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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Authors' Response to Peer Reviews of "Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers". JMIRx Med 2024; 5:e56439. [PMID: 38509604 PMCID: PMC11004510 DOI: 10.2196/56439] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers. JMIRx Med 2024; 5:e42211. [PMID: 38488740 PMCID: PMC11004515 DOI: 10.2196/42211] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 03/19/2024]
Abstract
Background Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. Objective We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. Methods This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Results Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Conclusions Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.
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Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Harden JT, Hill CV, Heyn PC, Oh ES, Perez GA, Whitfield K. Indispensable impact: From NIA Summer Institute to Butler-Williams Scholars Program. J Am Geriatr Soc 2024. [PMID: 38445767 DOI: 10.1111/jgs.18858] [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] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Affiliation(s)
- J Taylor Harden
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Carl V Hill
- Chief Diversity, Equity, and Inclusion Officer, Alzheimer's Association, Chicago, Illinois, USA
| | - Patricia C Heyn
- Center for Optimal Aging, Marymount University, Arlington, Virginia, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Departments of Psychiatry and Behavioral Sciences & Neuropathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G Adriana Perez
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Hwang Y, McPhillips MV, Huang L, Perez GA, Hodgson NA. Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment. BMC Nurs 2023; 22:307. [PMID: 37674161 PMCID: PMC10483800 DOI: 10.1186/s12912-023-01471-x] [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] [Received: 03/01/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND When caregivers have a high level of caregiver mastery, their care recipients with cognitive impairment have less behavioral health problems. However, the relationship between caregiver mastery and anxiety among care recipients over time is unknown. Therefore, this study was conducted to examine that better caregiver mastery is associated with less anxiety in individuals with cognitive impairment over time. METHODS A secondary data analysis was conducted using the Healthy Patterns Clinical Trial (NCT03682185) dataset and guided by Factors Associated with Behavioral and Psychological Symptoms of Dementia conceptual framework. This study included 154 dyads of individuals with cognitive impairment and their caregivers. Multiple linear regression analyses were performed on changes in anxiety. Model 1 included variables at the level of neurodegeneration (i.e., cognitive impairment and age). Model 2 added patient factors (i.e., sleep problems and depression) with the Model 1. Finally, Model 3 included caregiver factor (i.e., caregiver mastery) with the Model 2 to examine how changes in caregiver mastery influence changes in anxiety of care recipients. RESULTS Model 3 was statistically significant; after controlling for variables at the level of neurodegeneration associated with cognitive impairment and patient factors, improvement of caregiver mastery over time (β =-0.230, p = 0.015) was related to decreased anxiety over time (R2 = 0.1099). CONCLUSIONS Caregivers with high caregiver mastery may have better knowledge on how to care for their loved ones and how to manage their neuropsychiatric symptoms. Therefore, improving the level of caregiver mastery by providing psychoeducational programs and resources that family caregivers need will help reduce the frequency of anxiety in individuals with cognitive impairment.
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Affiliation(s)
- Yeji Hwang
- College of Nursing and Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | | | - Liming Huang
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - G Adriana Perez
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Hwang Y, McPhillips M, Huang L, Perez GA, Hodgson N. IMPROVEMENT OF CAREGIVER MASTERY IS RELATED TO DECREASED ANXIETY AMONG PEOPLE LIVING WITH COGNITIVE IMPAIRMENT. Innov Aging 2022. [PMCID: PMC9770852 DOI: 10.1093/geroni/igac059.2088] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Anxiety is common and distressing in people living with cognitive impairment. High caregiver mastery, a positive view of one’s ability to provide care, is known to be protective against anxiety in people whom they are caring for. However, the longitudinal relationship between caregiver mastery and anxiety is unknown. Our objective was to examine whether improvement in caregiver mastery was related to decrease in anxiety in people living with cognitive impairment. This was a secondary data analyses using Healthy Patterns Clinical Trial (NCT03682185), an RCT of a home-based activity intervention designed to improve circadian rhythm disorders in people living with cognitive impairment. A total of 158 participants with cognitive impairment who provided data at both pretest (T1) and posttest (T2) were analyzed. Measures included Caregiver Mastery Scale and Neuropsychiatric Inventory. We used linear regression analyses to examine the relationship between changes in caregiver mastery and changes in anxiety. The sample was primarily female (66.7%), Black (63.1%), with mean age 73.3±8.4. The mean change of anxiety frequency (T2-T1) was -0.2±1.0; anxiety frequency decreased over time. The mean change of caregiver mastery (T2-T1) was 0.4± 3.0; caregiver mastery improved over time. After controlling for age, cognition, changes in sleep impairments, changes in depression, and intervention group assignment, improvement of caregiver mastery over time (B=-0.087, SE=0.035, t=-2.51, p=0.013) was related to decreased anxiety frequency over time (R2= 0.112, F=2.31, p= 0.039). Interventions to improve caregiver mastery may alleviate anxiety symptoms in people living with cognitive impairment. Additional research and practice implications will be discussed.
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Affiliation(s)
- Yeji Hwang
- Drexel University, Philadelphia, Pennsylvania, United States
| | | | - Liming Huang
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - G Adriana Perez
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nancy Hodgson
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Perez GA. MHEALTH DESIGN AND IMPLEMENTATION IMPLICATIONS TO PROMOTE PHYSICAL ACTIVITY IN OLDER HISPANICS/LATINOS WITH MCI. Innov Aging 2022. [PMCID: PMC9765048 DOI: 10.1093/geroni/igac059.687] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Addressing physical inactivity for older Hispanics/Latinos with mild cognitive impairment (MCI) is a public health priority, since MCI increases the risk of developing Alzheimer’s Disease and related dementias (ADRD). Compared to non-Latino Whites, Hispanics/Latinos are 2X more likely to develop ADRD. One promising approach to promoting physical activity includes use of mobile health (mHealth) strategies that may deliver Spanish-language information and culturally relevant motivational messages to enhance intrapersonal/interpersonal factors for health behavior change. The purpose of this study is to test mHealth strategies as a mechanism to deliver booster sessions for reinforcing physical activity goals/progress among older Latinos with MCI who complete the Tiempos Juntos intervention treatment. Our hypothesis is that culturally adapting mHealth strategies may improve efficacy and maintenance of physical activity effect; as well as cognitive health outcomes (6 months post-intervention). Results among the first wave of participants will be discussed, including challenges and opportunities for future research. While the use of mHealth is not new, these approaches commonly exclude individuals with limited-English proficiency and thus, designing interventions that center the needs of older Hispanics/Latinos with MCI/ADRD and other historically excluded communities, is an important first step in promoting physical activity and advancing cognitive health equity.
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Affiliation(s)
- G Adriana Perez
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Munsterman E, Cacchione P, Hodgson N, Perez GA. DEMENTIA-FRIENDLY IN THE CONTEXT OF HOSPITALIZATION: A CONCEPT ANALYSIS. Innov Aging 2022. [PMCID: PMC9767201 DOI: 10.1093/geroni/igac059.2816] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Persons living with dementia experience more and longer hospitalizations when compared to those without dementia. In response, initiatives to address the hospital experience for individuals with dementia and their families are becoming more common. The term “dementia-friendly” attached to terms such as “hospital”, “ward”, “initiative”, “program”, etc. is being used to describe this response. Literature has begun to summarize current knowledge of dementia-friendly initiatives and define characteristics of dementia friendly hospitals, however, a formal definition of the concept of “dementia-friendly” is lacking. A concept analysis was completed using the 8-step Walker and Avant method including: selecting the concept and aim, identifying use of the concept in the literature, determining defining attributes, antecedents, consequences, and empirical referents, and developing cases that further distinguish the concept. The goal of this analysis was to clarify the definition of dementia-friendly in the context of hospitalization. Attributes of dementia-friendly in the hospital include dementia-specific staff education, use of person-centered care practices, environmental modification, and nursing-specific factors such as attitude, time to spend with patients and adapting responses based on patient need. Antecedents include recognition of the impact of hospitalization on older people with dementia. Consequences include enhanced staff knowledge and patient outcomes including decreased length of stay and decreased use of antipsychotic medication. Based on the above analysis, a conceptual definition for dementia-friendly in the context of hospitalization is proposed. This definition highlights the identified antecedents and attributes with a focus on the essential role of nursing in delivering dementia-friendly care.
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Affiliation(s)
- Ellen Munsterman
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Pamela Cacchione
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nancy Hodgson
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - G Adriana Perez
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Starr LT, Ulrich C, Perez GA, Aryal S, Junker P, O’Connor NR, Meghani SH. Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation. Am J Hosp Palliat Care 2022; 39:619-632. [PMID: 34318700 PMCID: PMC8795236 DOI: 10.1177/10499091211034383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/16/2022] Open
Abstract
BACKGROUND Palliative care consultation to discuss goals-of-care ("PCC") may mitigate end-of-life care disparities. OBJECTIVE To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. METHODS This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. RESULTS In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = -3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. CONCLUSIONS Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Connie Ulrich
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania
| | - G. Adriana Perez
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Subhash Aryal
- BECCA (Biostatistics * Evaluation * Collaboration *
Consultation * Analysis) Lab, University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania
| | | | - Nina R. O’Connor
- University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania
| | - Salimah H. Meghani
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Brooks Carthon JM, Perez GA, Brawner BM. Health equity and social determinants of health. Res Nurs Health 2022; 45:139-141. [DOI: 10.1002/nur.22222] [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] [Received: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/08/2022]
Affiliation(s)
- J. Margo Brooks Carthon
- Department of Family & Community Health University of Pennsylvania School of Nursing Philadelphia Pennsylvania USA
| | - G. Adriana Perez
- Leonard Davis Institute of Health Economics University of Pennsylvania School of Nursing Philadelphia Pennsylvania USA
| | - Bridgette M. Brawner
- M. Louise Fitzpatrick College of Nursing Villanova University Villanova Pennsylvania USA
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10
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Hwang Y, McPhillips MV, Talwar S, Perez GA, Hodgson NA. The Relationship Between Light Exposure before Bedtime and Daytime Sleepiness Among People Living With Cognitive Impairment. J Appl Gerontol 2022; 41:1686-1694. [PMID: 35341367 DOI: 10.1177/07334648221083658] [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: 11/15/2022] Open
Abstract
While sleep disturbances are common in people living with cognitive impairment, little is known about the influence of evening light exposure on their sleep. The purpose of this study was to examine the relationship between evening light exposure in natural living environment and daytime sleepiness in community residing people living with cognitive impairment. A secondary data analysis was conducted using the baseline data of the Healthy Patterns Clinical Trial. Actiwatch Spectrum Plus was used to collect information on the average white light intensity of 4 hours before sleep for three consecutive days. Multivariate regression analyses were used. Among 173 participants, the average light intensity during evening was 80.25 ± 123.04 lux. After controlling for covariates, greater intensity of light exposure during evening was related to excessive daytime sleepiness (β = 0.211, p = .004). The results of our study suggest exposure to light during evening may disturb sleep and subsequently influence daytime sleepiness the following day.
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Affiliation(s)
- Yeji Hwang
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sonia Talwar
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - G Adriana Perez
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
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Estrada LV, Resendez J, Perez GA. The Role of National Paid Family and Medical Leave Policies in Promoting Health Equity for Older Adults and Their Caregivers. J Gerontol Nurs 2022; 48:5-10. [PMID: 35201922 PMCID: PMC9017763 DOI: 10.3928/00989134-20220209-01] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More than 48 million unpaid family/friend caregivers in the United States provide care to older adults. This unpaid workforce provides essential support for family members or friends who have a serious, long-term illness or disability. However, family caregivers are often under supported, which contributes to negative health, economic, and psychological consequences. Despite the significant contributions of family caregivers, there are limited policy supports aimed at alleviating the hardships of care on this growing community. National paid family and medical leave policy in particular holds substantial potential to alleviate the compounding burdens faced by family caregivers and address systemic inequities that contribute to disproportionately poorer caregiving outcomes among historically marginalized older adults and their caregivers. The purpose of the current article is to provide an overview of the economic burdens and caregiving-related health disparities experienced by Black/African American and Hispanic/Latinx family caregivers and discuss the impact of paid leave policies on the overall health and well-being of older adults. We propose a "Call to Action" for gerontological nurses to work in partnership with transdisciplinary colleagues, stakeholders, and advocates to ensure all family care-givers have access to paid leave. [Journal of Gerontological Nursing, 48(3), 5-10.].
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Affiliation(s)
- Leah V. Estrada
- Center for Health Policy, Columbia University School of Nursing, 560 W. 168 Street, New York, NY
| | | | - G. Adriana Perez
- Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing, Philadelphia, PA
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12
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Starr L, Ulrich C, Perez GA, Aryal S, Junker P, O'Connor N, Meghani S. What’s Race got to do With it? How Palliative Care Consultation may Mitigate Racial Disparities in Future Care. Innov Aging 2021. [PMCID: PMC8682740 DOI: 10.1093/geroni/igab046.3174] [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: 12/03/2022] Open
Abstract
It is unknown if care and cost outcomes differ by race and ethnicity following discharge from a hospitalization involving palliative care consultation to discuss goals-of-care (PCC). In this secondary analysis of 1,390 seriously-ill patients age 18+ alive at discharge who self-identified as Black, Hispanic, Asian, white, or other race and received PCC at an urban, academic medical center, we used binomial logistic regression and multiple linear regression controlling for demographic and clinical variables to identify factors associated with care experiences and costs following discharge from a hospitalization with PCC. In adjusted analyses, discharge to hospice was associated with Medicaid (p=0.016). Thirty-day readmission was associated with age 75+ (P=0.015), Medicaid (P=0.004), admission 30 days prior (P<0.0001), and Black race compared to white (P=0.016). Number of future days hospitalized was associated with Medicaid (P=0.001), admission 30 days prior (P=0.017), and Black race compared to white (P=0.012). Having any future hospitalization cost was associated with patient ages 65-74 (P=0.022) and 75+ (P=0.023), Medicaid (P=0.014), admission 30-days prior (P<0.0001), and Black race compared to white (P=0.021). Total future hospitalization costs were associated with female gender (P=0.025), Medicaid (P=0.009), admission 30 days prior (P=0.040), and Black race compared to white (P=0.037). Race or ethnicity was not a predictor of hospice enrollment. Randomized controlled trials are needed to understand if PCC is an intervention that reduces racial disparities in end-of-life care. Qualitative insights are needed to explain how PCC and socioeconomic factors such as Medicaid may mitigate future acute care use among racial and ethnic groups.
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Affiliation(s)
- Lauren Starr
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Connie Ulrich
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - G Adriana Perez
- University of Pennsylvania School of Nursing, Phildelphia, Pennsylvania, United States
| | - Subhash Aryal
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Paul Junker
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Nina O'Connor
- Penn Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Salimah Meghani
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
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Perez GA, O'Brien K, Sabbagh M, Bruno M. Clinical Recommendations for Reducing the Risk of Cognitive Decline. Innov Aging 2021. [PMCID: PMC8682728 DOI: 10.1093/geroni/igab046.707] [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: 11/12/2022] Open
Abstract
As much as 40% of dementia cases can be attributed to modifiable risk factors (Livingston et al., 2020). Much of that risk-reduction can be accomplished by changing behavior in midlife. In light of the emerging evidence that dementia may be preventable, UsAgainstAlzheimer’s convened a workgroup of national experts to develop new recommendations that primary care clinicians and general neurologists can use to initiate primary prevention conversations with their patients about cognitive decline. Few resources address steps that clinicians can take in their routine care to help patients reduce risk. Some relevant resources provide excellent guidance but tend to be more focused on early detection or slowing disease progression rather than primary prevention. The Risk Reduction Workgroup (RRWG) was convened to help address the need for clinicians to know how to discuss cognitive decline with their patients. The workgroup aligned on 11 recommendations for primary care clinicians and general neurologists. In addition the RRWG provide considerations for implementing the recommendations in clinical practice. The recommendations are mindful of social determinants of health, account for cultural differences, and are designed for general accessibility. This effort is part of a broader initiative by UsAgainstAlzheimer’s to address risk-reduction for cognitive decline and early interventions. Under the guidance of a multidisciplinary Provider Leadership Group consisting of representatives from some of the nation's largest health provider serving organizations, three independent workgroups are developing guidance and tools to assist providers in their clinical practice and improve health outcomes for patients at-risk for Alzheimer's and related dementias.
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Affiliation(s)
- G Adriana Perez
- University of Pennsylvania School of Nursing, Phildelphia, Pennsylvania, United States
| | - Kelly O'Brien
- UsAgainstAlzheimer's, Chicago, Illinois, United States
| | - Marwan Sabbagh
- Cleveland Clinic Nevada, Las Vegas, Nevada, United States
| | - Michelle Bruno
- Avalere Health, Washington, District of Columbia, United States
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Petrovsky D, Dong F, Huang L, Aryal S, Perez GA, Hodgson N. Salivary Cortisol Patterns in People Living With Dementia. Innov Aging 2021. [PMCID: PMC8680131 DOI: 10.1093/geroni/igab046.1692] [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: 11/14/2022] Open
Abstract
Abstract
Salivary cortisol has a well-documented circadian pattern in older adults. Yet, the pattern of salivary cortisol in persons living with dementia (PLWD) due to circadian rhythm disturbances is unknown. This study examined diurnal salivary cortisol patterns in 176 PLWD (mean age 73.6±8.8, 33.3% male, clinical dementia rating >=0.5) by collecting saliva at waking (AM1), 30 minutes after waking (AM2) and bedtime (PM) over two consecutive days. Cortisol awakening response (CAR) was calculated as the change between AM2 and AM1 cortisol levels. The mean baseline salivary cortisol levels (ug/dl) were 0.35 (SD:0.3) at AM1, 0.40 (SD:0.39) at AM2, and 0.19 (SD:0.4) at PM. On average, cortisol levels decreased from morning to evening, with 58% exhibiting a positive CAR (mean 0.05; SD:0.34). There were no significant associations between cortisol levels with age, sex, obesity, and comorbidities. The findings demonstrated that diurnal cortisol rhythms are maintained in PLWD with a flattened CAR.
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Affiliation(s)
| | | | - Liming Huang
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Subhash Aryal
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - G Adriana Perez
- University of Pennsylvania School of Nursing, Phildelphia, Pennsylvania, United States
| | - Nancy Hodgson
- University of Pennsylvania, School of Nursing, philadelphia, Pennsylvania, United States
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Hwang Y, Dong F, Perez GA, Hodgson N. Relationships Between Salivary Cortisol Slope and Neuropsychiatric Symptoms in Persons Living With Dementia. Innov Aging 2021. [PMCID: PMC8680324 DOI: 10.1093/geroni/igab046.1693] [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: 11/23/2022] Open
Abstract
While a flatter diurnal cortisol slope has been related to poor health outcomes in healthy populations, little is known about this relationship in persons living with dementia (PLWD). The purpose of this study was to examine the association between diurnalcortisol slope and neuropsychiatric symptoms in PLWD. Secondary data analysis was conducted using baseline data from the Healthy Patterns Study (N=168). Diurnal cortisol slope was calculated using the difference between changes in salivary cortisol from 30 minutes after awakening to bedtime. Spearman rho coefficients were used. Flatter cortisol slope was associated with the presence of symptoms of agitation (r=-0.191, p=0.013) and disinhibition (r=-0.168, p=0.03). Steeper cortisol slope was related to a more severe level of anxiety symptoms (r=0.36, p=0.009) and higher frequency of insomnia (r=0.292, p=0.011). We found that cortisol slope was associated with neuropsychiatric symptoms in PLWD. Future research is needed to examine the mechanisms underlying the relationships.
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Affiliation(s)
- Yeji Hwang
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, United States
| | | | - G Adriana Perez
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, United States
| | - Nancy Hodgson
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, United States
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16
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Perez GA. Recruitment and Retention Framework for a Timed-Activity Intervention Among Older Latinos With ADRD. Innov Aging 2021. [PMCID: PMC8682261 DOI: 10.1093/geroni/igab046.809] [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: 11/14/2022] Open
Abstract
Abstract
Latino participation in ADRD research is essential to advance cognitive health equity. We present results of an adapted framework to increase recruitment and retention of older Latinos with ADRD and caregivers (CGs) in a timed-activity intervention. Framework factors include 3 structures with strategies informed by a Latino Community Advisory Board. For Characteristics of Study Processes, we included linguistically equivalent data collection procedures/measures, scheduled at times most convenient for participants/CGs. Participants were called weekly for questions/guidance with procedures. Intervention sessions built-in additional time to embed Latino cultural values: familismo, personalismo, confianza and respeto. Study Team Infrastructure, included bilingual/bicultural members/students; and trusted community partners to assist with participant referrals. For Preferences and Beliefs Toward Research, we conducted a series of focus groups to understand beliefs about “memory health” and perceptions of ADRD risks. Strategies yielded effective results. We reached our recruitment goal; started a wait-list of interested participants; had zero (n=0) attrition.
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Affiliation(s)
- G Adriana Perez
- University of Pennsylvania School of Nursing, Phildelphia, Pennsylvania, United States
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17
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Perez GA, Huang L. A Culturally Adapted Timed-Activity RCT for Latinos With ADRD and Caregivers: Feasibility, Acceptability, and Effects. Innov Aging 2021. [PMCID: PMC8680970 DOI: 10.1093/geroni/igab046.2092] [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: 11/17/2022] Open
Abstract
Latinos are twice as likely to develop Alzheimer’s disease (AD) compared to non-Latino whites, yet, account for <2% of clinical trial participants in AD research. This randomized controlled trial examined the feasibility, acceptability and effects of a culturally-adapted timed-activity intervention designed to promote quality of life (QOL) and reduce behavioral symptoms in older Latinos with AD and their caregivers. Healthy Patterns [Pautas Saludables] was implemented among 40 Spanish-speaking dyads. Measures assessed at baseline and 4 weeks post-intervention, indicate improvements in sleep efficiency (p=.06) and QOL (p=.01) among intervention participants. Pautas Saludables was found to be feasible and acceptable. Intervention attendance rate was >90% with low attrition (n=0); no adverse events. Most (74%) rated timed-activity sessions as helpful and appropriate; 58% recommended refreshers. Results provide evidence that Latinos with AD will participate in clinical trials and can improve on key health outcomes, when interventions are adapted to meet their cultural needs.
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Affiliation(s)
- G Adriana Perez
- University of Pennsylvania School of Nursing, Phildelphia, Pennsylvania, United States
| | - Liming Huang
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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18
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Perez GA, Rose KM, Caceres BA, Spurlock W, Bowers B, Lutz B, Arslanian-Engoren C, Reuter-Rice K, Bressler T, Wicks M, Taylor D, Johnson-Mallard V, Kostas-Polston E, Hagan T, Bertrand D, Reinhard SC. Position statement: Policies to support family caregivers. Nurs Outlook 2019; 66:337-340. [PMID: 29887190 DOI: 10.1016/j.outlook.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Toby Bressler
- Academy Jonas Policy Scholar; Acute and Critical Care Expert Panel
| | - Mona Wicks
- Health Equity and Cultural Competence Expert Panel
| | | | | | | | - Teresa Hagan
- Academy Jonas Policy Scholar; Women's Health Expert Panel
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19
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Brody AA, Bryant AL, Perez GA, Bailey DE. Best practices and inclusion of team science principles in appointment promotion and tenure documents in research intensive schools of nursing. Nurs Outlook 2019; 67:133-139. [PMID: 30598299 DOI: 10.1016/j.outlook.2018.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/24/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nurse scientists are highly sought after and find satisfaction in serving as members of interdisciplinary research teams. These teams also tend to be highly productive. However, nurse scientists in academia also have to reach certain productivity milestones to be promoted and receive tenure that may be incongruent with team science principles. PURPOSE This study therefore sought to examine whether APT documents in research intensive nursing schools incorporate team science principles. METHODS Qualitatively analyzed the appointment, promotion and tenure documents of 18 U.S. based research intensive schools of nursing with over $2 million in NIH funding in fiscal year 2014. FINDINGS The study found that only 8 of 18 documents included any reference to team science principles and even these mentions were largely negligible. There were few best practices to recommend across documents. By not recognizing team science within these documents, nursing risks marginalization within the larger scientific community by limiting mentorship and learning opportunities for early career nurse scientists. DISCUSSION Schools of nursing should revisit their promotion and tenure criteria and include a greater commitment to encouragement of team science.
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Affiliation(s)
- Abraham Aizer Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, NY.
| | - Ashley Leak Bryant
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - G Adriana Perez
- The University of Pennsylvania School of Nursing, Philadelphia, PA
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20
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Polansky P, Gorski MS, Green A, Perez GA, Wise RP. Nurses leading change to advance health. Nurs Outlook 2017; 65:746-752. [DOI: 10.1016/j.outlook.2017.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
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Perez GA. WHAT DOES THE FUTURE HOLD FOR HEALTHCARE DELIVERY? OPPORTUNITIES FOR EMERGING NURSE LEADERS. Imprint 2015; 63:38-39. [PMID: 26606777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Davitt JK, Perez GA, Miles TP. Policy Advocacy to Promote Healthy Aging: The Time to Engage Is Now. Res Gerontol Nurs 2015. [PMID: 26225552 DOI: 10.3928/19404921-20150612-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Mentes JC, Perez GA. The John A. Hartford Foundation Hartford gerontological nursing leaders: improving care for older adults across the health care continuum. Clin Nurs Res 2013; 22:399-401. [PMID: 24142906 DOI: 10.1177/1054773813501732] [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: 11/15/2022]
Affiliation(s)
- Janet C Mentes
- University of California, Los Angeles School of Nursing, USA
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Abstract
Although it has been proposed that preoperative analgesia with epidural administration of analgesics may prevent long-term phantom pain, published results to date have been contradictory and controversial. In this case report, we describe a 41-year-old man with local recurrence of squamous cell carcinoma of the anus who underwent a hemipelvectomy. Preoperatively he had a significant neuropathic pain syndrome requiring oxycodone 60 mg every 4 hours. An epidural infusion of morphine and bupivacaine was started 24 hours preoperatively and discontinued on the third postoperative day. Over the next 10 days the oxycodone was gradually decreased and eventually discontinued prior to discharge. A review of the literature reveals conflicting reports on the benefit of preoperative epidural pain management in the prevention of postoperative pain syndromes. Conflicting research and conclusions of commentators leaves unanswered questions for clinicians. Nevertheless, we do know that we need to provide the best pain relief for patients both before and after amputation. This may require a combination of the oral, subcutaneous or intravenous, and epidural routes.
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Affiliation(s)
- R L Fainsinger
- Division of Palliative Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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