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Bender AA, Pier E, Moore M, Jungerman J, Davis A, Perkins MM. Barriers to Community Service Use Among Persons With Dementia and Their Care Partners: A Focus on Consumers of a Novel Statewide Dementia Care Program. J Appl Gerontol 2024; 43:612-622. [PMID: 38171532 DOI: 10.1177/07334648231223295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Although the importance of access to, and utilization of, home and community-based services (HCBS) is a well-documented aspect of informal care and the ability to age in place among people living with dementia, these resources are underutilized, especially in the initial stages of the disease. In 2017, the Georgia Memory Net was established as a novel private-public partnership to extend dementia screening, diagnosis, care planning, and direct HCBS connections for people with memory concerns throughout the State of Georgia. We aimed to identify barriers and facilitators to HCBS utilization following a dementia diagnosis and subsequent referral for services. Data were collected through in-depth interviews with 7 Georgia Memory Net patients and 19 care partners (unconnected dyads) and analyzed using thematic analysis. We found that even with a direct handoff, many people do not use HCBS and face barriers to accessing services. We offer several recommendations based on these findings.
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Affiliation(s)
| | - Ellyn Pier
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | | | | | - Molly M Perkins
- Emory University, Atlanta, GA, USA
- Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center, Atlanta, GA, USA
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2
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Bunker JN, Hilgeman MM, McCreedy E, Gadbois E, Thomas KS. Evaluating the Implementation Fidelity of a Pilot Pragmatic Randomized Clinical Trial Comparing Daily-Delivered Meals to Mailed Frozen Meals. J Appl Gerontol 2024:7334648241248269. [PMID: 38686741 DOI: 10.1177/07334648241248269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
In pragmatic clinical trials (PCTs), the intervention is carried out by participating sites instead of research staff. In this paper, we evaluate study sites' implementation adherence during a pilot PCT of home-delivered meals for older adults with dementia. Participants at three home-delivered meal programs were randomized to receive either (1) meals delivered daily or (2) frozen meals mailed every two weeks; participants' outcomes were tracked for six months. Using the adherence domains from the Framework for Implementation Fidelity, we identified six metrics to assess adherence, with a total possible adherence score ranging from 6 (low adherence) to 18 (high adherence); all three sites scored within the top quartile of adherence. Despite challenges to meal delivery during the COVID-19 pandemic, sites successfully implemented the intervention, justifying a follow-on PCT to test the comparative effectiveness of models of meal delivery on the time to nursing home placement for people living with dementia.
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Affiliation(s)
| | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- The University of Alabama, Tuscaloosa, AL, USA
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ellen McCreedy
- Brown University School of Public Health, Providence, RI, USA
| | - Emily Gadbois
- Brown University School of Public Health, Providence, RI, USA
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3
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Siminoff LA, Wilson-Genderson M, Chwistek M, Thomson M. The cancer caregiving burden trajectory over time: varying experiences of perceived versus objectively measured burden. Oncologist 2024:oyae069. [PMID: 38652165 DOI: 10.1093/oncolo/oyae069] [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: 11/08/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The objective of this study was to comprehensively understand the burden experienced by caregivers (CGs) providing home-based, end-of-life care to patients with cancer. We examined the relationship between objective and subjective burden including whether and how burden changes over time. METHODS A case series of terminal cancer patient-caregiver dyads (n = 223) were recruited from oncology clinics and followed for 12 months or until patient death. Data were collected every other week and in-person from CGs in their homes using quantitative surveys, diaries, and monthly structured observations. RESULTS Bivariate correlations revealed a significant association between subjective burden and activities of daily living (ADLs), instrumental activities of daily living (IADL), high-intensity tasks, and time spent on ADLs; these correlations varied over time. Models examining the slope of subjective burden revealed little systematic change; spouse caregiver and patient functional limitations were positively, and Black caregiver was negatively associated with subjective burden. Generally, the slopes for measures of objective burden were significant and positive. Models showed subjective burden was positively associated with most measures of objective burden both within caregiver (concurrent measures were positively associated) and between CGs (those with higher subjective also had higher objective). CONCLUSIONS Cancer caregiving is dynamic; CGs must adjust to the progression of the patient's disease. We found an association between subjective and objective burden both within and between CGs. Black CGs were more likely to report lower subjective burden compared to their White counterparts. More detailed investigation of the sociocultural components that affect caregiver experience of burden is needed to better understand how and where to best intervene with targeted supportive care services.
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Affiliation(s)
- Laura A Siminoff
- College of Public Health, Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Maureen Wilson-Genderson
- College of Public Health, Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Marcin Chwistek
- Fox Chase Cancer Center/Temple University Health, Philadelphia, PA, United States
| | - Maria Thomson
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
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Wang S, Temkin-Greener H, Simning A, Konetzka RT, Cai S. Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services. J Appl Gerontol 2024:7334648241242942. [PMID: 38581163 DOI: 10.1177/07334648241242942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180 days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30 days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.
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Affiliation(s)
- Sijiu Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Adam Simning
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Shubing Cai
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Beauregard LK, Miller EA. A Comparative Analysis of State Implementation of the Community First Choice Program. J Appl Gerontol 2022; 41:2140-2147. [PMID: 35658730 DOI: 10.1177/07334648221107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Patient Protection and Affordable Care Act included Community First Choice (CFC), a new optional Medicaid home and community-based services (HCBS) state plan benefit which states could adopt. Through the CFC program, states can provide expanded home and community-based attendant services and supports to older adults and persons with disabilities. A benefit of CFC is that states receive a higher federal match rate than other HCBS programs. Thus far, eights states have adopted CFC. This comparative case study analysis examines state-level implementation of CFC to identify what facilitated implementation and what created challenges. The results suggest that consulting with the Centers for Medicare and Medicaid Services facilitated implementation while existing programs, insufficient engagement with stakeholders, aggressive timelines, and limited staff resources presented challenges. Based on these findings, states may want to consider how they approach implementing expansions or enhancements to HCBS benefits under the American Rescue Plan Act.
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Affiliation(s)
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
- Department of Health Services Policy & Practice and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
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Geeraedts F, Luttje M, Visschedijk J, van Hattem M, Hasper HJ, Kohnen R, Loman R, de Goede R, Jansen D, Hess D, Al Naiemi N. Low-Threshold Testing for SARS-CoV-2 (COVID-19) in Long-Term Care Facilities Early in the First Pandemic Wave, the Twente Region, the Netherlands: A Possible Factor in Reducing Morbidity and Mortality. J Appl Gerontol 2022; 41:1802-1811. [PMID: 35543170 PMCID: PMC9127376 DOI: 10.1177/07334648221093050] [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] [Indexed: 01/08/2023] Open
Abstract
During the first wave of the COVID-19 pandemic, there was a shortage of
SARS-CoV-2 diagnostic tests, and testing patients with mild symptoms
(low-threshold testing) was not recommended in the Netherlands. Despite these
guidelines, to protect those who were most at risk, low-threshold testing was
advocated and offered to the majority of long-term care institutions in the
Twente region. In this manner, 144 healthcare workers and
96 residents tested SARS-CoV-2-positive and were isolated before the same
service was provided nationwide by public health services. Strikingly, excess
mortality rate in the Twente region 1 month after the
introduction of this strategy was found to be 62%–89% lower than that in
neighboring regions, which may be explained by this divergent testing strategy.
In an emerging pandemic, early implementation of a liberal testing policy may be
more effective than restricted testing in settings with a high death rate.
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Affiliation(s)
- Felix Geeraedts
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
| | - Mariska Luttje
- Carintreggeland Nursing Homes and Home Care, Hengelo, the Netherlands
| | - Jan Visschedijk
- Carintreggeland Nursing Homes and Home Care, Hengelo, the Netherlands
| | | | - Henk-Jan Hasper
- Trivium Meulenbelt Zorg Nursing Homes and Home Care, Almelo, the Netherlands
| | - Roy Kohnen
- Livio Nursing Homes and Home Care, Enschede, the Netherlands
| | - Rene Loman
- Zorggroep Sint Maarten Nursing Homes and Home Care, Denekamp, the Netherlands
| | - Rudi de Goede
- Liberein Nursing Homes and Home Care, Enschede, the Netherlands
| | - Desiré Jansen
- De Posten Nursing Homes and Home Care, Enschede, the Netherlands
| | - Dorine Hess
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
| | - Nashwan Al Naiemi
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
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Koumoutzis A, Heston-Mullins J, Mayberry PS, Applebaum R. If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community. J Appl Gerontol 2022; 41:1860-1869. [PMID: 35506658 DOI: 10.1177/07334648221090945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Some communities across the nation are utilizing alternative funding sources to better support home and community-based services for older adults. METHODS A variety of methods identified local initiatives across the United States. An online survey was distributed to a total of 377 communities in 15 states identified as using locally raised funds to provide aging services, yielding a 55% response rate. RESULTS Total funding from programs generated almost 400 million dollars annually with funding ranging from $8000-$47 million. Commonly provided services with local funds include home-delivered and congregate meals, transportation, and homemaker services with provision varying by the size of the levy initiative. Additionally, six in 10 initiatives reported local funds being used to provide at least one family or friend caregiver service. CONCLUSION Locally-funded initiatives fill a gap in long-term services needs for older adults, yet policy concerns regarding potential inequities across states and communities warrant attention.
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Affiliation(s)
- Athena Koumoutzis
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | | | | | - Robert Applebaum
- Department of Sociology and Gerontology, Scripps Gerontology Center, Miami University, Oxford, OH, USA
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Sheth K, Ritter PL, Lorig K, Steinman L, FallCreek S. Remote Delivery of the Chronic Pain Self-management Program Using Self-directed Materials and Small-group Telephone Support: A Pilot Study. J Appl Gerontol 2021; 41:1329-1335. [PMID: 34965766 DOI: 10.1177/07334648211062805] [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: 01/02/2023] Open
Abstract
A remote (telephone and tool kit) chronic pain program was studied using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. This 6-week pilot took place in underserved communities in Cleveland, Ohio. We determined reach by the diversity of the population, nearly 50% Black and mostly low income. Effectiveness over 7 weeks was shown with validated instruments (depression, pain, sleep, quality of life, self-rated health, and self-efficacy). Changes in pain, depression, and self-efficacy were significant. (p < .01). Remote implementation was accomplished by sending participants a box of materials (book, exercise and relaxation CDs, a self-test, and tip sheets). Participants also participated in peer-facilitated, weekly, scripted telephone calls. Maintenance was demonstrated as the study site has offered nine additional programs with more plan. In addition, 60 additional organizations are now offering the program. This proof-of-concept study offers an alternate to in-person chronic pain self-management program delivery.
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Affiliation(s)
- Khushboo Sheth
- Division of Immunology and Rheumatology, Department of Medicine, 6429Stanford University, Stanford, CA, USA.,19977VA Palo Alto Health Care System, Palo Alto, CA, USA.,Chinook Therapeutics, Seattle, WA, USA
| | - Philip L Ritter
- Division of Immunology and Rheumatology, Department of Medicine, 6429Stanford University, Stanford, CA, USA
| | - Kate Lorig
- Division of Immunology and Rheumatology, Department of Medicine, 6429Stanford University, Stanford, CA, USA
| | - Lesley Steinman
- Health Promotion Research Center, Department of Health Services, 7284University of Washington, Seattle, WA, USA
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Lendon JP, Rome V, Sengupta M. Variations Between Adult Day Services Centers in the United States by the Racial and Ethnic Case-Mix of Center Participants. J Appl Gerontol 2021; 40:1029-1038. [PMID: 32613885 PMCID: PMC7775908 DOI: 10.1177/0733464820934996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers' survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.
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Affiliation(s)
| | - Vincent Rome
- Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - Manisha Sengupta
- Centers for Disease Control and Prevention, Hyattsville, MD, USA
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Abstract
OBJECTIVE The number of homebound older adults is increasing in the United States. We aimed to examine their social and lived experiences and to understand their perspectives on their situation, feelings, and coping mechanisms. METHODS We conducted a cross-sectional qualitative study using semi-structured interviews with 18 older homebound individuals in Central Virginia. RESULTS Homebound older adults experienced both physical and mental health challenges that restricted their ability to participate in activities of daily living, recreation, and social interactions. Participants often felt dependent, helpless, lonely, and socially isolated. Those who communicated regularly with friends, family, and health care providers reported positive benefits from these interactions. DISCUSSION Participants faced challenges to their physical, emotional, and mental well-being. Our findings might help clinicians, policymakers, and community organizations understand how to better support homebound older adults. We should provide educational opportunities, respect their autonomy, and implement initiatives to address their isolation and loneliness.
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Affiliation(s)
- Joyce M Cheng
- University of Virginia, Charlottesville, USA.,Johns Hopkins University, Baltimore, MD, USA
| | | | - Nengliang Aaron Yao
- University of Virginia, Charlottesville, USA.,Home Centered Care Institute, Schaumburg, IL, USA.,Shandong University, Jinan, China
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11
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Motta-Ochoa R, Leibing A, Bresba P, Williams M, Shaffer S, Julien O, Racine E, Blain-Moraes S. "You're Part of Us and We're Happy to Have You Here": Practices of Social Inclusion for Persons with Dementia. Clin Gerontol 2021; 44:470-481. [PMID: 33662221 DOI: 10.1080/07317115.2021.1891170] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Practices of social inclusion are important for maintaining the relationships of persons with dementia and are associated with positive clinical outcomes. The objective of this study was to explore the in-action practices of social inclusion in the activity center of a community-based organization.Methods: This study applies an ethnographic approach - including participant observation, informal and semi-structured interviews - with persons with dementia (n = 31) and organization staff members (n = 9) to explore the in-action practices of social inclusion.Results: Seven in-action practices of inclusion were identified: ensuring time for individual relationships, building schedules centered around flexibility, empowering decision-making, normalizing dementia-related behaviors, involving family members, soliciting and integrating persons with dementia's feedback, and supporting persons with dementia to practice social inclusion.Conclusions: Care providers of individuals with dementia can effectively facilitate active connections with them by continually soliciting and incorporating their feedback, and by supporting persons with dementia to practice inclusion and care for others.Clinical Implications: Community-based organizations can be effective at supporting the active connection of individuals with dementia with others and should be promoted for individuals with mild to moderate dementia.
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Affiliation(s)
- Rossio Motta-Ochoa
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Canada
| | - Annette Leibing
- Faculté Des Sciences Infirmières, Université De Montréal, Montreal, Canada
| | | | | | | | | | - Eric Racine
- Pragmatic Health Ethics, Institut De Recherche Cliniques De Montréal, Montreal, Canada
| | - Stefanie Blain-Moraes
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Biosignal Interaction and Personhood Technology (BIAPT) Lab, Montreal General Hospital, Montreal, Canada
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12
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Reckrey JM, Boerner K, Franzosa E, Bollens-Lund E, Ornstein KA. Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit? Clin Ther 2021; 43:930-941. [PMID: 33972126 DOI: 10.1016/j.clinthera.2021.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/08/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience. METHODS Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving). FINDINGS About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33). IMPLICATIONS The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.
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Affiliation(s)
- Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA
| | - Emily Franzosa
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, New York, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Abstract
Despite high-intensity caregiving support, those with dementia may experience adverse consequences because the care they receive does not match their care needs. This study evaluates the relationship between content of care (i.e., specific assistance with toileting) and adverse consequences (i.e., toileting accidents because no one was there to help) in a population of community-dwelling Medicare beneficiaries with dementia and impairment in toileting enrolled in the National Health and Aging Trends Study (NHATS). Only two thirds of individuals received specific assistance with toileting, which was associated with a reduced risk of adverse consequences related to toileting in a multivariable model adjusted for key variables including high-intensity caregiving (odds ratio [OR] = 0.36, 95% confidence interval [CI] = [0.23, 0.58]). To ensure care meets the needs of those with dementia living in the community, it is important to consider not only the quantity but also the content of care received.
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Igarashi A, Matsumoto H, Takaoka M, Kugai H, Suzuki M, Yamamoto-Mitani N. Educational Program for Promoting Collaboration Between Community Care Professionals and Convenience Stores. J Appl Gerontol 2019; 39:760-769. [PMID: 31478434 DOI: 10.1177/0733464819871878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Convenience stores play an important role in supporting community-dwelling older adults' lives. This study aimed to describe the development of and to evaluate an educational program to promote collaboration between communities and convenience stores in Japan. We developed the educational program based on interviews of convenience store staff to encourage them to collaborate with health/social care professionals for helping older adults. We conducted pre- and post-program questionnaire surveys of 184 participants to evaluate the program. After the program, the total score for attitudes toward dementia (p = .010) improved significantly among the convenience store staff. On the contrary, the score for "solidarity and proactiveness," a subscale for sense of community, improved significantly among health/social care professionals (p = .003). This educational program can have a significant effect on the perceptions and attitudes for supporting older adults, depending on the participants' occupations. This educational program could foster community networks, leading to an age-friendly community.
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15
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Conrad KJ, Liu PJ, Iris M. Examining the Role of Substance Abuse in Elder Mistreatment: Results From Mistreatment Investigations. J Interpers Violence 2019; 34:366-391. [PMID: 27044491 DOI: 10.1177/0886260516640782] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected on 948 cases with yes/no substantiation decisions where 357 cases had no abuse in elder mistreatment investigations. Hypotheses were tested using odds ratios, bivariate, and multiple linear regression analyses including a control for victim vulnerability. Of 948 alleged victims, 42 (4.4%) exhibited signs of substance use problems. Among the 323 alleged perpetrators, 87 (26.9%) were reported to have substance use problems. Substance use problems by alleged perpetrators were associated ( p < .01) with financial exploitation, physical abuse, and emotional abuse but not neglect. Substance use problems by alleged victims were associated with neglect, but not the other types. Alleged perpetrators with substance use problems tended to commit multiple forms of abuse, were male and not caregivers. Except for the findings on neglect, the associations with elder mistreatment were stronger for alleged perpetrators with substance use problems, than for alleged victims. Clarification of the role of perpetrator risk factors such as substance abuse should improve risk identification and subsequent intervention.
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Affiliation(s)
- Kendon J Conrad
- 1 University of Illinois at Chicago, IL, USA
- 2 Chestnut Health Systems, Normal, IL, USA
| | - Pi-Ju Liu
- 3 University of California, San Francisco, CA, USA
| | - Madelyn Iris
- 4 Leonard Schanfield Research Institute, Chicago, IL, USA
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