1
|
Phillips OW, Kunicki Z, Jones R, Belanger E, Shireman TI, Friedman JH, Kim DS, Kluger B, Akbar U. Inpatient Mortality in Parkinson's Disease. Neurohospitalist 2023; 13:144-152. [PMID: 37064936 PMCID: PMC10091425 DOI: 10.1177/19418744231153477] [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: 04/07/2023] Open
Abstract
Introduction Although a majority of the American public prefer to die at home, a large percentage of Parkinson's disease patients die in acute care hospitals. We examine trends in the clinical and demographic characteristics of Parkinson's disease patients who die in a hospital to identify populations potentially vulnerable to unwanted inpatient mortality. Methods Patients with Parkinson's disease admitted to a hospital from 2002-2016 were identified from the National Inpatient Sample (n = 710,013) along with their associated clinical and demographic characteristics. The main outcome examined was mortality during inpatient admission. From these data, logistic regression models were estimated to obtain the odds ratios of inpatient mortality among clinical and demographic attributes, and their change over time. Results Characteristics significantly associated with increased odds of inpatient mortality included increased age (OR = 1.70 for 55-65, 2.52 for 66-75, 3.99 for 76-85, 5.72 for 86+, all P < 0.001), length of stay ≤5 days (reference; 6 + days OR = 0.37, P < 0.001), white race or ethnicity (reference; Black OR = .84 P < .001, Hispanic OR = 0.91 P = 0.01), male (reference; female OR = 0.93 P < 0.001), hospitalization in Northeast (reference; Midwest OR = 0.78, South 0.84, West OR = 0.82; all P < 0.001), higher severity of illness (moderate OR = 1.50, major OR = 2.32, extreme OR = 5.57; all P < 0.001), and mortality risk (moderate OR = 2.88, major OR = 10.92, extreme OR = 52.30; all P < 0.001). Fitted probabilities overall declined over time. Conclusion Differences exist among PD patient populations regarding likelihood of in-hospital mortality that are changing with time. Insight into which PD patients are most at risk for inpatient mortality may enable clinicians to better meet end-of-life care needs.
Collapse
Affiliation(s)
- Oliver W. Phillips
- Cleveland Clinic Center for
Neurological Restoration, Cleveland, OH, USA
| | - Zachary Kunicki
- Department of Psychiatry and Human
Behavior, Brown University, Providence, RI, USA
| | - Richard Jones
- Department of Psychiatry and Human
Behavior, Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services,
Policy and Practice, Center for Gerontology and Health Care Research, Brown University, Providence, RI, USA
| | - Theresa I. Shireman
- Department of Health Services,
Policy and Practice, Center for Gerontology and Health Care Research, Brown University, Providence, RI, USA
| | | | - Duk Soo Kim
- Department of Neurology, Brown University, Providence, RI, USA
| | - Benzi Kluger
- Department of Neurology, University of Rochester Medical
Center, Rochester, NY, USA
| | - Umer Akbar
- Department of Neurology, Brown University, Providence, RI, USA
| |
Collapse
|
2
|
Braun TD, Olson K, Panza E, Lillis J, Schumacher L, Abrantes AM, Kunicki Z, Unick JL. Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention. Obes Sci Pract 2022; 8:816-827. [PMID: 36483124 PMCID: PMC9722463 DOI: 10.1002/osp4.616] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control. Methods Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up). Results Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON. Conclusion Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.
Collapse
Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Kayloni Olson
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Emily Panza
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Jason Lillis
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Leah Schumacher
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Ana M. Abrantes
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Zachary Kunicki
- Quantitative Sciences ProgramBrown UniversityProvidenceRIUSA
| | - Jessica L. Unick
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| |
Collapse
|
3
|
Kunicki Z, Jones R. Prevalence of Binge Drinking by Caregivers of Persons with Alzheimer’s Disease or Related Dementia. Innov Aging 2021. [PMCID: PMC8681388 DOI: 10.1093/geroni/igab046.2985] [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: 11/19/2022] Open
Abstract
Some caregivers of persons with Alzheimer’s Disease and related dementias (ADRD) are known to be under high levels of burden, which is associated with higher levels of anxiety, depression, and stress. Previous research has established anxiety, depression, and stress are associated with binge drinking, but little research has examined binge drinking rates among ADRD caregivers. Binge drinking could influence the ability of ADRD caregivers to provide care. The purpose of this study was to explore the prevalence and prevalence correlates of binge drinking among ADRD caregivers using the 2019 Behavior Risk Factor Surveillance Survey (BRFSS). We identified N = 1,642 persons who were the primary informal caregivers of a person with ADRD. Among them, the prevalence of binge drinking was 14 per 100 persons. Bivariable analyses suggested male caregivers and caregivers with 14 or more days of poor mental health in the past 30 days had the highest prevalence of binge drinking at 18 per 100 persons. Caregivers who were 65 or older or had the lowest prevalence at 3 per 100 persons. Caregiving characteristics revealed providing 20 to 39 hours of care per week had the highest prevalence of binge drinking (17 per 100) whereas spousal caregivers (9 per 100) had the lowest prevalence. Smoking status and hours per week providing care were associated with higher odds of binge drinking in multivariable analyses. Future research should examine if binge drinking by ADRD caregivers is related caregiver burden and the quality of care provided to the persons with ADRD.
Collapse
Affiliation(s)
| | - Richard Jones
- Brown University, Providence, Rhode Island, United States
| |
Collapse
|
4
|
Abrantes AM, Kunicki Z, Braun T, Miranda R, Blevins CE, Brick L, Thomas G, Marsh E, Feltus S, Stein MD. Daily associations between alcohol and sweets craving and consumption in early AUD recovery: Results from an ecological momentary assessment study. J Subst Abuse Treat 2021; 132:108614. [PMID: 34493429 DOI: 10.1016/j.jsat.2021.108614] [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: 02/22/2021] [Revised: 07/24/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Alcohol cravings can predict relapse in persons with alcohol use disorder (AUD). Consuming sweets is a commonly recommend strategy to quell alcohol cravings in early recovery from AUD, yet research is equivocal on whether consuming sweets mitigates alcohol cravings or relapse risk. The current study used ecological momentary assessment (EMA) data to examine real-time alcohol cravings, sweet cravings, and consumption of sweets among adults in early recovery from AUD. METHODS We used EMA methods to follow 25 adults (n = 14 women, 56%; M. age 40, S.D. 10.68) recently discharged from a partial hospitalization program for AUD for 21 days. Prompts were sent to the participants for completion four times per day via a mobile app. EMA data were disaggregated prior to analysis to examine between- and within-person effects. A series of three mixed linear models tested: 1) the contemporaneous effect of sweet and alcohol cravings, 2) alcohol cravings predicting sweet consumption later in the day, and 3) sweet consumption predicting alcohol craving later in the day. RESULTS The results of the first model revealed alcohol cravings were associated with sweet cravings early in recovery. In the second model, no effect occurred between alcohol cravings earlier in the day predicting sweet consumption later in the day. The third model suggested consuming sweets earlier in the day predicted higher alcohol cravings later in the day. DISCUSSION Sweet craving and consumption are associated with alcohol cravings among adults in early recovery from AUD. These findings suggest consuming sweets may increase alcohol cravings. If future studies can replicate this result, consuming sweets in early recovery may emerge as a potential risk for relapse in this population.
Collapse
Affiliation(s)
- Ana M Abrantes
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America.
| | - Zachary Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Tosca Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America; Centers for Diabetes and Weight Control, The Miriam Hospital, Providence, RI, United States of America
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America; Centers for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Claire E Blevins
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Leslie Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America; Centers for Diabetes and Weight Control, The Miriam Hospital, Providence, RI, United States of America
| | - Eliza Marsh
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, United States of America
| | - Sage Feltus
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, United States of America
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, United States of America; Department of Health Law, Policy, and Management, Boston University School of Public Health, United States of America
| |
Collapse
|
5
|
Cohen S, Kunicki Z, Drohan M, Greaney M. Exploration of COVID-19-Based Changes to Caregiver Burden and Caregiving Intensity among Informal Caregivers. Innov Aging 2020. [PMCID: PMC7741654 DOI: 10.1093/geroni/igaa057.3459] [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
Individuals providing unpaid care of assistance to family members and friends (e.g. informal caregivers), may have been uniquely impacted by the COVID-19 pandemic. Research is needed to examine the pandemic’s effect on informal caregivers’ caregiving intensity and burden. Therefore, this cross-sectional study was conducted to explore self-reported changes in caregiver intensity (CI) and caregiver burden (CB) due to the pandemic to identify factors associated with changes in responsibilities and burdens. In June 2020, informal caregivers providing care to someone aged 50+ (n=835) reported their current and pre-pandemic caregiving intensity and burden. Data were collected via Amazon’s Mechanical Turk. Chi-square tests were used to examine bivariate associations between pandemic time (pre vs. post) differences in CI and CB. Multinomial regression was used to assess multivariate predictors of changes to CI and CB due to COVID-19. Results showed a significant U-shaped association between initial CB and CB change due to COVID-19. Higher levels of initial CB were associated with both a significant decrease in CB during COVID-19 (OR 1.33, 95%CI 1.06-1.67), and a significant increase in CB during COVID-19 (OR 1.22, 95%CI 1.05-1.43). There were no significant associations between initial CB and changes in CI due to COVID-19, although older caregivers were more likely to experience a decrease in CB due to caregiving (OR 1.02, 95%CI 1.00-1.05). These mixed results suggest that caregivers with high initial CB experienced the most extreme changes to CB due to COVID-19. Future planned analyses will focus on understanding the potential drivers behind these unexpected results.
Collapse
Affiliation(s)
- Steven Cohen
- University of Rhode Island, Kingston, Rhode Island, United States
| | | | - Megan Drohan
- University of Rhode Island, Kingston, Rhode Island, United States
| | - Mary Greaney
- University of Rhode Island, Kingston, Rhode Island, United States
| |
Collapse
|
6
|
Abstract
Abstract
The population of older adults aged 65+ in the US is projected to increase from 15% to 21% in the next 30 years. Aging in place provides cost-savings and familiarity to the older adult, but often requires informal caregivers. Informal caregivers, individuals who provide unpaid care of assistance to family members and friends may have been uniquely impacted by the COVID-19 pandemic and shelter-at-home orders. Research is needed to examine how the pandemic impacted caregivers’ caregiving responsibilities and health behaviors (e.g., physical activity, sedentary time, fruit and vegetable intake, snacking, etc.) as this information will be invaluable to determine if health promotion interventions are needed for informal caregivers. Self-reported data were gathered from informal caregivers providing care to someone aged 50+ (n=835) through Amazon’s Mechanical Turk. Respondents reported their current and pre-pandemic health behaviors and demographics. Chi-square tests were used to examine bivariate associations between pandemic time (pre vs. post) and each examined behavior. The analysis identified some positive health behavior changes due to the pandemic: caregivers felt since the pandemic they ate more fruits and vegetables (p < .001), walked more, exercised more (p < .001), increased amounts of sleep (p < .001), and higher sleep quality (p < .001). However, respondents also had more screen time (p < .001) and sedentary time (p < .001). Future planned analyses will focus on examining whether these changes were consistent across all sociodemographic subgroups of caregivers and whether they persist after the pandemic recedes.
Collapse
Affiliation(s)
- Mary Greaney
- University of Rhode Island, Kingston, Rhode Island, United States
| | | | - Megan Drohan
- University of Rhode Island, Kingston, Rhode Island, United States
| | - Steven Cohen
- University of Rhode Island, Kingston, Rhode Island, United States
| |
Collapse
|
7
|
Kunicki Z, Jones R. Prevalence of Heavy Alcohol Use by Caregivers of Persons With Alzheimer’s Disease or Related Dementia. Innov Aging 2020. [PMCID: PMC7740466 DOI: 10.1093/geroni/igaa057.1154] [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: 11/30/2022] Open
Abstract
Some caregivers of persons with Alzheimer’s Disease and related dementias (ADRD) are known to be under high levels of burden, which is associated with higher levels of anxiety, depression, and stress. Previous research has established anxiety, depression, and stress are associated with heavy alcohol use, but little research has examined heavy alcohol use among ADRD caregivers. Heavy alcohol use could influence the ability of ADRD caregivers to provide care. The purpose of this study was to explore the prevalence and prevalence correlates of heavy alcohol use among ADRD caregivers using the 2016 Behavior Risk Factor Surveillance Survey (BRFSS). We identified 2,028 persons among the 486,303 BRFSS respondents who were the primary informal caregivers of a person with ADRD. Among them, the prevalence of heavy alcohol use was 6.3 per 100 persons. Adult child caregiver relationship, positive smoking status, and fewer hours of providing care per day were all positively and significantly associated with heavy alcohol use. Notably, sex was not. Future research should examine if heavy alcohol use by ADRD caregivers is related to personally and clinically relevant outcomes of care provided to the persons with ADRD.
Collapse
Affiliation(s)
| | - Richard Jones
- Brown University, Providence, Rhode Island, United States
| |
Collapse
|