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Yoo JW, Reed PS, Shen JJ, Carson J, Kang M, Reeves J, Kim Y, Choe I, Kim P, Kim L, Kang HT, Tabrizi M. Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study. Int J Environ Res Public Health 2023; 20:6157. [PMID: 37372743 PMCID: PMC10298291 DOI: 10.3390/ijerph20126157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.
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Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Peter S. Reed
- Sanford Center for Aging, Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
- School of Public Health, University of Nevada, Reno, NV 89557, USA
| | - Jay J. Shen
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA (Y.K.)
| | - Jennifer Carson
- Sanford Center for Aging, Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
- School of Public Health, University of Nevada, Reno, NV 89557, USA
| | - Mingon Kang
- Department of Computer Science, Howard Hughes College of Engineering, University of Nevada, Las Vegas, NV 89154, USA
| | | | - Yonsu Kim
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA (Y.K.)
| | - Ian Choe
- Telehealth Divison, Optum Care Network of Nevada, Las Vegas, NV 89128, USA;
| | - Pearl Kim
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA (Y.K.)
| | - Laurie Kim
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Hee-Taik Kang
- Department of Family Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Maryam Tabrizi
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV 89154, USA
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Yoo JW, Kang HT, Choe I, Kim L, Han DH, Shen JJ, Kim Y, Reed PS, Ioanitoaia-Chaudhry I, Chong MT, Kang M, Reeves J, Tabrizi M. Racial and Ethnic Disparity in 4Ms among Older Adults Among Telehealth Users as Primary Care. Gerontol Geriatr Med 2023; 9:23337214231189053. [PMID: 37529374 PMCID: PMC10387800 DOI: 10.1177/23337214231189053] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Telehealth has been widely accepted as an alternative to in-person primary care. This study examines whether the quality of primary care delivered via telehealth is equitable for older adults across racial and ethnic boundaries in provider-shortage urban settings. The study analyzed documentation of the 4Ms components (What Matters, Mobility, Medication, and Mentation) in relation to self-reported racial and ethnic backgrounds of 254 Medicare Advantage enrollees who used telehealth as their primary care modality in Southern Nevada from July 2021 through June 2022. Results revealed that Asian/Hawaiian/Pacific Islanders had significantly less documentation in What Matters (OR = 0.39, 95%, p = .04) and Blacks had significantly less documentation in Mobility (OR = 0.35, p < .001) compared to their White counterparts. The Hispanic ethnic group had less documentation in What Matters (OR = 0.18, p < .001) compared to non-Hispanic ethnic groups. Our study reveals equipping the geriatrics workforce merely with the 4Ms framework may not be sufficient in mitigating unconscious biases healthcare providers exhibit in the telehealth primary care setting in a provider shortage area, and, by extrapolation, in other care settings across the spectra, whether they be in-person or virtual.
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Affiliation(s)
- Ji Won Yoo
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | | | | | - Laurie Kim
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | | | | | | | | | - Iulia Ioanitoaia-Chaudhry
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Veterans Affairs Southern Nevada Health System, North Las Vegas
| | - Maria Teresa Chong
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
- Veterans Affairs Southern Nevada Health System, North Las Vegas
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Nolan RW, Friedman S, Carson J, Gibb Z, Acklin C, Reed PS. Exploring the Impact of The NEST Collaborative's Remote Social Intervention on Feelings of Depression and Isolation. Gerontol Geriatr Med 2022; 8:23337214221125357. [PMID: 36157521 PMCID: PMC9493711 DOI: 10.1177/23337214221125357] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Early evidence of remote, volunteer-led social support interventions to reduce
social isolation in older adults has been encouraging; however, evaluation data
on outcomes related to social isolation associated from these interventions is
scarce. Here, we share programmatic details of a novel, statewide initiative,
called the NEST Collaborative, rolled out to meet immediate emotional,
informational, and instrumental needs of older adults in Nevada during the
COVID-19 pandemic. The evaluation included 31 older adults participating in
weekly one-to-one empathy-based phone calls with multi-generational volunteers
seeking to enhance participants’ social networks through meaningful friendships.
The calls were associated with programmatically meaningful, though not
statistically significant, improvements in modified Hawthorne Friendship Scale
and PHQ-2 Depression Scale scores over two waves of survey responses. These
results suggest that social isolation and depression among older adults
decreased among our sample over a period of increased isolation and mental
health burden across the general population. With the potential for sustained
impact in reducing social isolation over time, remote social support programs,
such as the NEST Collaborative, may have persistent value long-term, beyond
time-limited crisis response contexts.
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Affiliation(s)
| | | | | | - Zebbedia Gibb
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | | | - Peter S Reed
- University of Nevada, Reno, USA.,University of Nevada, Reno School of Medicine, Reno, NV, USA
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Reed PS, Gibb Z. ELDER CARE COMPLEXITIES AND OUTCOMES: A MANDATE FOR INTERDISCIPLINARY GERIATRIC CLINICAL ASSESSMENT. Innov Aging 2019. [PMCID: PMC6841231 DOI: 10.1093/geroni/igz038.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Interdisciplinary geriatric assessment has long been considered best practice to identify the full range of elder care needs. In 2015, the Sanford Center for Aging launched an interdisciplinary comprehensive geriatric assessment clinic. This team-based assessment includes a geriatrician, social worker and pharmacist meeting together with each client to review all aspects of their health and well-being, resulting in a comprehensive care plan to coordinate care with the client’s primary care provider. To assess this approach, a survey was conducted with 415 randomly-selected clients prior to the clinical visit, with a 6-month follow-up survey completed for 170 clients (41%), gathering data on hospitalizations, long-term care utilization and quality of life. Combining these data with clinical assessment data provides a picture of clinical complexities of elder clients and offers a mandate for comprehensive interdisciplinary care. Baseline data showed 44% hospitalized in the prior year; an average of 4 chronic conditions and 10 medications; 44% with dementia or MCI and 29% with frailty. At 6-months post-assessment, 29% reported being hospitalized, 3.5% reported moving into long-term care, and there was a slight, non-significant decrease in quality of life. These data demonstrate the profound complexities that can be identified and addressed through comprehensive assessment and care, as well as the potential to reduce hospitalizations, enable people to age-in-place and maintain quality of life. Despite the well-documented value of these approaches, Medicare and other payers have not fully embraced the opportunity to achieve these positive outcomes and remain hesitant to adequately fund comprehensive approaches to care.
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Affiliation(s)
- Peter S Reed
- Sanford Center for Aging, University of Nevada Reno School of Medicine, Reno, Nevada, United States
| | - Zebbedia Gibb
- Sanford Center for Aging, University of Nevada Reno School of Medicine, Reno, Nevada, United States
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Anderson LA, Day KL, Beard RL, Reed PS, Wu B. The public's perceptions about cognitive health and Alzheimer's disease among the U.S. population: a national review. Gerontologist 2009; 49 Suppl 1:S3-11. [PMID: 19525214 DOI: 10.1093/geront/gnp088] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The present review assesses the public's perceptions about cognitive health and Alzheimer's disease among adults in the United States. We searched the published literature and Internet, and contacted experts in the field to locate surveys assessing the public's perceptions about cognition. We found 10 eligible surveys and abstracted data concerning the public's knowledge, beliefs, concerns, and sources of information. Most of the surveys were conducted in the 2000s and focused on Alzheimer's disease rather then cognitive health. Based on the findings from the surveys, most adults were found to be aware of Alzheimer's disease but lacked specific information about the disease and its treatments. Most respondents did not perceive themselves as being very knowledgeable about Alzheimer's disease. Although we could classify the findings into several overarching domains, such as knowledge, we found considerable variability among surveys in the questions asked. Additional work is needed to understand the public's perceptions about cognitive health. Moreover, we also lack studies that help us understand perceptions about cognition across diverse demographic and cultural groups. Only by addressing these gaps can we develop targeted and effective strategies to enhance knowledge and beliefs about cognitive impairment and health.
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Affiliation(s)
- Lynda A Anderson
- Healthy Aging Program, Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MSK45, Atlanta, GA 30341, USA.
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Zimmerman S, Williams CS, Reed PS, Boustani M, Preisser JS, Heck E, Sloane PD. Attitudes, stress, and satisfaction of staff who care for residents with dementia. Gerontologist 2006; 45 Spec No 1:96-105. [PMID: 16230756 DOI: 10.1093/geront/45.suppl_1.96] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Considering the increasing proportion of residents in long-term care who have dementia, and the important influence that direct care providers have on resident quality of life, this study explores the dementia-related attitudes of residential care/assisted living (RC/AL) and nursing home staff, as well as their work stress and satisfaction. DESIGN AND METHODS Data were derived from interviews with 154 direct care providers from 31 RC/AL facilities and 10 nursing homes who participated in the Collaborative Studies of Long-Term Care. RESULTS Stress was more often reported by care providers who had been working for 1 to 2 years (compared with longer); in addition, those who had been working for 1 to 2 years were more likely to espouse hopeful or person-centered attitudes than those who had been working for a longer period of time. Also, a person-centered attitude related to satisfaction, and perceived competence in providing dementia care was consistently associated with dementia-sensitive attitudes and job satisfaction. IMPLICATIONS Attending to the welfare and ongoing training of workers who have demonstrated job commitment may lessen their tendency to become jaded over time or seek job opportunities elsewhere. Further, the attitudes the staff hold related to dementia and the training they receive to provide dementia care are important for their own well-being.
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Affiliation(s)
- Sheryl Zimmerman
- Program on Aging, Disability and Long-Term Care, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC27599-7590, USA.
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Zimmerman S, Sloane PD, Williams CS, Reed PS, Preisser JS, Eckert JK, Boustani M, Dobbs D. Dementia care and quality of life in assisted living and nursing homes. Gerontologist 2006; 45 Spec No 1:133-46. [PMID: 16230760 DOI: 10.1093/geront/45.suppl_1.133] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE There are few empirical studies relating components of long-term care to quality of life for residents with dementia. This study relates elements of dementia care in residential care/assisted living (RC/AL) facilities and nursing homes to resident quality of life and considers the guidance this information provides for practice and policy. DESIGN AND METHODS We used a variety of report and observational measures of the structure and process of care and 11 standardized measures of quality of life to evaluate the care for and quality of life of 421 residents with dementia in 35 RC/AL facilities and 10 nursing homes in four states. Data were collected cross sectionally on-site, and we conducted a 6-month follow-up by telephone. RESULTS Change in quality of life was better in facilities that used a specialized worker approach, trained more staff in more domains central to dementia care, and encouraged activity participation. Residents perceived their quality of life as better when staff was more involved in care planning and when staff attitudes were more favorable. Better resident-staff communication was related to higher quality of life as observed and reported by care providers. Also, more stable resident-staff assignment was related to care providers' lower quality-of-life ratings. IMPLICATIONS Improvement in resident quality of life may be achieved by improved training and deployment of staff.
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Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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Boustani M, Zimmerman S, Williams CS, Gruber-Baldini AL, Watson L, Reed PS, Sloane PD. Characteristics Associated With Behavioral Symptoms Related to Dementia in Long-Term Care Residents. The Gerontologist 2005; 45 Spec No 1:56-61. [PMID: 16230750 DOI: 10.1093/geront/45.suppl_1.56] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This article describes care for behavioral symptoms related to dementia (BSRD) and identifies their potential correlates among 347 residents with dementia living in 45 assisted living facilities and nursing homes from four states. The prevalence of BSRD was associated with staff training and resident cognition, mood, mobility, and psychotropic use. Attention to staff training and depression management might improve BSRD.
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Affiliation(s)
- Malaz Boustani
- Regenstrief Institute, Inc., and Indiana University Center for Aging Research, Indianapolis, IN 46202-2872, USA.
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Williams SW, Williams CS, Zimmerman S, Sloane PD, Preisser JS, Boustani M, Reed PS. Characteristics Associated With Mobility Limitation in Long-Term Care Residents With Dementia. The Gerontologist 2005; 45 Spec No 1:62-7. [PMID: 16230751 DOI: 10.1093/geront/45.suppl_1.62] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article describes the prevalence, assessment, and treatment of, as well as characteristics associated with, mobility limitation in 343 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 89% of residents had some degree of mobility limitation. Mobility limitation was associated with fewer behavioral symptoms, low fluid intake, professional assessment, and professional and informal treatment.
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Affiliation(s)
- Sharon Wallace Williams
- Department of Allied Health Sciences, Division of Speech and Hearing Sciences; Wing D Medical School, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7190, USA.
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Abstract
This article describes the prevalence, assessment, and treatment of pain, as well as characteristics associated with pain, in 331 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 21% of residents had pain, and pain was more commonly reported in for-profit facilities, and for those receiving professional assessment and treatment.
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Affiliation(s)
- Christianna S Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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Sloane PD, Zimmerman S, Williams CS, Reed PS, Gill KS, Preisser JS. Evaluating the Quality of Life of Long-Term Care Residents With Dementia. The Gerontologist 2005; 45 Spec No 1:37-49. [PMID: 16230748 DOI: 10.1093/geront/45.suppl_1.37] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study's purpose was to better understand existing measures of quality of life in dementia residents of long-term care facilities. DESIGN AND METHODS We gathered data from 421 residents in 45 facilities. Analyses determined the psychometric properties of each measure, estimated the relationship between measures, and identified the extent to which resident characteristics predicted scores. RESULTS Most instruments had good to excellent dispersion and interrater reliability, and most scales had good to excellent internal consistency. Proxy measures tended to correlate best with each other, less well with observational measures, and least well with resident measures. Resident cognition and activities of daily living (ADLs) function were associated with most quality-of-life measures but predicted no more than a quarter of the observed variance in any measure. IMPLICATIONS Various measures and sources of data provide different perspectives on quality of life. No "gold standard" exists; so a combination of methods and sources is likely to provide the most complete picture of quality of life.
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Affiliation(s)
- Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, Department of Family Medicine, University of North Carolina Chapel Hill, NC 27599-7595, USA.
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Gruber-Baldini AL, Zimmerman S, Boustani M, Watson LC, Williams CS, Reed PS. Characteristics Associated With Depression in Long-Term Care Residents With Dementia. The Gerontologist 2005; 45 Spec No 1:50-5. [PMID: 16230749 DOI: 10.1093/geront/45.suppl_1.50] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe the prevalence, assessment, and treatment of, as well as characteristics associated with, depression in residential care/assisted living and nursing home residents with dementia. Overall, 25% of the participants were depressed. Depression was related to severe cognitive impairment, behavioral symptoms, pain, and for-profit nursing home residence.
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Affiliation(s)
- Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology & Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Dobbs D, Munn J, Zimmerman S, Boustani M, Williams CS, Sloane PD, Reed PS. Characteristics Associated With Lower Activity Involvement in Long-Term Care Residents With Dementia. The Gerontologist 2005; 45 Spec No 1:81-6. [PMID: 16230754 DOI: 10.1093/geront/45.suppl_1.81] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article describes the characteristics associated with activity involvement in 400 residents with dementia in 45 assisted living facilities and nursing homes. Activity involvement was related to family involvement in care and staff encouragement, after adjusting for resident age, gender, race, cognitive and functional status, and comorbidity.
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Affiliation(s)
- Debra Dobbs
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
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Reed PS, Zimmerman S, Sloane PD, Williams CS, Boustani M. Characteristics Associated With Low Food and Fluid Intake in Long-Term Care Residents With Dementia. The Gerontologist 2005; 45 Spec No 1:74-80. [PMID: 16230753 DOI: 10.1093/geront/45.suppl_1.74] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article describes the prevalence, assessment, and treatment of, as well as characteristics associated with, the food and fluid intake of 407 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 54% of observed residents had low food intake, and 51% had low fluid intake. Staff monitoring of residents, having meals in a public dining area, and the presence of noninstitutional features were each associated with higher food and fluid intake.
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Affiliation(s)
- Peter S Reed
- Alzheimer's Association, National Office, Chicago, IL 60601, USA.
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Reed PS, Foley KL, Hatch J, Mutran EJ. Recruitment of older African Americans for survey research: a process evaluation of the community and church-based strategy in The Durham Elders Project. Gerontologist 2003; 43:52-61. [PMID: 12604746 DOI: 10.1093/geront/43.1.52] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The disproportionately high burden of morbidity and mortality among older African Americans is due, in part, to a lack of understanding of the factors contributing to these outcomes. In order to more fully understand the factors that contribute to African American morbidity and mortality, researchers must identify strategies for increasing the inclusion of older African Americans in research on social and health phenomena. DESIGN AND METHODS This article is a process evaluation describing the successes and challenges associated with recruitment of older African Americans into research. It considers an effort to nurture collaboration between university and community institutions to both facilitate research endeavors and offer meaningful and culturally-appropriate contributions to the community. RESULTS The primary challenges discovered in this observational process evaluation of a church-based recruitment strategy include the effective coordination of a community research advisory board, ensuring participant autonomy, and reducing concerns of exploitation among potential participants. IMPLICATIONS A strategy of coordinating a community research advisory board to incorporate the views of community members and to drive a church-based recruitment procedure provides a starting point for tapping into an immensely important segment of society historically ignored by the research community.
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Affiliation(s)
- Peter S Reed
- Center on Minority Aging, Institute on Aging, School of Public Health, University of North Carolina at Chapel Hill, 27599, USA.
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Abstract
This manuscript examines the measurement adequacy of the CES-D when applied in older African-Americans (n=227). The response distribution was skewed towards less symptomatology on all items, and the internal consistency of the CES-D was acceptable (alpha=0.86). An exploratory factor analysis revealed four underlying factors of depressive symptomatology: (1) depressive/somatic; (2) positive; (3) interpersonal; and (4) social well-being. The primary factor was a combination of depression and somatic symptoms, a commonly reported uni-dimensional factor among ethnic groups. Additionally, a fourth factor emerged that has not previously been identified, labeled 'social well-being'. This factor consisted of three items that may tap into the social interactions of the elderly: appetite, hopeful, and talk. These findings contribute to the growing body of evidence on the unique measurement properties of the CES-D across diverse populations.
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Affiliation(s)
- Kristie Long Foley
- Department of Public Health Sciences, Wake Forest University School of Medicine, Piedmont Plaza II, Suite 512, Winston-Salem, NC 27157, USA.
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Affiliation(s)
- B A Franklin
- Department of Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan
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