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Pillemer K, Teresi JA, Ramirez M, Eimicke J, Silver S, Boratgis G, Meador R, Schultz L, Kong J, Ocepek-Welikson K, Chang ES, Lachs MS. Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living. JAMA Netw Open 2024; 7:e249668. [PMID: 38700860 PMCID: PMC11069077 DOI: 10.1001/jamanetworkopen.2024.9668] [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: 11/02/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants This study used cross-sectional, observational data from a clinical trial, in which residents of assisted living facilities were monitored for events over a 1-month period. All residents of 14 large facilities randomly selected from 2 geographic locations (N = 1067), except those receiving hospice care (n = 11), were invited to participate; 93 died or moved prior to enrollment. There were 33 family and resident refusals; 930 residents were enrolled. Data were collected between May 30, 2018, and August 11, 2022. Main Outcomes and Measures The data are from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. In addition, the study was designed to assess prevalence using the Time 1 (baseline) data, using a probability sample of facilities to allow for this analysis. Resident-to-resident aggression was identified using a mixed-method, case-finding strategy involving 6 sources: (1) cognitively capable resident reports regarding 22 possible events, (2) direct care staff report, (3) staff member reports collected from event-reporting forms, (4) research assistant observation of events in real time, (5) facility accident or incident reports, and (6) resident records. Results The prevalence of resident-to-resident aggression among the 930 participants (mean [SD] age, 88.0 [7.2] years; 738 women [79.4%]) during the past month was estimated to be 15.2% (141 of 930 residents; 95% CI, 12.1%-18.8%). The most common forms of aggression included verbal (11.2% [104 of 930 residents; 95% CI, 8.8%-14.2%]), physical (41 of 930 residents; 4.4% [95% CI, 3.1%-6.3%]), sexual (0.8% [7 of 930 residents; 95% CI, 0.4%-1.6%]), and other (70 of 930 residents; 7.5% [95% CI, 5.5%-10.2%]). These categories are not mutually exclusive as residents could be involved with more than 1 type of aggressive behavior. Conclusions and Relevance In this cross-sectional, observational prevalence study, resident-to-resident aggression in assisted living facilities was highly prevalent. Verbal aggression was the most common form, and physical aggression also occurred frequently. The effects of resident-to-resident aggression can be both morbid and mortal; therefore, intervention research is needed to prevent it and to treat it when it occurs.
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Affiliation(s)
- Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute, New York
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mildred Ramirez
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Joseph Eimicke
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Stephanie Silver
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Boratgis
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Rhoda Meador
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Leslie Schultz
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York
| | - Jian Kong
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Katja Ocepek-Welikson
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
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Yan E, Wan D, To L, Ng HKL, Lai DWL, Cheng ST, Kwok T, Leung EMF, Lou VWQ, Fong D, Chaudhury H, Pillemer K, Lachs M. Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue. J Am Med Dir Assoc 2024; 25:396-402. [PMID: 37972647 DOI: 10.1016/j.jamda.2023.10.008] [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] [Received: 05/06/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff. DESIGN Cross-sectional descriptive study design. SETTING AND PARTICIPANTS A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling. METHODS The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics. RESULTS Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention. CONCLUSIONS AND IMPLICATIONS Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.
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Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Debby Wan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Louis To
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Haze K L Ng
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong SAR, China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Daniel Fong
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Karl Pillemer
- Cornell College of Human Ecology, Cornell University, New York, NY, USA
| | - Mark Lachs
- Weill Cornell Medicine, Cornell University, New York, NY, USA
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Zhang H, Bao Y, Baek D, Clark S, Elman A, Hancock D, Chang ES, Jeng P, Gassoumis Z, Fettig N, Zhang Y, Wen K, Lachs MS, Pillemer K, Rosen T. Healthcare costs for legally adjudicated elder mistreatment victims in comparison to non-mistreated older adults. J Am Geriatr Soc 2024; 72:236-245. [PMID: 38112382 PMCID: PMC10872321 DOI: 10.1111/jgs.18712] [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: 06/15/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Elder mistreatment (EM) is associated with adverse health outcomes and healthcare utilization patterns that differ from other older adults. However, the association of EM with healthcare costs has not been examined. Our goal was to compare healthcare costs between legally adjudicated EM victims and controls. METHODS We used Medicare insurance claims to examine healthcare costs of EM victims in the 2 years surrounding initial mistreatment identification in comparison to matched controls. We adjusted costs using the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk score. RESULTS We examined healthcare costs in 114 individuals who experienced EM and 410 matched controls. Total Medicare Parts A and B healthcare costs were similar between cases and controls in the 12 months prior to initial EM detection ($11,673 vs. $11,402, p = 0.92), but cases had significantly higher total healthcare costs during the 12 months after initial mistreatment identification ($15,927 vs. $10,805, p = 0.04). Adjusting for CMS-HCC scores, cases had, in the 12 months after initial EM identification, $5084 of additional total healthcare costs (95% confidence interval [$92, $10,077], p = 0.046) and $5817 of additional acute/subacute/post-acute costs (95% confidence interval [$1271, $10,362], p = 0.012) compared with controls. The significantly higher total costs and acute/sub-acute/post-acute costs among EM victims in the post-year were concentrated in the 120 days after EM detection. CONCLUSIONS Older adults experiencing EM had substantially higher total costs during the 12 months after mistreatment identification, driven by an increase in acute/sub-acute/post-acute costs and focused on the period immediately after initial EM detection.
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Affiliation(s)
- Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
- Department of Health Policy and Organization, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Vanderbilt University, Nashville, TN, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York
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Reid MC, Pillemer K. Introduction to Special Issue: Translational Research on Pain and Pain Management in Later Life. Innov Aging 2023; 7:igad119. [PMID: 38094939 PMCID: PMC10714899 DOI: 10.1093/geroni/igad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- M Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
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Baek D, Elman A, Gottesman E, Shaw A, Makaroun LK, Stern ME, Mulcare MR, Sullivan M, Pino C, McAuley J, LoFaso VM, Chang ES, Hancock D, Bloemen EM, Tietz S, Lindberg DM, Sharma R, Clark S, Lachs MS, Pillemer K, Rosen T. Initial steps in addressing the challenges of elder mistreatment evaluation: Protocol for evaluating the Vulnerable Elder Protection Team. BMJ Open 2023; 13:e071694. [PMID: 37832983 PMCID: PMC10583105 DOI: 10.1136/bmjopen-2023-071694] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Although many programmes have been developed to address elder mistreatment, high-quality, rigorous evaluations to assess their impact are lacking. This is partly due to challenges in conducting programme evaluation for such a complex phenomenon. We describe here the development of a protocol to mitigate these challenges and rigorously evaluate a first-of-its-kind emergency department/hospital-based elder mistreatment intervention, the Vulnerable Elder Protection Team (VEPT). METHODS AND ANALYSIS We used a multistep process to develop an evaluation protocol for VEPT: (1) creation of a logic model to describe programme activities and relevant short-term and long-term outcomes, (2) operationalisation of these outcome measures, (3) development of a combined outcome and (4) design of a protocol using telephone follow-up at multiple time points to obtain information about older adults served by VEPT. This protocol, which is informing an ongoing evaluation of VEPT, may help researchers and health system leaders design evaluations for similar elder mistreatment programmes. ETHICS AND DISSEMINATION This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #20-02021422. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Lena K Makaroun
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania, USA
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mary R Mulcare
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Chloe Pino
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jennine McAuley
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - David Hancock
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Elizabeth M Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah Tietz
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel M Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Losada-Baltar A, Falzarano FB, Hancock DW, Márquez-González M, Pillemer K, Huertas-Domingo C, Jiménez-Gonzalo L, Fernandes-Pires JA, Czaja SJ. Cross-National Analysis of the Associations Between Familism and Self-Efficacy in Family Caregivers of People With Dementia: Effects on Burden and Depression. J Aging Health 2023:8982643231193579. [PMID: 37585806 PMCID: PMC10858290 DOI: 10.1177/08982643231193579] [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: 08/18/2023]
Abstract
Objectives: To examine the cross-national associations between familism and self-efficacy dimensions, and levels of burden and depression. Methods: Sociodemographic, familism, self-efficacy, depressive symptoms, and burden variables were measured in 349 dementia family caregivers from the US and Spain. Results: US sample: greater support from family was positively related to self-efficacy for obtaining respite and self-efficacy for controlling upsetting thoughts and behaviors. Both self-efficacy constructs were negatively related to depression. Similar findings were obtained for burden. Spanish sample: higher scores on family as referents were associated with lower scores on self-efficacy for obtaining respite; lower scores on self-efficacy for obtaining respite were associated with higher depressive symptomatology. Discussion: Study findings suggest that a significant interplay exists between the various facets of familism and self-efficacy, leading to differential caregiving outcomes. Unique cultural contexts and values derived from each country may exert distinct influences on how the caregiving role is perceived and appraised.
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Affiliation(s)
| | - Francesca B. Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David W. Hancock
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - María Márquez-González
- Department of Clinical and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | | | | | | | - Sara J. Czaja
- Department of Psychology, Universidad Rey Juan Carlos, Madrid, Spain
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Riffin C, Brody L, Mukhi P, Herr K, Pillemer K, Rogers M, Henderson CR, Reid MC. Establishing the Feasibility and Acceptability of a Caregiver Targeted Intervention to Improve Pain Assessment Among Persons With Dementia. Innov Aging 2023; 7:igad074. [PMID: 38094933 PMCID: PMC10714902 DOI: 10.1093/geroni/igad074] [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] [Received: 01/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques. Research Design and Methods Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n = 19) or a control condition (n = 15). Caregivers in the PICT group participated in four weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12 weeks. Caregivers in the intervention group also completed semistructured interviews at 12 weeks. Quantitative data were analyzed using descriptive statistics and t tests; qualitative data were analyzed using content analysis. Results All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12 weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT's components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems. Discussion and Implications This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully powered efficacy trial, an important step toward future integration into real-world care delivery. Clinical Trial Registration Number NCT03853291.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Madeline Rogers
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - M Cary Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Park T, Pillemer K, Loeckenhoff C, Suitor JJ, Riffin C. What Motivates Physicians to Address Caregiver Needs? The Role of Experiential Similarity. J Appl Gerontol 2023; 42:1003-1012. [PMID: 36661199 PMCID: PMC10081953 DOI: 10.1177/07334648231151937] [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: 01/21/2023] Open
Abstract
Despite the significant stress of family caregiving, caregivers' needs and risks are often overlooked in healthcare settings. This study examined the factors associated with primary care physicians' perceived responsibility to identify and address caregiver needs and risks. Using a national random sample of U.S. primary care physicians (N = 106), multivariable logistic regression analyses were conducted to examine associations of physicians' perceived responsibility to assess caregivers' needs with experiential similarity (personal experience with caregiving), structural similarity (being older and female), and secondary exposure variables (time seeing older adults in the outpatient setting). Most (76.5%) physicians felt responsible for identifying caregivers' needs and risks. In multivariable models, physicians who had personal experience with caregiving were four times more likely than those without it to feel responsible for identifying caregivers' needs and risks and assessing caregivers' mental health concerns. Thus, physicians may benefit from educational interventions that immerse them in caregivers' lived experiences.
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Affiliation(s)
- Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
| | - Karl Pillemer
- Department of Psychology, Cornell University, Ithaca, NY, 14850 USA
| | | | - J. Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, IN, 47907 USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065 USA
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Joshi S, Park T, Brody L, Cruz K, Mukhi P, Reid MC, Herr K, Pillemer K, Riffin C. Recruitment of family caregivers of persons with dementia: Lessons learned from a pilot randomized controlled trial. Front Pain Res (Lausanne) 2023; 4:1125914. [PMID: 37051457 PMCID: PMC10083411 DOI: 10.3389/fpain.2023.1125914] [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: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Family caregivers play an essential role in supporting the health and well-being of older adults with dementia, a population projected to increase rapidly over the coming decades. Enrolling caregivers of people with dementia (PWD) in research studies is vital to generating the evidence necessary to support broader implementation of efficacious intervention programs in real-world care delivery, but a range of challenges impede recruitment and enrollment of sufficiently large and representative sample sizes. In this article, we characterize the challenges and lessons learned from recruiting caregivers of PWD to participate in a pilot randomized control trial. We utilize Bronfenbrenner's ecological model to categorize the challenges into three levels: individual (i.e., understanding caregivers' time constraints and motivations), community (i.e., reaching underrepresented populations and accessing caregiver support groups) and institutional (i.e., obtaining informed consent and navigating research registries). We found that establishing rapport and maintaining flexibility with participants was crucial for motivating individuals to enroll in our study. Building trust with local communities by collaborating with support group leaders, appointing a co-investigator who is already embedded within a given community, and establishing equitable partnerships with organizations increased recruitment rates. At the institutional level, engaging experts in regulatory affairs and geriatrics may help overcome barriers in obtaining approval from institutional review boards. We also recommend using research registries of individuals who offer their contact information to researchers. The lessons learned from our research-including the challenges and potential solutions to overcome them-may promote more effective and efficient recruitment in future research.
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Affiliation(s)
- Sama Joshi
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Taeyoung Park
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Kiana Cruz
- Hackensack Meridian School of Medicine, Seton Hall University, South Orange, NJ, United States
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, IA, UnitedStates
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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10
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Rosen T, Zhang H, Wen K, Clark S, Elman A, Jeng P, Baek D, Zhang Y, Gassoumis Z, Fettig N, Pillemer K, Lachs MS, Bao Y. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment. JAMA Netw Open 2023; 6:e2255853. [PMID: 36787139 PMCID: PMC9929702 DOI: 10.1001/jamanetworkopen.2022.55853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/25/2022] [Indexed: 02/15/2023] Open
Abstract
Importance Elder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment. Objective To examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults. Design, Setting, and Participants This retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022. Main Outcomes and Measures We used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses. Results This study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P < .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P < .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P < .001). Conclusions and Relevance In this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Katherine Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Philip Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Zach Gassoumis
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | | | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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11
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Burnes D, MacNeil A, Nowaczynski A, Sheppard C, Nekolaichuk E, Lachs M, Pillemer K. A SCOPING REVIEW OF OUTCOMES IN ELDER ABUSE INTERVENTION RESEARCH: THE CURRENT LANDSCAPE AND WHERE TO GO NEXT. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1179] [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
Abstract
Researchers, practitioners, and policy-makers worldwide recognize elder abuse (EA) as a major threat to the health and well-being of older adults, but rigorous intervention research has greatly lagged behind this interest. A major weakness is the lack of cohesive understanding of appropriate program outcomes to be measured. To address this knowledge gap, we conducted a scoping review of the EA intervention research literature to understand the range of outcomes considered to date and to provide guidance for future research. We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, Ovid Social Work Abstracts, Ebsco AgeLine, Ebsco CINAHL, Wiley Cochrane Central, and Proquest Sociological Abstracts for studies evaluating community-based EA response programs. Two independent reviewers completed record search, screening, and data extraction procedures. We identified 52 eligible studies (1986-2019) that employed a total of 184 outcomes (range: 1–16, mean = 3.5). This study revealed that a large range of outcomes has been employed in EA intervention studies to date, mostly attached to victims or the intervention process itself, with inconsistent operational definitions and measurement procedures. Several key recommendations for future EA intervention research are: 1) implementing intervention outcomes that reflect multiple levels of eco-systemic influence, 2) heightening the analysis of intervention process outcomes beyond description toward identifying factors that mediate or moderate successful case outcomes, 3) conducting qualitative research with EA victims and other relevant stakeholders to understand meaningful intervention outcomes from their perspectives, and 4) establishing common EA outcome measures for implementation across studies to facilitate greater data pooling and synthesis.
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Affiliation(s)
- David Burnes
- University of Toronto , Toronto, Ontario , Canada
| | | | | | | | | | - Mark Lachs
- Weill Cornell Medicine , New York, New York , United States
| | - Karl Pillemer
- Cornell University , Ithaca, New York , United States
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12
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Nolte J, Cope M, Pillemer K. WHAT CAUSES OLDER PARENT–ADULT CHILD ESTRANGEMENT?: A QUALITATIVE INTERVIEW STUDY. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2343] [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
Abstract
The life-course perspective’s emphasis on “linked lives” highlights the importance of positive parent-child relationships for adults’ well-being in mid-life and beyond. However, one in ten Americans experiences parent-child estrangement, defined as ending all contact and communication for a period of time. Despite the prevalence, the reasons underlying family estrangements are poorly understood. In this study, we conducted in-depth, qualitative interviews with 43 middle-aged and older adults (age range = 46-81, M = 65.05 years) who are or were estranged from an adult child (estrangement range = 1-26, mean = 6.53 years). On the basis of a jointly developed codebook, independent coding from the first and second author revealed 22 estrangement reasons across eight categories, with parents citing reasons from across four categories on average. Estrangement was most often attributed to the behavior, issues, or traits of the child (79%), problems surrounding a difficult in-law/ partner (72%), or disagreements about beliefs and values (67%). To a lesser degree, estrangements were linked to separation or divorce (49%), financial problems and conflicts (42%), adverse childhood experiences of the estranged child (30%), and interference from someone other than a partner (16%). More than half of the parents (58%) also endorsed other reasons, including their own traits and behaviors, communication issues, a family history of estrangement, and passive loss of contact. Older parent–adult child estrangements are perceived as multi-causal, with four out of five parents describing the estranged child as difficult or troubled. Implications of the findings for professionals working with older adults are discussed.
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Affiliation(s)
- Julia Nolte
- Cornell University , Ithaca, New York , United States
| | - Marie Cope
- Cornell University , Ithaca, New York , United States
| | - Karl Pillemer
- Cornell University , Ithaca, New York , United States
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13
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Hancock D, Pillemer K, Burnes D, Czaja S, Lachs M. PSYCHOMETRIC PROPERTIES OF A NOVEL MEASURE OF FINANCIAL ABUSE OF OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9766714 DOI: 10.1093/geroni/igac059.2294] [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
Background and Objectives Elder abuse, or mistreatment affects at least 1 in 10 older adults. Financial abuse, or exploitation, of older adults is among the most commonly reported forms of abuse. Few validated measures exist to measure this construct. We aim to present a new psychometrically validated measure of financial abuse of older adults.Research Design and Methods Classical test theory and item response theory methodologies were used to examine a five-item measure of financial abuse of older adults, administered as part of the New York State Elder Mistreatment Survey. Results Factor analysis revealed a single factor best fits the data, which we labeled as financial abuse. Moreover, IRT analyses revealed that these items discriminated well between abused and non-abuse persons and provided information at high levels of the latent trait θ, as is expected in cases of abuse. Discussion and Implications: The FIVE has acceptable psychometric properties and has been used successfully in large scale survey research. We recommend this measure as an indicator of financial abuse in elder abuse, or mistreatment prevalence research studies.
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Affiliation(s)
- David Hancock
- Weill Cornell Medicine, New York City, New York, United States
| | | | | | - Sara Czaja
- Weill Cornell Medicine, New York City, New York, United States
| | - Mark Lachs
- Weill Cornell Medicine, New York, New York, United States
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14
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Burnes D, Pillemer K, MacNeil A. INVESTIGATING THE CONNECTION BETWEEN AGEISM AND ELDER ABUSE. Innov Aging 2022. [PMCID: PMC9770552 DOI: 10.1093/geroni/igac059.2287] [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
Elder abuse is recognized as a pervasive public health problem with detrimental consequences for older adults and society. Although considerable research has examined elder abuse risk factors at the individual level, there is a growing call for the field to move beyond proximal causes and consider broader socio-cultural and structural factors that influence elder abuse. Illustrating this shift, organizations, advocacy groups and researchers have proposed a connection between ageism and elder abuse. However, despite the assertion that ageism is a causal factor for elder abuse, there is a scarcity of research to demonstrate this relationship, and a coherent theoretical framework linking ageism to elder abuse remains to be articulated. The purpose of the current study was to examine the conceptual pathways and limited empirical research connecting ageism and elder abuse, and to develop a conceptual model that links ageism and elder abuse. We conducted a comprehensive review and synthesis of the ageism/elder abuse literature, as well as research from other domains of interpersonal/family violence. Based on this synthesis, the proposed model includes plausible mediators (social isolation, devaluation, depersonalization, infantilization, powerlessness, blame) and moderators (intersection with socio-cultural identities, internalized ageism, policy/social norms) that could be targeted as mechanisms of change in interventions designed to address the issue. As such, it provides a framework for hypothesis-testing and future research on the topic. This study informs a research agenda to bring conceptual clarity and empirical evidence to the study of the connection between ageism and elder abuse.
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15
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Riffin C, Griffin J, Bangerter L, Brody L, Falzarano F, Pillemer K, Czaja S, Adelman R. SUPPORTING DEMENTIA CAREGIVERS IN HEALTHCARE DELIVERY: RECOMMENDATIONS FROM A NATIONAL CONSENSUS CONFERENCE. Innov Aging 2022. [PMCID: PMC9767263 DOI: 10.1093/geroni/igac059.2345] [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
More than 6 million adults in the United States are affected by Alzheimer’s Disease and related dementias (ADRD), the majority of whom rely on assistance from an unpaid caregiver (family, friends). The goal of the 2021 Conference on Engaging Family and Other Unpaid Caregivers of Persons with Dementia in Healthcare Delivery, funded by the National Institute on Aging, was to establish a policy- and practice-aligned research agenda for enhancing ADRD caregiver engagement and support in healthcare settings. The Conference convened multidisciplinary thought leaders from across the United States to establish a set of actionable recommendations to advance the field. Recommendations centered on five key topics: 1) Identification and assessment of ADRD caregivers, 2) Reimbursement and financing for provider time spent on ADRD caregiver, identification, assessment, and support, 3) ADRD caregiver training and support, 4) Healthcare provider education, and 5) Technology. To support future work in each of the five priority areas, conference participants highlighted the importance of leveraging lessons from implementation science and models of equity and inclusion. Recommendations are intended to inform federal agencies and foundations about high-priority areas and motivate multidisciplinary collaborations to design care delivery systems that effectively engage and support ADRD caregivers.
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Affiliation(s)
- Catherine Riffin
- Weill Cornell Medical College, New York, New York, United States
| | - Joan Griffin
- Mayo Clinic, Rochester, Minnesota, United States
| | | | - Lilla Brody
- Weill Cornell Medicine, New York, New York, United States
| | | | | | - Sara Czaja
- Weill Cornell Medicine, New York City, New York, United States
| | - Ronald Adelman
- Weill Cornell Medicine, New York City, New York, United States
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16
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Park T, Pillemer K, Löckenhoff C, Riffin C. WHAT MOTIVATES PHYSICIANS TO ADDRESS CAREGIVER NEEDS? THE ROLE OF EXPERIENTIAL SIMILARITY. Innov Aging 2022. [PMCID: PMC9767297 DOI: 10.1093/geroni/igac059.2484] [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
Despite the negative emotional and physical consequences of caregiving, caregivers’ needs and risks are often overlooked in health care settings. This study used survey data from a national random sample of primary care physicians (N=106) to examine the factors associated with physicians’ perceived responsibility to identify caregiver needs and risks, focusing on three theoretically implicated variables: 1) experiential similarity (i.e., physicians having personal experience with caregiving), 2) structural similarity (i.e., physicians being older and female), and 3) secondary exposure to caregivers (i.e., more time seeing older patients and a higher percentage of older adults in their patient panel). Physicians in our sample consisted of 42.5% women; most of whom were white (73.6%). The majority (76.5%) agreed or strongly agreed that they were responsible for identifying caregivers’ needs and risks. Multivariable models controlling for physicians’ age and gender revealed that physicians who had personal experience with caregiving were four times more likely than those without caregiving experience to feel responsible to identify caregivers’ needs and risks (adjusted odds ratio [aOR] 3.90; 95% confidence interval [CI] 1.34-11.41) and to assess caregivers’ mental health concerns (aOR 3.58; 95% CI 1.29-9.94). Structural similarity and secondary exposure did not play significant roles in motivating physicians. Findings highlight the role of experiential similarity in physicians’ motivation to assess caregivers’ needs and risks. Future work may benefit from designing intervention programs for physicians that incorporate experiential learning activities (e.g., conversations in which caregivers share their experiences) and evaluating whether such programs enhance physicians’ sensitivity toward family caregivers.
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Affiliation(s)
| | | | | | - Catherine Riffin
- Weill Cornell Medical College, New York, New York, United States
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17
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Riffin C, Brody L, Mukhi P, Reid C, Herr K, Pillemer K. IMPROVING CAREGIVER ASSESSMENT AND COMMUNICATION ABOUT PAIN IN RELATIVES WITH DEMENTIA. Innov Aging 2022. [PMCID: PMC9765737 DOI: 10.1093/geroni/igac059.2097] [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
Pain is under-detected and poorly managed in persons with dementia (PWD). Family caregivers are well situated to detect and facilitate management of pain in PWD, but they receive little guidance and training in these tasks. Our group developed the Pain Identification and Communication Toolkit (PICT), a manualized, multicomponent intervention to help caregivers recognize pain in their care recipients and communicate their observations to healthcare providers. PICT includes a) training in administering an observational pain assessment tool, b) coaching in effective pain communication, and c) building caregivers’ skills through practice. To evaluate PICT’s acceptability, feasibility, and preliminary efficacy, we conducted a pilot randomized controlled trial of N=34 caregivers (n=18 randomized to PICT; n=16 randomized to a control condition). Participants were from diverse racial and ethnic backgrounds (14% Black; 15% Hispanic; 8% Asian; 8% multiracial). Of the caregivers enrolled in the intervention group, 66.7% reported that PICT improved their confidence in identifying pain symptoms, and 83.3% reported that PICT improved their confidence in communicating pain-related concerns to providers. Retention was excellent: 100% of caregivers in the PICT group completed all intervention sessions (4 total); only 5% prematurely terminated the study (did not complete the 12-week post-assessment questionnaire). Notably, caregivers in the PICT group showed a significant improvement in confidence communicating with healthcare providers from baseline to 12-week follow-up (M=3.9 vs. M=4.4; p<.01). Collectively, these findings suggest PICT’s potential as an intervention to help caregivers recognize and communicate about pain in PWD and that a full-scale efficacy trial with larger sample is warranted.
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Affiliation(s)
- Catherine Riffin
- Weill Cornell Medical College, New York, New York, United States
| | - Lilla Brody
- Weill Cornell Medicine, New York, New York, United States
| | - Priya Mukhi
- Cornell University, Ithaca, New York, United States
| | - Cary Reid
- Weill Cornell Medicine, New York City, New York, United States
| | - Keela Herr
- University of Iowa, Iowa City, Iowa, United States
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18
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Pillemer K. A FRAMEWORK FOR IDENTIFYING MAJOR RESEARCH PRIORITIES: THE CITRA RESEARCH-TO-PRACTICE CONSENSUS WORKSHOP MODEL. Innov Aging 2022. [PMCID: PMC9770698 DOI: 10.1093/geroni/igac059.284] [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
The CITRA Research-to-Practice Consensus Workshop Model is an evidence-based method for identifying research priorities on aging-related topics. Its major goals are to promote knowledge translation and equal-status dialogue among stakeholders from multidisciplinary backgrounds. In this presentation, Dr. Pillemer, co-creator of the CITRA model, will provide an overview of the 5-step method: (1) Identifying a topic that is both an important challenge in aging-related policy or practice and one on which there is scientific evidence; (2) Selecting a panel of multidisciplinary experts from relevant stakeholder groups; (3) Preparing a non-technical background document that summarizes available research findings; (4) Convening multidisciplinary experts in a consensus conference involving panel presentations, discussion of the background document, and consensus activities; and (5) Preparing a final consensus report and disseminating the findings to relevant policy organizations, practice groups, and funding agencies. Common challenges and practical tips for executing each of the 5 steps will be addressed.
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19
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Yan E, Lai DWL, Lou VWQ, Chaudhury H, Pillemer K, Lachs M. RESIDENT-TO-RESIDENT AGGRESSION: PREVALENCE AND RISK FACTORS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1182] [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
Abstract
This study examines the rates and risk factors of resident-to-resident aggression in long term care facilities in Hong Kong. A total of 800 personal care worker participated. Participants averaged 42.03 years of age (SD=7.63), were mostly female (92.7%), married (79.1%) and reported an average of 6.28 years of experience in long term care. 96.9 percent of the participants provided care to residents with dementia but 58.9% considered the training they received insufficient. Resident-to-resident aggression was common: All participants reported having witnessed verbal aggression (100%), 18% disruptive behaviors, 11.8% physical violence, and 3.1% sexual aggression.Resident-to-staff aggression was commonly reported with verbal aggression being the most common (97.6%) following by other disruptive behaviors (13.7%), physical violence (10.7%), and sexual aggression (8.5%). Logistic regression analysis indicated that disruptive behaviors and physical violence were associated with perpetrator male gender, dementia, and neuropsychiatry symptoms, as well as staff prior and current experience of taking care of persons with dementia, not having received training in dementia care, and perceived insufficiency of training. Sexual aggression was associated with perpetrator male gender and staff female gender. There is an urgent need to provide supportive services to prevent and intervene resident-to-resident aggression in long term care facilities. Improving management of behavioral and psychological symptoms of dementia through sufficient staff training and adequate staffing ration may be helpful in this aspect.
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Affiliation(s)
- Elsie Yan
- The Hong Kong Polytechnic University , Hong Kong , Hong Kong
| | | | | | - Habib Chaudhury
- Simon Fraser University , Vancouver, British Columbia , Canada
| | - Karl Pillemer
- Cornell University , Ithaca, New York , United States
| | - Mark Lachs
- Weill Cornell Medicine , New York, New York , United States
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20
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Yan E, Lai DWL, Cheng S, Kwok T, Leung EMF, Lou VWQ, Fong D, Chaudhury H, Pillemer K, Lachs M. Resident‐to‐resident
aggression in long‐term care facilities: Prevalence and risk factors. J Am Geriatr Soc 2022; 71:1666-1670. [PMID: 36519730 DOI: 10.1111/jgs.18175] [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: 06/23/2022] [Revised: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences The Hong Kong Polytechnic University Hong Kong SAR China
| | - Daniel W. L. Lai
- Facuty of Social Sciences Hong Kong Baptist University Hong Kong SAR China
| | - Sheung‐Tak Cheng
- Department of Health and Physical Education The Education University of Hong Kong Hong Kong SAR China
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public Health The Chinese University of Hong Kong Hong Kong SAR China
| | | | - Vivian W. Q. Lou
- Department of Social Work and Social Administration University of Hong Kong Hong Kong SAR China
| | - Daniel Fong
- School of Nursing University of Hong Kong Hong Kong SAR China
| | - Habib Chaudhury
- Department of Gerontology Simon Fraser University Burnaby Canada
| | - Karl Pillemer
- Cornell College of Human Ecology Cornell University, Ithaca New York USA
| | - Mark Lachs
- Weill Cornell Medicine Cornell University, Ithaca New York USA
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21
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Mikton C, Beaulieu M, Burnes D, Choo WY, Herbst JH, Pillemer K, Yon Y. High time for an intervention accelerator to prevent abuse of older people. Nat Aging 2022; 2:973-975. [PMID: 37118090 PMCID: PMC10148954 DOI: 10.1038/s43587-022-00301-0] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Currently, there are no evidence-based interventions to prevent and respond to abuse of older people. We propose to create, within the Decade of Healthy Ageing 2021–2030, an intervention accelerator to speed up the development of effective interventions for abuse of older people in community and institutional settings within low-, middle- and high-income countries.
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Affiliation(s)
- Christopher Mikton
- Department of Social Determinants of Health, World Health Organization, Geneva, Switzerland.
| | - Marie Beaulieu
- Center for Research on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - David Burnes
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Wan-Yuen Choo
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey H Herbst
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Yongjie Yon
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
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22
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Rosen T, Elman A, Clark S, Gogia K, Stern ME, Mulcare MR, Makaroun LK, Gottesman E, Baek D, Pearman M, Sullivan M, Brissenden K, Shaw A, Bloemen EM, LoFaso VM, Breckman R, Pillemer K, Sharma R, Lachs MS. Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program. J Am Geriatr Soc 2022; 70:3260-3272. [PMID: 35860986 PMCID: PMC9669128 DOI: 10.1111/jgs.17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED-based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. METHODS We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. RESULTS During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty-two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy-five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety-four percent reported believing that there is merit in establishing a VEPT Program in other EDs. CONCLUSION VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer-term outcomes.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine / Boston Medical Center, Boston, MA, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mary R. Mulcare
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Lena K. Makaroun
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Morgan Pearman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kelly Brissenden
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elizabeth M. Bloemen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
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Burnes D, Pillemer K, Rosen T, Lachs MS, McDonald L. Elder abuse prevalence and risk factors: findings from the Canadian Longitudinal Study on Aging. Nat Aging 2022; 2:784-795. [PMID: 37118505 PMCID: PMC10154033 DOI: 10.1038/s43587-022-00280-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/04/2022] [Indexed: 04/30/2023]
Abstract
Elder abuse (EA) is a pervasive problem with serious consequences. Previous population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims, which threatens external validity. Based on a national, prospective, population-based cohort sample of older adults (n = 23,468) over a 3-year period from the Canadian Longitudinal Study on Aging, the current study sought to estimate the prevalence of EA and identify risk and protective factors. Past-year prevalence of any EA was 10.0%. Older adults with greater vulnerability related to physical, cognitive and mental health, childhood maltreatment and shared living were at higher EA risk, while social support was protective against EA. Older adults identifying as Black or reporting financial need were at heightened EA risk. This longitudinal, population-based study advances our understanding of EA risk/protective factors across several domains and informs the development of EA prevention strategies.
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Affiliation(s)
- David Burnes
- University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Ontario, Canada.
| | - Karl Pillemer
- Cornell University, College of Human Ecology, Ithaca, NY, USA
| | - Tony Rosen
- Division of Geriatric Emergency Medicine, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark S Lachs
- Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lynn McDonald
- University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Ontario, Canada
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24
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Falzarano F, Moxley J, Pillemer K, Czaja SJ. Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes. J Gerontol B Psychol Sci Soc Sci 2022; 77:1269-1279. [PMID: 34473247 PMCID: PMC9255933 DOI: 10.1093/geronb/gbab160] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics. METHODS Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden. RESULTS African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans' endorsement of familism predicted more positive caregiving appraisals. African Americans also reported greater levels of social support, which in turn predicted lower burden and depressive symptoms when compared with Whites. Exploratory analyses demonstrated significant associations between familism and self-efficacy. In the Hispanic subgroup, familism varied as a function of acculturation. DISCUSSION Results indicate that greater levels of familism and social support may exert a protective influence against adverse psychosocial caregiving outcomes. These findings can be used to inform intervention efforts targeting culturally congruent, family-centered approaches.
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Affiliation(s)
- Francesca Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Sara J Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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25
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Mikton C, Beaulieu M, Yon Y, Cadieux Genesse J, St‐Martin K, Byrne M, Phelan A, Storey J, Rogers M, Campbell F, Ali P, Burnes D, Band‐Winterstein T, Penhale B, Lachs M, Pillemer K, Estenson L, Marnfeldt K, Eustace‐Cook J, Sutton A, Lacasse F. PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions. Campbell Syst Rev 2022; 18:e1227. [PMID: 36911355 PMCID: PMC9046657 DOI: 10.1002/cl2.1227] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: to produce a mega-map which identifies, maps and provides a visual interactive display, based on systematic reviews on all the main aspects of elder abuse in both the community and in institutions, such as residential and long-term care institutions.
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Affiliation(s)
- Christopher Mikton
- Department of Social Determinants of HealthWorld Health OrganizationGenevaSwitzerland
| | - Marie Beaulieu
- École de travail social, Faculté des lettres et sciences humainesUniversité de SherbrookeSherbrookeQuébecCanada
- Research Chair on Mistreatment of Older AdultsSherbrookeQuébecCanada
| | - Yongjie Yon
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | | | - Kevin St‐Martin
- École de travail social, Faculté des lettres et sciences humainesUniversité de SherbrookeSherbrookeQuébecCanada
| | - Mark Byrne
- School of Nursing and Midwifery, Trinity College DublinDublinIreland
| | - Amanda Phelan
- School of Nursing and Midwifery, Trinity College DublinDublinIreland
| | | | - Michaela Rogers
- Department of Sociological StudiesUniversity of SheffieldSheffieldUK
| | - Fiona Campbell
- School of Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Parveen Ali
- Department of Sociological StudiesUniversity of SheffieldSheffieldUK
| | - David Burnes
- Rotman Research Institute, Factor‐Inwentash Faculty of Social Work Affiliate Scientist, BaycrestUniversity of TorontoOntarioTorontoCanada
| | - Tova Band‐Winterstein
- Department of GerontologyFaculty of Social Welfare and Health SciencesUniversity of HaifaHaifaIsrael
| | | | - Mark Lachs
- Geriatric MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Karl Pillemer
- Cornell Institute for Translational Research on AgingCornell UniversityNew YorkNew YorkUSA
| | - Lilly Estenson
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kelly Marnfeldt
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Anthea Sutton
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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26
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Scher C, Henderson CR, Pillemer K, Kim P, Reid MC. Which Pain Treatment Goals Are Important to Community-Dwelling Older Adults? Pain Med 2022; 23:1401-1408. [PMID: 35385109 PMCID: PMC9608001 DOI: 10.1093/pm/pnac055] [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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this cross-sectional study of 237 older adults, we ascertained the importance of 7 pain treatment goals and identified factors associated with their perceived importance. METHODS Participants (mean age = 72 years) ranked each goal (e.g., pain reduction; finding a cure) on a 1 (not at all important) to 10 (extremely important) scale. We used general linear models to identify sociodemographic and pain factors independently associated with the perceived importance of each goal and repeated measures mixed models to examine their relative importance. RESULTS The goal with the lowest adjusted score was "minimize harmful side effects from pain medications" with a mean (SE) of 6.75 (0.239), while the highest ranked goals, "finding a cure," and "reducing my pain" had mean scores of 8.06 (0.237) and 7.89 (0.235), respectively. Pain reduction did not differ significantly from the average of the other 6 goals (p = 0.072) but was significantly different when compared with the goals of minimizing side effects (p < 0.0001) and finding a cause for the pain (p = 0.047), and different from the average of the 5 other goals excluding finding a cure (p = 0.021). We did not identify differences in the importance of the 7 goals by gender or race/ethnicity. Age was inversely associated with the goals of minimizing harmful side effects and decreasing pain's effects on everyday activities. Pain reduction was rated more important than all other goals but finding a cure. CONCLUSIONS Future research is needed to establish the benefits of eliciting treatment goals when delivering pain care to older adults.
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Affiliation(s)
- Clara Scher
- Rutgers School of Social Work, 120 Albany Street, New Brunswick, New Jersey 08901
| | | | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York
| | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, 525 East 68th Street, New York, New York, 10065
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, 525 East 68th Street, New York, New York, 10065
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27
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Pillemer K, Nolte J, Schultz L, Yau H, Henderson CR, Cope MT, Baschiera B. The Benefits of Intergenerational Wisdom-Sharing: A Randomized Controlled Study. Int J Environ Res Public Health 2022; 19:ijerph19074010. [PMID: 35409693 PMCID: PMC8997747 DOI: 10.3390/ijerph19074010] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023]
Abstract
Adolescents’ opportunities to benefit from the life wisdom of older persons are very limited. To address this issue, we designed and tested the Building a Community Legacy Together (BCLT) program based on research on the benefits of older people’s wisdom for youth development. In the intervention, the youth participants were trained prior to conducting interviews with older persons regarding their advice for living. The youth participants analyzed the information obtained and presented a summary report to the community. The participants were 93 middle and high school youth who were randomly assigned to the treatment condition with the BCLT program (n = 47) or to the control condition (n = 46). The outcome measures included sense of purpose, self-esteem, attitudes toward older people, confidence interacting with older people, and interest in working with older people. Quantitative and qualitative data were also collected regarding the subjective assessments of the program’s success. We found significant positive effects for the BCLT participants regarding their sense of purpose in life, attitudes toward older people, comfort interacting with older people, and interest in working with older people. The subjective assessments of the participants were overwhelmingly positive. The findings indicate that BCLT had positive effects for the youth participants and support the further development and testing of wisdom-sharing intergenerational programs.
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Affiliation(s)
- Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY 14850, USA; (J.N.); (L.S.); (H.Y.); (C.R.H.J.); (M.T.C.)
- Correspondence:
| | - Julia Nolte
- College of Human Ecology, Cornell University, Ithaca, NY 14850, USA; (J.N.); (L.S.); (H.Y.); (C.R.H.J.); (M.T.C.)
| | - Leslie Schultz
- College of Human Ecology, Cornell University, Ithaca, NY 14850, USA; (J.N.); (L.S.); (H.Y.); (C.R.H.J.); (M.T.C.)
| | - Harry Yau
- College of Human Ecology, Cornell University, Ithaca, NY 14850, USA; (J.N.); (L.S.); (H.Y.); (C.R.H.J.); (M.T.C.)
| | - Charles R. Henderson
- College of Human Ecology, Cornell University, Ithaca, NY 14850, USA; (J.N.); (L.S.); (H.Y.); (C.R.H.J.); (M.T.C.)
| | - Marie Tillema Cope
- College of Human Ecology, Cornell University, Ithaca, NY 14850, USA; (J.N.); (L.S.); (H.Y.); (C.R.H.J.); (M.T.C.)
| | - Barbara Baschiera
- Dipartimento di Filosofia e Beni Culturali, Università Ca’ Foscari, Dorsoduro 3246, 30123 Venice, Italy;
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28
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Pillemer K, Silver S, Ramirez M, Kong J, Eimicke JP, Boratgis GD, Meador R, Schultz L, Lachs MS, Nolte J, Chen EK, Teresi JA. Factors associated with resident-to-resident elder mistreatment in nursing homes. J Am Geriatr Soc 2021; 70:1208-1217. [PMID: 34958677 DOI: 10.1111/jgs.17622] [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] [Received: 07/13/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resident-to-resident elder mistreatment (RREM) in nursing homes has serious physical and psychological consequences, but factors related to RREM occurrence remain unclear. This study identifies individual and environmental characteristics associated with involvement in RREM episodes. METHODS The design was an observational study carried out in five urban and five suburban New York state nursing homes randomly selected on the basis of size and location. The sample consisted of 2011 residents in 10 facilities; 83% of facilities and 84% of eligible residents participated. RREM and potential correlates were identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports. RESULTS A multivariate analysis controlling for relevant covariates found that individuals involved in RREM incidents exhibit milder dementia, show behavioral symptoms, and are less functionally impaired. Although special care units (SCU) for dementia have benefits for residents, one potential hazard for SCU residents is elevated risk for RREM. CONCLUSIONS Interventions to prevent and intervene in RREM incidents are greatly needed. The correlates identified in this research point to the need for targeted interventions, specifically for residents with milder impairment and with behavioral symptoms and individuals in SCUs.
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Affiliation(s)
- Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA.,Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Stephanie Silver
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Mildred Ramirez
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA.,Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Jian Kong
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Gabriel D Boratgis
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Rhoda Meador
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Leslie Schultz
- Bronfenbrenner Center for Translational Research, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Mark S Lachs
- Division of Geriatric Medicine and Gerontology, Weill Cornell Medical College, New York, New York, USA
| | - Julia Nolte
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - Emily K Chen
- Rand Corporation, Washington, District of Columbia, USA
| | - Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA.,Columbia University Stroud Center, New York State Psychiatric Institute, New York, New York, USA
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29
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Burnes D, Hancock D, Eckenrode J, Lachs M, Pillemer K. Incidence and Risk Factors of Elder Mistreatment in the Community: A Longitudinal Population-Based Study. Innov Aging 2021. [PMCID: PMC8680684 DOI: 10.1093/geroni/igab046.335] [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
Abstract
Prior population-based elder mistreatment (EM) risk factor research has focused on problem prevalence using cross-sectional designs, which cannot make causal inferences between proposed risk factors and EM or discern existing cases from new cases entering the population. This study sought to estimate the incidence of EM and identify risk factors for new cases. It is a ten-year prospective, population-based cohort study with data collected between 2009 (Wave 1) and 2019 (Wave 2). Based on Wave 1 random, stratified sampling to recruit English/Spanish-speaking, cognitively intact, community-dwelling older adults (age ≥ 60) across New York State, this study conducted computer assisted telephone interviews (CATI) with 628 respondents participating in both Wave 1 and Wave 2 interviews (response rate=60.7%). Ten-year EM incidence was regressed on factors related to physical vulnerability, living arrangement, and socio-cultural characteristics using logistic regression. Ten-year incidence rates included overall EM (11.4%), financial abuse (8.5%), emotional abuse (4.1%), physical abuse (2.3%), and neglect (1.0%). Poor self-rated health at Wave 1 significantly predicted increased risk of new Wave 2 overall EM (odds ratio [OR]=2.8), emotional abuse (OR=3.67), physical abuse (OR=4.21), and financial abuse (OR=2.8). Black older adults were at significantly heightened risk of overall EM (OR=2.61), specifically financial abuse (OR=2.8). Change from co-residence (Wave 1) toward living alone (Wave 2) significantly predicted financial abuse (OR=2.74). Healthcare visits represent important opportunities to detect at-risk older adults. Race is highlighted as an important social determinant for EM requiring urgent attention. This study represents the first longitudinal, population-based EM incidence study.
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Affiliation(s)
| | - David Hancock
- Weill Cornell Medicine, New York City, New York, United States
| | | | - Mark Lachs
- Weill Cornell Medicine, New York City, New York, United States
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30
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Cruz K, Joshi S, Park T, Reid MC, Herr K, Pillemer K, Riffin C. Research Participation among Community Dwelling Dementia Caregivers: Reflections and Suggestions. Innov Aging 2021. [PMCID: PMC8681371 DOI: 10.1093/geroni/igab046.2926] [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
Clinical trials for dementia caregivers have suffered from small sample sizes that lack adequate power to detect treatment benefits. Addressing these methodological shortcomings is contingent upon successful recruitment and enrollment of caregiver participants, but major barriers impede their participation in research. This presentation describes the lessons learned from recruiting and enrolling dementia caregivers into a pilot randomized controlled trial designed to help caregivers recognize and communicate about pain in dementia care recipients. Using Bronfenbrenner’s ecological model, we organize our discussion of challenges and opportunities into three levels: community (ecosystem), institution (microsystem), and individual. A key challenge at the community level was gatekeeping by organization leaders, including those from support groups, senior centers, and congregate living facilities. At the institutional-level, challenges included an absence of administrative mechanisms for identifying caregivers and a lack of caregiver research expertise on the Institutional Review Board. At the individual-level, challenges included time constraints and varying motivations for participating in research. Strategies for overcoming these challenges spanned the three levels and included establishing trust and rapport with various constituencies; adapting our recruitment approaches to meet the specific motivations of prospective participants; and refining recruitment scripts to allow for greater personalization. Employing these strategies, which can be generalized to recruit other hard-to-reach populations, helped to overcome recruitment challenges and expedite enrollment of caregivers from a diverse range of sociodemographic backgrounds. Further improvement will require coordinated changes at the institutional and community levels, including the development of central research registries and administrative mechanisms for identifying caregivers.
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Affiliation(s)
- Kiana Cruz
- Weill Cornell Medical College, New York, New York, United States
| | - Sama Joshi
- Cornell University, Ithaca, New York, United States
| | | | | | - Keela Herr
- University of Iowa, Iowa City, Iowa, United States
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31
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Falzarano F, Moxley J, Pillemer K, Czaja S. Cross-Cultural Differences in Caregiving: Investigating the Role of Familism and Social Support. Innov Aging 2021. [PMCID: PMC8680255 DOI: 10.1093/geroni/igab046.1249] [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: 11/29/2022] Open
Abstract
Cultural diversity in the United States (US) reflects a demographic shift, with a growing population of minority older adults and a subsequent increase in minority family caregivers providing care to aging adults. Research has demonstrated heterogeneity in the caregiving experience, with increasing focus placed on examining the impact of cultural values on caregiver (CG) outcomes. Familism has been investigated as a driving mechanism of cross-cultural differences in caregiving outcomes, yet prior work examining this relationship has yielded mixed findings. Using the sociocultural stress and coping model as a guiding framework, we examined, in a sample of 243 CGs who participated in the Caring for the Caregiver Network Study, a randomized controlled trial examining a culturally-tailored technology-based psychosocial intervention, the influence of familism and social support on positive aspects of caregiving, depressive symptoms, and caregiver burden. We also examined how these relationships vary as a function of race/ethnicity, the CG’s relationship to the care-recipient, other sociodemographic characteristics (e.g., SES status), and acculturation. Results showed that African American and Hispanic CGs exhibited higher levels of familism compared to Whites. In African Americans, familism predicted higher positive caregiving appraisals, and social support significantly predicted lower burden and depression. In Hispanics, levels of familism varied as a function of acculturation, with lower levels of familism identified among US Hispanic natives. Our findings highlight that cultural beliefs, such as familism, as well as social support may be adaptive in protecting against adverse CG outcomes and point to directions for future culturally congruent, family-centered intervention approaches.
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Affiliation(s)
| | - Jerad Moxley
- Weill Cornell Medicine, New York, New York, United States
| | | | - Sara Czaja
- Weill Cornell Medicine/Center on Aging and Behavioral Research, New York, New York, United States
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32
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Abstract
There is growing interest in deprescribing of antihypertensive medications in response to adverse effects, or when a patient’s situation evolves such that the benefits are outweighed by the harms. We conducted a retrospective cohort study to evaluate the incidence and predictors of deprescribing of antihypertensive medication among VA long-term care residents ≥ 65 years admitted between 2006 and 2017. Data were extracted from the VA electronic health record, CMS Minimum Data Set, and Bar Code Medication Administration. Deprescribing was defined as a reduction in the number of antihypertensive medications, sustained for 2 weeks. Potentially triggering events for deprescribing included low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and fall in the past 30 days. Among 22,826 VA nursing home residents on antihypertensive medication, 57% had describing event during their stay (median length of stay = 6 months). Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, acute renal impairment was associated with greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: among residents with this event, 32.7% were described compared to 7.3% in those without (risk difference = 25.5%, p<0.001). Falls were associated with the smallest increased risk of deprescribing (risk difference = 2.1%, p<0.001) of the events considered. Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event.
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33
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Rosen T, Wen K, Clark S, Elman A, Jeng P, Zhang Y, Pillemer K, Bao Y. Emergency Department Utilization Patterns Among Physical Elder Abuse Victims in Comparison to Other Older Adults. Innov Aging 2021. [PMCID: PMC8682264 DOI: 10.1093/geroni/igab046.579] [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
Abstract
Background: Physical elder abuse is common and has serious health consequences. Little is known, however, about the patterns of health care utilization among these victims, including whether opportunities may exist for earlier identification and intervention. Our goal was to describe Emergency Department (ED) utilization known physical elder abuse victims compared with non-victims. Methods: We used Medicare insurance claims to examine ED utilization patterns among a well-characterized cohort of 139 known physical elder abuse victims in the year before abuse was identified and compared this to control subjects matched on age, sex, race, and residential zip code. Results: Physical elder abuse victims were significantly more likely than control subjects to visit the ED (47.5% vs. 35.9%, p=0.01) during the year before identification and to have at least one visit for an injury-related complaint (14.4% vs. 8.3%, p=0.03). Victims were also more likely to have multiple visits (18.7% vs. 14.6%, p=0.24), visit multiple EDs (7.9% vs. 6.7%, p=0.63), or be high frequency utilizers (≥4 visits, 3.6% vs. 2.7%, p=0.58), but differences did not reach statistical significance. The most common diagnoses in ED visits among victims were: open wound of knee/ankle, exacerbation of chronic bronchitis, pneumonia, and chest pain. Conclusion: This work provides preliminary evidence that physical elder abuse victims use the ED more frequently and potentially have different patterns of utilization than other older adults. We plan to further characterize these different patterns to potentially to use them to develop tools for earlier identification.
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Affiliation(s)
- Tony Rosen
- Weill Cornell Medical College / NewYork-Presbyterian Hospital, PELHAM, New York, United States
| | | | - Sunday Clark
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Alyssa Elman
- Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, New York, United States
| | - Philip Jeng
- Weill Cornell Medical College, New York, New York, United States
| | - Yiye Zhang
- Weill Cornell Medical College, New York, New York, United States
| | | | - Yuhua Bao
- Weill Cornell Medical College, New York, New York, United States
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Pillemer K, Burnes D, Hancock D, Eckenrode J, Rosen T, MacNeil A, Lachs MS. Lack of Association of Elder Mistreatment With Mortality. J Gerontol A Biol Sci Med Sci 2021; 77:1699-1705. [PMID: 34939085 PMCID: PMC9373958 DOI: 10.1093/gerona/glab348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prior research is limited and inconsistent on the degree to which elder mistreatment (EM) is associated with mortality. This study uses data from a 10-year, prospective, population-based study of EM to determine the adjusted effects of EM on older adult mortality, after controlling for other health and socioeconomic covariates. METHODS The New York State Elder Mistreatment Prevalence Study conducted a random-sample telephone survey of older adults (n = 4 156) in 2009 (Wave 1). The current study employs EM and covariate data from Wave 1 and data on mortality status through Wave 2 (2019). EM was operationalized both as experiencing EM and as severity of EM. The survey measured overall EM and separate subtypes (emotional, physical, and financial abuse, and neglect). RESULTS The hypothesis was not supported that abused and neglected older people would have higher rates of death over the study. Individuals who were victims of EM were no more likely to die over the following 10 years, compared with those who were not mistreated, after controlling for covariates. Furthermore, the severity of EM, as measured by the frequency of mistreatment behaviors, also was not associated with mortality risk. CONCLUSIONS The finding that self-reported EM did not raise the risk of earlier death in this sample is encouraging. Future research should work to identify factors that may moderate the relationship between EM and mortality, such as social support/isolation, quality of family relationships, or involvement with formal support service systems.
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Affiliation(s)
- Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA.,Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, New York, USA
| | - David Burnes
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - David Hancock
- Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, New York, USA
| | - John Eckenrode
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Lachs
- Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, New York, USA
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Ayalon L, Keating N, Pillemer K, Rabheru K. Climate Change and Mental Health of Older Persons: A Human Rights Imperative. Am J Geriatr Psychiatry 2021; 29:1038-1040. [PMID: 34294541 DOI: 10.1016/j.jagp.2021.06.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Climate change threatens the basic prerequisites for wellbeing, including clean air and water, food supply and the adequacy and security of shelter. Climate change is a powerful and ongoing presence in the lives of older persons, both creating and exacerbating vulnerabilities. The absence of a legally binding international instrument specifically protecting the human rights of older persons and minimal references to older persons in key international climate instruments attest to the lack of attention to and visibility of older persons in national and international law. There is a need to integrate the areas of older people and environmental sustainability to ensure that the rights of older people are preserved especially now, as the effects of the climate change crisis become more pronounced.
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Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University (LA), Ramat Gan, Israel.
| | - Norah Keating
- Swansea University (NK), Swansea, Wales, UK; North-West University (NK), Vanderbijlpark, South Africa; University of Alberta (NK), Edmonton, Alberta, Canada
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, NY
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Gilligan M, Suitor JJ, Pillemer K. Patterns and Processes of Intergenerational Estrangement: A Qualitative Study of Mother-Adult Child Relationships Across Time. Res Aging 2021; 44:436-447. [PMID: 34551648 DOI: 10.1177/01640275211036966] [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] [Indexed: 11/15/2022]
Abstract
Drawing from the life course perspective, we explored patterns of estrangement between mothers and their adult children across time, and the processes through which these ties remained estranged, or moved in or out of estrangement. We used a prospective design in which data were collected in face-to-face semi-structured interviews with 61 older mothers about their relationships with their 274 adult children at two time points 7 years apart. We began by examining the patterns of stability and change in intergenerational estrangement and identified movement in and out of estrangement across time. Qualitative analyses of the processes underlying estrangement revealed that movement in and out of estrangement reflected nuanced changes in contact and closeness over time rather than abrupt changes resulting from recent transitions in either mothers' or children's lives. Taken together, these findings illustrate the complexity of patterns and processes of intergenerational estrangement in later-life families.
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Affiliation(s)
- Megan Gilligan
- Department of Human Development and Family Studies, Iowa State University, IA, USA
| | - J Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, NY, USA
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Yang Y, Grol-Prokopczyk H, Reid MC, Pillemer K. The Relationship between Pain and Psychological Distress during the COVID-19 Pandemic: Is Social Technology Use Protective? Pain Med 2021; 23:280-287. [PMID: 34480572 PMCID: PMC8499956 DOI: 10.1093/pm/pnab262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/27/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022]
Abstract
Objectives The COVID-19 pandemic and resulting shelter-in-place orders have profoundly changed the everyday social environment. This study examines the relationship between pain and psychological distress (depression, anxiety, and loneliness) among U.S. adults ages 54 and older during the pandemic. We also test whether use of technology for social purposes moderates the association between pain severity and psychological distress. Methods Using cross-sectional data on 1,014 adults ages 54 and older (pain free, n = 637; mild pain, n = 106; moderate pain, n = 227; and severe pain, n = 64) from the 2020 Health and Retirement Study COVID-19 Project (Early, Version 1.0), we conducted regression analyses to test the association between pain severity and psychological outcomes and to assess social technology use frequency as a moderator. Results Compared with their pain-free peers, participants with mild-to-moderate pain reported more depressive symptoms and greater loneliness; those with severe pain reported higher levels of depression, anxiety, and loneliness. Social technology use was associated with lower levels of depression and loneliness. However, interaction analyses show that social technology use predicted an increase in depression for individuals with pain but a decrease in depression among pain-free individuals. For anxiety and loneliness, no significant effects of social technology use were observed. Conclusion Older adults with pain are at high risk of depression, anxiety, and loneliness during the pandemic. Although social technologies have become a common alternative to face-to-face interactions during the COVID-19 crisis, and overall they can provide mental health benefits, our results suggest that social technologies can be detrimental to psychological well-being among people with pain. These findings can inform technology-based interventions aiming to promote well-being among older adults with pain.
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Affiliation(s)
- Yulin Yang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
| | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY.,Department of Human Development, Cornell University, Ithaca, NY
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Pérez-Rojo G, López J, Noriega C, Martínez-Huertas JA, Velasco C, Carretero I, López-Frutos P, Galarraga L, Pillemer K. Older People's Personal Strengths During the First Wave of the COVID-19 Pandemic. Psicothema 2021; 33:423-432. [PMID: 34297672 DOI: 10.7334/psicothema2020.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although several biopsychosocial variables could play an important role as risk and protective factors of mental health, COVID-19 outbreak studies among older people have seldom focused on protective factors. The purpose of this study was to analyze how older adults' personal strengths predict their well-being and emotional distress. METHOD 783 Spanish people aged 60 and over completed a survey that included sociodemographic characteristics, perceived health, direct or indirect infection by COVID-19, resilience, gratitude, experiential avoidance, family functioning, emotional distress and well-being. Structural Equation Modelling (SEM) was performed. SEM invariance was also used to analyze whether there were differences between older people affected by COVID-19 and those not affected. RESULTS The best model supports the mediation effect of resilience, gratitude and experiential avoidance on older people's well-being and emotional distress. Whether participants or relatives had been infected by the virus or not did not affect the results. CONCLUSIONS Variables used as criteria in older adults are related to well-being and emotional distress, but only indirectly and mediated by resilience, gratitude and experiential avoidance. This confirms the importance of considering psychological strengths in older people's well-being. Interventions focused on these personal resources should be considered.
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Abstract
IMPORTANCE Elder mistreatment is associated with major health and psychosocial consequences and is recognized by clinicians, policy makers, and researchers as a pervasive problem affecting a rapidly aging global population. OBJECTIVE To estimate the incidence of elder mistreatment and identify factors associated with the risk of new cases. DESIGN, SETTING, AND PARTICIPANTS This research is a 10-year, longitudinal, population-based, cohort study of the incidence of elder mistreatment in New York State households conducted between 2009 (wave 1) and 2019 (wave 2). At wave 1, random digit-dial (landline and cellular telephones) stratified sampling was done to recruit English-speaking and/or Spanish-speaking, cognitively intact, community-dwelling older adults (aged ≥60 years) across New York State. The current study conducted computer-assisted telephone interviews with older adults who participated in wave 1 and gave permission to be contacted again for wave 2 interviews (response rate, 60.7%). Data analysis was performed from October 2020 to January 2021. EXPOSURES Physical factors (health status, functional capacity, and age), living arrangement (coresidence), and sociocultural characteristics (sex, race/ethnicity, geocultural context, and household income). MAIN OUTCOMES AND MEASURES Ten-year incidence for overall elder mistreatment and subtypes (financial abuse, emotional or psychological abuse, physical abuse, and neglect) were measured using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale, and the New York State Elder Mistreatment Prevalence Study financial abuse tool. RESULTS The analytical sample included 628 older adults (mean [SD] age at wave 1, 69.20 [6.95] years; age at wave 2, 79.40 [6.93] years; 504 non-Hispanic White individuals [80.9%]; 406 women [64.6%]). Ten-year incidence rates were 11.4% (95% CI, 8.8%-14.3%) for overall elder mistreatment, 8.5% (95% CI, 6.3%-10.9%) for financial abuse, 4.1% (95% CI, 2.6%-5.7%) for emotional abuse, 2.3% (95% CI, 1.2%-3.6%) for physical abuse, and 1.0% (95% CI, 0.3%-1.8%) for neglect. Poor self-rated health at wave 1 was associated with increased risk at wave 2 of new overall mistreatment (odds ratio [OR], 2.86; 95% CI, 1.35-5.84), emotional abuse (OR, 3.67; 95% CI, 1.15-11.15), physical abuse (OR, 4.21; 95% CI, 1.14-13.70), and financial abuse (OR, 2.80; 95% CI, 1.16-6.38). Compared with non-Hispanic White participants, Black participants were at heightened risk of overall mistreatment (OR, 2.61; 95% CI, 1.16-5.70) and financial abuse (OR, 2.80; 95% CI, 1.09-6.91). A change from coresidence to living alone was associated with increased risk of financial abuse (OR, 2.74; 95% CI, 1.01-7.21). CONCLUSIONS AND RELEVANCE These findings suggest that health care visits may be important opportunities to detect older adults who are at risk of mistreatment. Race is highlighted as an important social determinant for elder mistreatment requiring urgent attention.
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Affiliation(s)
- David Burnes
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - David W Hancock
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York City, New York
| | - John Eckenrode
- Department of Human Development, Cornell University, Ithaca, New York
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York City, New York
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
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40
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Yang Y, Reid MC, Grol-Prokopczyk H, Pillemer K. Racial-ethnic disparities in pain intensity and interference among middle-aged and older U.S. adults. J Gerontol A Biol Sci Med Sci 2021; 77:e74-e81. [PMID: 34265049 DOI: 10.1093/gerona/glab207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aims to better understand differing pain experiences across U.S. racial/ethnic subgroups by estimating racial-ethnic disparities in both pain intensity and domain-specific pain-related interference. To address this issue, we use a nationally-representative sample of non-Hispanic White, non-Hispanic Black, and Hispanic adults ages 50+ who report recently experiencing pain. METHODS Using data from the 2010 wave of the Health and Retirement Study (HRS; N=684), we conducted a series of multivariate analyses to assess possible racial/ethnic disparities in pain intensity and seven domains of pain interference, controlling for relevant sociodemographic variables and other health problems. RESULTS Black and Hispanic participants reported higher pain intensity than White participants after controlling for socioeconomic status (SES) and other health conditions. Both Black and Hispanic individuals reported more domain-specific pain interference in bivariate analyses. In multivariate analyses, Black (vs. White) participants reported significantly higher levels of pain interference with family-home responsibilities, occupation, sexual behavior, and daily self-care. We did not find significant Hispanic-White differences in the seven pain interference domains, nor did we find Black-White differences in three domains (recreation, social activities, and essential activities). CONCLUSIONS Our findings highlight the need for using multi-dimensional measures of pain when assessing for possible pain disparities with respect to race/ethnicity. Future studies on pain interventions should consider contextualizing the pain experience across different racial subgroups to help pain patients with diverse needs, with the ultimate goal of reducing racial/ethnic disparities in pain.
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Affiliation(s)
- Yulin Yang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY
| | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY.,Department of Human Development, Cornell University, Ithaca, NY
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Kincaid R, Rurka M, Suitor JJ, Gillian M, Pillemer K, Mohebbi L, Mundell N. Prodigal Children: Why Older Mothers Favor Their Once-Deviant Adult Children. J Gerontol B Psychol Sci Soc Sci 2021; 77:1325-1335. [PMID: 33912909 PMCID: PMC9255942 DOI: 10.1093/geronb/gbab075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Past research suggests that adult children who reform their deviant behaviors (i.e., problems with drugs/alcohol or the law) are more likely to become favored by their mothers, yet the reasons underlying this phenomenon are unclear. This study employs a longitudinal, qualitative approach to explore why adult children's behavioral reforms shape changes in maternal favoritism. METHODS Analyses are based on qualitative interview data collected at two points seven years apart from older mothers regarding their adult children in 20 families. Each of these families had a "prodigal child"-a child for whom desistance from deviant behaviors between the two waves was accompanied by newfound maternal favoritism. RESULTS Findings revealed two conditions under which mothers came to favor reformed deviants over their siblings. First, this occurred when adult children's behavioral reformations were accompanied by mothers' perceptions of these children as having grown more family-oriented. Second, this occurred when mothers came to see reformed deviants as exhibiting a stronger need and appreciation for maternal support, relative to their siblings. DISCUSSION Mothers' perceptions of children's behavioral reformations as being accompanied by greater dedication to family or reflecting a need for their mothers' support offer two explanations for why previously deviant adult children may become mothers' favored offspring. These findings contribute to a growing body of scholarship on the complexity of intergenerational relations by shedding new light on changing patterns of favoritism in families with a history of parental disappointment, conflict, and strain.
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Fingerman KL, Pillemer K. Continuity and Changes in Attitudes, Health Care, and Caregiving for Older Adults During the COVID-19 Pandemic. J Gerontol B Psychol Sci Soc Sci 2021; 76:e187-e189. [PMID: 33548128 PMCID: PMC7798481 DOI: 10.1093/geronb/gbaa231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Karen L Fingerman
- Department of Human Development and Family Sciences, The University of Texas at Austin, USA
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA
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Lachs M, Mosqueda L, Rosen T, Pillemer K. Bringing Advances in Elder Abuse Research Methodology and Theory to Evaluation of Interventions. J Appl Gerontol 2021; 40:1437-1446. [PMID: 33586494 PMCID: PMC8362821 DOI: 10.1177/0733464821992182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist. Significant advances have been made in elder abuse research methodology, measurement, justice theory, and other relevant areas, which may remedy this gap. Particular advances include the use of elder abuse severity measures and goal attainment scaling, and the application of restorative justice theory to intervention. Elder abuse research also may benefit from advances in biomedical clinical trial methodology, including characterizing and following up with subjects excluded from trials or those who drop out, estimating numbers needed to treat to assess cost-effectiveness, and a priori stopping rules for when an intervention proves quickly beneficial or harmful. In this article, we argue these advances can and should inform elder abuse intervention research, propose a theoretical framework to guide such efforts, and demonstrate how this framework can inform practice, using elder abuse multidisciplinary teams and nursing home shelters as examples.
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Affiliation(s)
- Mark Lachs
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York City, USA
| | | | - Tony Rosen
- Weill Cornell Medicine/New York-Presbyterian Hospital, New York City, USA
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Rosen T, Bao Y, Zhang Y, Clark S, Wen K, Elman A, Jeng P, Bloemen E, Lindberg D, Krugman R, Campbell J, Bachman R, Fulmer T, Pillemer K, Lachs M. Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case-control study using data linkage and machine learning. BMJ Open 2021; 11:e044768. [PMID: 33550264 PMCID: PMC7925867 DOI: 10.1136/bmjopen-2020-044768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims. METHODS AND ANALYSIS We hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims' healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation. ETHICS AND DISSEMINATION This project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yuhua Bao
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Yiye Zhang
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Katherine Wen
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip Jeng
- Department of Health Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth Bloemen
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard Krugman
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jacquelyn Campbell
- John Hopkins University School of Nursing, John Hopkins University, Baltimore, Maryland, USA
| | - Ronet Bachman
- Department of Criminology, University of Delaware, Newark, Delaware, USA
| | - Terry Fulmer
- John A Hartford Foundation, New York, New York, USA
| | - Karl Pillemer
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Mark Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Pillemer K, Burnes D, MacNeil A. Investigating the connection between ageism and elder mistreatment. Nat Aging 2021; 1:159-164. [PMID: 37118633 PMCID: PMC10687725 DOI: 10.1038/s43587-021-00032-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 04/30/2023]
Abstract
Elder mistreatment is recognized as a pervasive public health problem with detrimental consequences for older adults and society. Although considerable research has examined elder mistreatment risk factors at the individual level, there is a growing call for the field to move beyond proximal causes and consider underlying structural factors that influence elder mistreatment. Illustrating this shift, organizations, advocacy groups and researchers have proposed a connection between ageism and elder mistreatment. However, despite the assertion that ageism is a causal factor for elder mistreatment, there is a scarcity of research to demonstrate this relationship. In this Perspective, we examine the proposed conceptual pathways and limited empirical research connecting ageism and elder mistreatment. After identifying critical gaps in current knowledge, we propose a model that links ageism and elder mistreatment and a research agenda to bring conceptual clarity and empirical evidence to the study of this topic.
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Affiliation(s)
- Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, NY, USA.
- MVR Hall, Cornell University, Ithaca, NY, USA.
| | - David Burnes
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- , Toronto, Ontario, Canada
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- , Toronto, Ontario, Canada
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Breckman R, Burnes D, Ross S, Marshall P, Suitor JJ, Lachs M, Pillemer K. When Helping Hurts: Nonabusing Family, Friends, and Neighbors in the Lives of Elder Mistreatment Victims. Innov Aging 2020. [PMCID: PMC7742954 DOI: 10.1093/geroni/igaa057.2145] [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
Research conducted by the NYC Elder Abuse Center (NYCEAC) at Weill Cornell Medicine and colleagues found that concerned persons experience significant distress knowing about elder abuse and trying to assist victims. Data will be presented from a nationally representative survey which included items on concerned persons in elder abuse. Thirty-one percent of all respondents reported that they had a relative or friend who experienced elder abuse; of these, 61% had attempted to help the victim and over 80% reported the experience is very or extremely stressful (2017). By both knowing about and becoming involved in elder abuse situations, concerned persons experience significant emotional and practical problems and often need professional help. NYCEAC’s Elder Abuse Helpline for Concerned Persons is the first of its kind in the country. The Helpline’s services and structure will be explained, and possibilities for replication in other locations will be explored.
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Affiliation(s)
- Risa Breckman
- Weill Cornell Medicine/ NYC Elder Abuse Center, New York, New York, United States
| | | | - Sarah Ross
- Cornell University, Ithaca, New York, United States
| | - Philip Marshall
- Historic Preservation Program, Roger Williams University, Bristol, Rhode Island, United States
| | - J Jill Suitor
- Purdue University, West Lafayette, Indiana, United States
| | - Mark Lachs
- Weill Cornell Medicine, New York City, New York, United States
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Riffin C, Wolff J, Maisano J, Lee S, Pillemer K. Family Caregiver Assessment in Primary Care: A Nationwide Survey. Innov Aging 2020. [PMCID: PMC7741539 DOI: 10.1093/geroni/igaa057.239] [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
Family caregivers play an important role in the healthcare of older adults, but their circumstances, needs, and risks are often unknown to medical professionals. Standardizing how caregivers’ needs are assessed in healthcare delivery can help clinicians design care plans that take caregivers’ capabilities into account and provide targeted recommendations for caregiver support. Despite the potential of caregiver assessment, little is known about its use in primary care practice. The present study surveyed a national random sample of 1,000 U.S. primary care clinicians (physicians, nurses, social workers) to characterize current practices, barriers, and facilitators of caregiver assessment. A total of 231 completed responses were received. A minority of respondents (11%) reported that their practice or clinic had a standardized procedure for caregiver assessment; one in ten (10%) reported that they had personally conducted a caregiver assessment using a standardized instrument in the past year. The most common barriers to caregiver assessment were lack of time (65%), inability to have private discussions with caregivers (36%), lack of access to referral options (30%), inadequate reimbursement (30%), and reluctance of caregivers to discuss their needs (30%). The most frequently endorsed facilitators to aid future implementation included better availability of referral options (77%), easier referral mechanisms (67%), co-location of mental health specialists, care managers, or social workers (65%), and training in how to address caregiver issues (61%). Findings are discussed within the context of emerging healthcare policies and practice initiatives designed to promote caregiver assessment in health care settings.
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Affiliation(s)
| | - Jennifer Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | | | - Sylvia Lee
- Weill Cornell Medicine, New York, New York, United States
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Falzarano F, Reid MC, Schultz L, Pillemer K. Interpersonal Relationships in Assisted Living: Findings From a Survey of Family Members and Staff. Innov Aging 2020. [PMCID: PMC7740423 DOI: 10.1093/geroni/igaa057.1235] [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
In recent decades, assisted living facilities (ALFs) have grown dramatically as an alternative to nursing homes. Research in nursing homes has shed light on the nature of the relationships that exist between family members and staff. However, little is known about family-staff relations within ALFs. We present data from the first study to describe the prevalence of conflict and positive and negative family-staff interactions in ALFs and to examine whether positive and negative aspects of the relationship contribute to salient staff and family outcomes. We use data collected from 252 family members and 472 staff members across 20 ALFs from the Partners in Care in Assisted Living (PICAL) study. Participants completed measures including interpersonal conflict, depression, perception of treatment, and stress-related to caregiving. Results showed that conflict among family and staff members is relatively low in ALFs. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depression. For families, only gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative has dementia. Despite the relatively harmonious relationships identified among family members and staff in ALFs, sources of conflict and negative interactions were identified, revealing the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts targeting family-staff interactions within ALFs.
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Affiliation(s)
| | - M Cary Reid
- Weill Cornell Medical College, New York City, New York, United States
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Riffin C, Lee S, Reid MC, Herr K, Pillemer K. Caregiver-Provider Communication About Pain in Persons With Dementia. Innov Aging 2020. [PMCID: PMC7740598 DOI: 10.1093/geroni/igaa057.233] [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: 11/29/2022] Open
Abstract
Pain in older persons with dementia (PWD) is severely under-detected and under-managed. Family caregivers can play an important role in addressing these disparities by acquiring the requisite skills to communicate PWD’s pain symptoms and behaviors to health care providers, but little is known about how caregivers of dementia patients and their providers approach such pain-related discussions. We employed qualitative methods to explore the perspectives of family caregivers of PWD (n=18) and health care providers (geriatricians, general internists, neurologists, emergency room physicians) involved in PWD’s treatment (n=16) regarding pain communication. We specifically focused on participants’: 1) priorities and expectations for communicating about pain and dementia, 2) challenges to communicating about pain and dementia, and 3) strategies and recommendations for optimizing communication about pain and dementia. Analyses revealed that caregivers and health care providers expected to receive accurate, detailed information from one another, but uncertainty in both groups around differentiating pain behaviors from dementia symptoms acted as a barrier to effective information exchange. Additional challenges to productive pain-related discussions were identified by caregivers, including provider fatalism and lack of interpersonal skills, and by providers, including patient-caregiver disagreement about pain symptoms and unreliable caregiver reporting. Participants endorsed using practical approaches, such as pain scales and logs, as well as rapport-building strategies, such as affirmation of caregivers’ input, to facilitate collaborative discussions.
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Affiliation(s)
| | - Sylvia Lee
- Weill Cornell Medicine, New York, New York, United States
| | - M Cary Reid
- Weill Cornell Medical College, New York City, New York, United States
| | - Keela Herr
- University of Iowa, Iowa City, Iowa, United States
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50
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Falzarano F, Reid MC, Schultz L, Meador RH, Pillemer K. Getting Along in Assisted Living: Quality of Relationships Between Family Members and Staff. Gerontologist 2020; 60:1445-1455. [PMID: 32614048 PMCID: PMC7681211 DOI: 10.1093/geront/gnaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Assisted living facilities (ALFs) have quickly expanded as an alternative to nursing homes. Research on nursing homes has revealed problems in relationships between family members and staff. However, little is known about these relationships within ALFs. The purpose of the current study was to examine the prevalence of conflict and positive and negative interactions from the perspective of both family members and staff and to examine the effects of positive and negative aspects of the relationship on salient staff and family outcomes in ALFs. RESEARCH DESIGN AND METHODS Data were collected from 252 family members and 472 staff members across 20 ALFs who participated in the Partners in Care in Assisted Living study. Participants completed measures including interpersonal conflict, depressive symptoms, perception of treatment, and stress related to caregiving. RESULTS Conflict among family and staff members was found to be relatively low. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depressive symptoms. For families, only female gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative had dementia. DISCUSSION AND IMPLICATIONS Despite the relatively harmonious relationships among family-staff in ALFs, sources of conflict and negative interactions were identified, revealing the importance of collaborative relationships and the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts to improve family-staff interactions within ALFs.
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Affiliation(s)
- Francesca Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Leslie Schultz
- Bronfenbrenner Center, Cornell University, Ithaca, New York
| | - Rhoda H Meador
- Bronfenbrenner Center, Cornell University, Ithaca, New York
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
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