
- Candace L Kemp
- Georgia State University, Atlanta, Georgia, United States
| | | | | | - Mary H Coyle
- Emory University School of Medicine, Atlanta, Georgia, United States
| | - Molly M Perkins
- Emory University School of Medicine, Atlanta, Georgia, United States
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Ciofi J, Kemp CL, Bender AA, Burgess EO, Morgan JC, Epps F, Doyle P, Perkins MM. MEANINGFUL ENGAGEMENT AND QUALITY OF LIFE AMONG ASSISTED LIVING RESIDENTS WITH DEMENTIA: EMERGENT FINDINGS. Innov Aging 2019. [PMCID: PMC6846787 DOI: 10.1093/geroni/igz038.3430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This poster provides an overview of the aims, methods, and emergent findings from an ongoing five-year NIA-funded project (R01AG062310) examining meaningful engagement and quality of life among assisted living (AL) residents with dementia. The overall goal of this project is to determine how opportunities for meaningful engagement can best be recognized, created, and maintained for individuals with different dementia types and varying levels of functional ability. Guided by grounded theory, this qualitative study will involve 12 diverse AL communities in and around Atlanta, Georgia, USA. Presently, our interdisciplinary team is collecting data in four communities using ethnographic observations, semi-structured interviews, and resident record review. We are studying daily life in each community, following 30 resident participants, and actively recruiting and interviewing their formal and informal care partners. Based on ongoing analysis, we offer key emergent findings. First, meaningful engagement is highly individualized and dynamic. Differing personal interests, along with wide variations in cognitive and physical abilities, can present challenges for AL community staff and other care partners when trying to recognize what constitutes meaningful engagement for residents. Second, multiple complex factors interplay to shape the experience of meaningful engagement among persons living with dementia, such as personal characteristics, care partner background and training, AL community design and philosophy, and state/corporate regulations. Finally, flexibility and ‘meeting the resident where they are at’ appear to be critical to identifying and fostering meaningful engagement for persons living with dementia. We discuss the implications of these preliminary findings for translation, dissemination, and future research.
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Affiliation(s)
- Joy Ciofi
- Georgia State University, Atlanta, Georgia, United States
| | - Candace L Kemp
- Georgia State University, Atlanta, Georgia, United States
| | | | - Elisabeth O Burgess
- Gerontology Institute, Georgia State University, Atlanta, Georgia, United States
| | | | - Fayron Epps
- Emory University, Atlanta, Georgia, United States
| | - Patrick Doyle
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Molly M Perkins
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, United States
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Vargas IL, Bender AA, Kemp CL, Perkins MM. BEYOND BINGO: THE IMPACT OF ACTIVITY ENGAGEMENT IN AN ALL-AFRICAN AMERICAN ASSISTED LIVING COMMUNITY. Innov Aging 2019. [PMCID: PMC6846048 DOI: 10.1093/geroni/igz038.3480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
More than one million older adults reside in assisted living (AL) communities in America. This figure is projected to double by the year 2030. It is typical for residents in these communities to have cognitive and physical impairments requiring differing levels of care. Due in part to these impairments, it is vital to the health and well-being of residents to participate in meaningful recreational activities. This secondary analysis of ethnographic observations totaling 818 hours and semi-structured interviews with 25 residents enrolled in an NIA-funded study (5R01AG047408) explores in depth barriers and facilitators to activity engagement in a large (90+ bed) moderate-income, all-African-American AL community located in a large urban city in the southern US. Residents range in age from 59 to 103 (mean = 85) and are predominantly female. We linked our findings from thematic analysis to six domains of quality palliative care identified by the 2018 National Consensus Project (NCP) Guidelines for Quality Palliative Care: cultural, physical, psychological, social, structures and processes, and spiritual aspects of care. Key barriers include limitations related to staffing (a low staff-to-resident ratio and high staff turnover) and activities that do not adequately address needs of residents with varying interests and abilities. A robust daily devotion and other activities that incorporate culturally relevant music are activities highly valued by most residents. Implications of these findings contribute to a larger effort to create positive change in the structures and processes of care in AL and can inform best practices for palliative care within these communities.
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Affiliation(s)
| | | | - Candace L Kemp
- Georgia State University, Atlanta, Georgia, United States
| | - Molly M Perkins
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, United States
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Burgess EO, Barmon C, Moorhead JR, Perkins MM, Bender AA. "That Is So Common Everyday . . . Everywhere You Go": Sexual Harassment of Workers in Assisted Living. J Appl Gerontol 2018; 37:397-418. [PMID: 26912732 PMCID: PMC10754257 DOI: 10.1177/0733464816630635] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In assisted living (AL) facilities, workers are intimately involved in the lives of residents. Existing research on AL demonstrates the imbalance of this environment, which is a personal home for the residents and a workplace for staff. Using observational and interview data collected from six AL facilities, this grounded theory project analyzes how AL staff define, understand, and negotiate sexual comments, joking, and physical touch. We developed a conceptual model to describe how such harassment was perceived, experienced by AL workers, and how they responded. Sexualized behavior or harassment was experienced by workers of every status. We found that words and actions were contextualized based on resident and worker characteristics and the behavior. Staff members refused to engage residents, redirected them, or reframed the words and gestures to get the job done. Reporting the incidents was less common. We conclude by discussing implications for policy and research.
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Affiliation(s)
| | | | | | | | - Alexis A. Bender
- Army Public Health Center (Provisional), Aberdeen Proving Ground, MD, USA
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Abstract
Despite continuity in the desire for sex and partnership, many older adults experience a lack of intimacy in late life. The use of assisted living is a complicating factor for understanding issues of partnership, sex, and intimacy for older adults. Using in-depth interviews with 23 assisted living residents and grounded theory methods, we examined how residents negotiate a lack of intimacy in assisted living. The process of negotiation entailed three factors: desire, barriers, and strategies. Although some residents continued to desire intimacy, there was a marked absence of dating or intimacy in our study sites. Findings highlight unique barriers to acting on desire and the strategies residents used as aligning actions between desire and barriers. This research expands previous studies of sexuality and older adults by examining the complex ways in which they balanced desire and barriers through the use of strategies within the assisted living environment.
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Barmon C, Burgess EO, Bender AA, Moorhead JR. Understanding Sexual Freedom and Autonomy in Assisted Living: Discourse of Residents' Rights Among Staff and Administrators. J Gerontol B Psychol Sci Soc Sci 2017; 72:457-467. [PMID: 27317691 PMCID: PMC5927084 DOI: 10.1093/geronb/gbw068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/30/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In contrast to nursing homes, assisted living (AL) facilities emphasize independence and autonomy as part of their mission. However, we do not know to what extent this extends to sexual freedom and autonomy. METHOD Using grounded theory methodology and symbolic interactionism, we examine how staff and administrators in AL facilities discuss residents' rights to sexual freedom and how this influences the environment of AL. RESULTS Staff and administrators engage in a contradictory discourse of residents' rights that simultaneously affirms the philosophy of AL while behaving in ways that create an environment of surveillance and undermine those rights. DISCUSSION A discourse of residents' rights masks a significant conflict between autonomy and protection in regards to sexual freedom in AL.
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Affiliation(s)
- Christina Barmon
- The Gerontology Institute and
- Department of Sociology, Georgia State University, Atlanta
| | - Elisabeth O. Burgess
- The Gerontology Institute and
- Department of Sociology, Georgia State University, Atlanta
| | | | - James R. Moorhead
- Georgia Department of Human Services, Division of Aging Services, Atlanta
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Jungels AM, Bender AA. Missing Intersections: Contemporary Examinations of Sexuality and Disability. Handbooks of Sociology and Social Research 2015. [DOI: 10.1007/978-3-319-17341-2_10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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