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Alegría M, Cruz-Gonzalez M, Markle SL, Falgas-Bague I, Poindexter C, Stein GL, Eddington K, Martinez Vargas AE, Fuentes L, Cheng M, Shrout PE. Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults. Am J Public Health 2024; 114:S278-S288. [PMID: 37948053 PMCID: PMC10976451 DOI: 10.2105/ajph.2023.307442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 11/12/2023]
Abstract
Objectives. To examine whether referral for social determinants of health (SDH) needs decreases psychological distress and posttraumatic stress disorder (PTSD) symptoms and improves level of functioning and quality of care among diverse adults. Methods. Data are from control participants (n = 503 adults) in a randomized controlled trial testing a mental health intervention in North Carolina and Massachusetts. We fitted multilevel mixed-effects models to repeated assessments (baseline, 3, 6, and 12 months) collected between September 2019 and January 2023. Results. After referral to services for trouble paying utility bills, participants reported lower PTSD symptoms. Participants reported better quality of care when receiving referrals to mental health care. After adjusting for income and employment status, we found that participants who were referred more often also had lower PTSD symptoms and better levels of functioning. Conclusions. Referrals for certain SDH needs might decrease PTSD symptoms and improve self-reported quality of care and functioning. However, referrals alone, without ensuring receipt of services, might be insufficient to affect other mental health outcomes. Research is needed on training and providing care managers time for offering interpersonal support, securing services, and understanding agencies' contexts for addressing high SDH needs. (Am J Public Health. 2024;114(S3):S278-S288. https://doi.org/10.2105/AJPH.2023.307442).
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Affiliation(s)
- Margarita Alegría
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Mario Cruz-Gonzalez
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Sheri Lapatin Markle
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Irene Falgas-Bague
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Claire Poindexter
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Gabriela Livas Stein
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Kari Eddington
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Abraham Ezequiel Martinez Vargas
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Larimar Fuentes
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Michelle Cheng
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
| | - Patrick E Shrout
- Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E. Shrout is with the Department of Psychology, New York University, New York
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Tops L, Beerten SG, Vandenbulcke M, Vermandere M, Deschodt M. Integrated Care Models for Older Adults with Depression and Physical Comorbidity: A Scoping Review. Int J Integr Care 2024; 24:1. [PMID: 38222854 PMCID: PMC10786096 DOI: 10.5334/ijic.7576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Multimorbidity is a growing challenge in the care for older people with mental illness. To address both physical and mental illnesses, integrated care management is required. The purpose of this scoping review is to identify core components of integrated care models for older adults with depression and physical comorbidity, and map reported outcomes and implementation strategies. Methods PubMed, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers for studies concerning integrated care interventions for older adults with depression and physical comorbidity. We used the SELFIE framework to map core components of integrated care models. Clinical and organisational outcomes were mapped. Results Thirty-eight studies describing thirteen care models were included. In all care models, a multidisciplinary team was involved. The following core components were mainly described: continuity, person-centredness, tailored holistic assessment, pro-activeness, treatment interaction, individualized care planning, and coordination tailored to complexity of care needs. Twenty-seven different outcomes were evaluated, with more attention given to clinical than to organisational outcomes. Conclusion The core components that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g., the cost of the intervention for the healthcare user, more transparently.
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Affiliation(s)
- Laura Tops
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Simon Gabriël Beerten
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Geriatric Psychiatry, University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Competence Center for Nursing, University Hospitals Leuven, Belgium
- Gerontology and Geriatrics, University Hospitals Leuven, Belgium
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Pinton A, Wroblewski K, Schumm LP, Hawkley LC, Huisingh-Scheetz M. Relating depression, anxiety, stress and loneliness to 5-year decline in physical function and frailty. Arch Gerontol Geriatr 2023; 115:105199. [PMID: 37776753 PMCID: PMC10615850 DOI: 10.1016/j.archger.2023.105199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES While depression has been associated with physical function decline and worsening frailty in older adults, the impact of other mental health symptoms on physical function and frailty is unknown. The study objective was to determine whether depression, perceived stress, loneliness, and anxiety symptoms affect 5-year physical function and frailty trajectories of older adults. METHODS The National Social Life, Health, and Aging Project (NSHAP) is a nationally-representative study of adults born between 1920 and 1947. The analysis included data collected in 2010-11 and 2015-16. Mental health symptoms were quantified using NSHAP's measures of anxiety (range:0-21), perceived stress (0-8), depression (0-22), and loneliness (0-6); higher scores indicated worse symptoms. We regressed 2015-16 3 m usual walk time, five-repeated chair stand time or an adapted frailty phenotype scale (0-4) separately on each 2010-11 mental health scale, adjusting for baseline physical function or frailty, demographics, and comorbidities. RESULTS In separate models, every one-point increase on the depression or perceived stress scales was associated with, respectively, a 0.06 s slower (95 % CI: 0.03, 0.10) or 0.09 s slower (95 % CI: 0.01, 0.16) 5-year walk time. Every one-point increase on the depression or perceived stress scales was associated with a 0.15 s slower (95 % CI: 0.06, 0.23) or 0.16 s slower (95 % CI: 0.02, 0.29) 5-year chair stand time. Every one-point increase on the depression scale predicted 0.06 higher log odds of having a worse frailty score 5 years later. Only depression's association with 3 m walk time and chair stands remained significant in models including all four mental health scales. DISCUSSION Older adults with more depression and to a lesser extent stress symptoms may experience faster physical function decline and worsening frailty. Future work exploring and addressing the mechanisms underlying these relationships are warranted.
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Affiliation(s)
- Anabella Pinton
- University of Chicago, Biological Sciences Collegiate Division, Chicago, IL, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Megan Huisingh-Scheetz
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Ave. MC 6098, Chicago, IL 60637, USA.
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Blodgett JM, Norris T, Pinto Pereira SM, Hamer M. Does moderate to vigorous physical activity mediate the association between depression and physical function in midlife: Evidence from two British birth cohort studies. J Affect Disord 2023; 326:206-215. [PMID: 36584709 DOI: 10.1016/j.jad.2022.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/08/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mental health and physical health are intrinsically linked, yet the mechanisms are not well understood. We investigated whether moderate-vigorous physical activity (MVPA) mediated the association between depression and physical function (PF) in midlife. METHODS Individuals from two UK birth cohorts born within one week in 1958 (n = 7278) and 1970 (n = 6097) with data on depression (ages 33/34; Malaise Inventory), MVPA (age 42; self-reported) and PF (ages 50/56; Short Form-36 subscale). Covariates included sex, childhood and adulthood social class, maternal mental health, childhood mood, alcohol consumption, smoking habits, sleep, marital status, BMI and long-standing illness/disability. Linear or multinomial logistic regression models examined associations between depression, MVPA and PF. We used a parametric g-computation mediation analysis approach to estimate percent differences in PF. RESULTS Depression was associated with less frequent MVPA and poorer PF. Lower MVPA was associated with worse PF. The direct effect - randomised analogue not operating via MVPA - of depression on PF was -18.8 % (95%CI:--25.8,-11.8) and -15.8 % (20.6,-11.0) in the 1958 and 1970 cohorts, respectively. The indirect effect - operating via MVPA - was -0.5 % (-1.0,-0.03) and -0.2 % (-0.6, 0.3), resulting in a total proportion mediated of 3.1 % (0.1, 6.0) and 0.9 % (-1.6, 3.4). LIMITATIONS MVPA was self-reported. Intermediate confounders and mediators were measured at the same age, however associations did not change in sensitivity analysis considering age 46 MVPA (1958 cohort). CONCLUSIONS Although higher MVPA was protective against poor PF, there was only minor evidence that it mediated the association between depression and PF. Further investigation into other potential mediators of pathways from mental to physical health is needed.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA London, UK.
| | - Tom Norris
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA London, UK.
| | - Snehal M Pinto Pereira
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA London, UK.
| | - Mark Hamer
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA London, UK.
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Kumar M, Kumari N, Chanda S, Dwivedi LK. Multimorbidity combinations and their association with functional disabilities among Indian older adults: evidence from Longitudinal Ageing Study in India (LASI). BMJ Open 2023; 13:e062554. [PMID: 36746539 PMCID: PMC9906171 DOI: 10.1136/bmjopen-2022-062554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aims to identify the unique multimorbidity combinations (MMCs) and their associations with the functional disability of Indian older adults. Moreover, the population attributable fractions (PAFs) were calculated to assess the potential impact of additional diseases in the nested groups on disability. DESIGN A cross-sectional data were analysed in this study. SETTING AND PARTICIPANTS The present study uses data from the first wave of the Longitudinal Ageing Study in India (2017-2018). The sample for the study consists of 27 753 aged 60 years and over. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome variable was functional disability, measured by the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index. RESULTS Out of 197 uniquely identified MMCs, the combination of hypertension and high depressive symptoms (HDS) was the most prevalent (10.3%). Overall, all MMCs were associated with increased functional limitation. Specifically, the combination of hypertension, arthritis and HDS was associated with greater ADL-IADL disability than any other MMC. The addition of HDS in group 3 (hypertension and arthritis) (incidence rate ratios (IRR)=1.44; 95% CI 1.26 to 1.64) and the addition of arthritis in group 1 (hypertension, HDS) (IRR=1.48; 95% CI 1.28 to 1.71) and group 2 (hypertension, diabetes) (IRR=1.49; 95% CI 1.22 to 1.82) significantly increases the rates of ADL-IADL disability. The estimated PAFs of the group 1 (hypertension and HDS), group 3 (hypertension and arthritis) and group 4 (arthritis and HDS) for ADL-IADL disability were 22.5% (19.2-25.5), 21.6% (18.7-24.4) and 23.5% (20.6-26.3), respectively. CONCLUSION The findings from this study underscore the importance of addressing the morbidity combinations which are more disabling than the others in older adults. Understanding the somatic and psychological relevance of the morbidities in functional health is necessary and can help reduce disabilities among older adults.
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Affiliation(s)
- Manish Kumar
- Population Research Centre, Dharwad, Karnataka, India
| | - Neha Kumari
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Srei Chanda
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Jakimovski D, Wicks TR, Bergsland N, Dwyer MG, Weinstock-Guttman B, Zivadinov R. Neuroimaging Correlates of Patient-Reported Outcomes in Multiple Sclerosis. Degener Neurol Neuromuscul Dis 2023; 13:21-32. [PMID: 36756005 PMCID: PMC9900239 DOI: 10.2147/dnnd.s384038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Background Patient-reported outcomes (PROs) are increasingly associated with concurrent and future impairments in persons with multiple sclerosis (pwMS). The structural and pathological relationships with PROs in pwMS have not been elucidated. Methods One hundred and forty-two pwMS and 47 healthy controls (HCs) were scanned using 3T MRI and completed a PRO questionnaire named Lifeware® that outlines the physical and psychosocial abilities. Beck's Depression Inventory (BDI) assessed levels of depression. T1- and T2-lesion volume, volumes of the whole brain (WBV), gray matter (GMV), white matter (WMV) and lateral ventricle (LVV) were derived using JIM and SIENAX software. Additional deep GM (DGMV) and nuclei-specific volumes of the thalamus, caudate, globus pallidus, putamen, and hippocampus were calculated using FIRST. Ordinal regression models adjusted for age and depression and mediation analyses were used. Results When compared to HCs, pwMS reported significantly greater limitations in mobility domains, including standing up from low seat (p < 0.001), climbing flight of stairs (p < 0.001), lower limb limitation (p < 0.001), limitations in bladder continence (p = 0.001) and fatigability (p < 0.001). Patient-reported limitations related to lower extremity function were explained by age, BDI, and all DGM nuclei volumes (p < 0.029). No such relationships were seen in the HCs. Fatiguability and the extent of life satisfaction were only related to depression (BDI p < 0.001) and not associated with any MRI-based outcomes. Most relationships between structural pathology and PROs were mediated by BDI scores (p < 0.001). In the pwMS group, there were no significant differences in any MRI-based brain volumes between the levels of reported life satisfaction. Conclusion PRO measures of lower extremity limitations were associated with DGM structures and DGM-specific nuclei. These findings promote the relevance of measuring DGM structures as measures directly related to subjective well-being and walking limitations. Depression is a significant mediator of PROs and in particular of life satisfaction.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA,Correspondence: Dejan Jakimovski, Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA, Tel +1 716-859-7040, Fax +1 716-859-7066, Email
| | - Taylor R Wicks
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA,IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA,Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
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Botoseneanu A, Elman MR, Allore HG, Dorr DA, Newsom JT, Nagel CL, Quiñones AR. Depressive Multimorbidity and Trajectories of Functional Status among Older Americans: Differences by Racial/Ethnic Group. J Am Med Dir Assoc 2023; 24:250-257.e3. [PMID: 36535384 PMCID: PMC10280885 DOI: 10.1016/j.jamda.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/08/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of depressive multimorbidity (ie, including depressive symptoms) on the long-term development of activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations according to racial/ethnic group in a representative sample of US older adults. DESIGN Prospective, observational, population-based 16-year follow-up study of nationally representative sample. SETTING AND PARTICIPANTS Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from the Health and Retirement Study (2000‒2016, N = 16,364, community-dwelling adults ≥65 years of age). METHODS Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL limitations (range 0‒11) among participants with depressive (8-item Center for Epidemiologic Studies Depression score≥4) vs somatic (ie, physical conditions only) multimorbidity vs those without multimorbidity (no or 1 condition). Generalized estimating equations included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline age, sex, body mass index, education, partnered, and net worth. RESULTS Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater accumulation of functional limitations, respectively, relative to no disease [incidence rate ratio (IRR) = 5.18, 95% confidence interval, CI (4.38,6.13), IRR = 2.95, 95% CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of ADL-IADL limitations than White respondents [IRR = 1.27, 95% CI (1.14, 1.41), IRR = 1.31, 95% CI (1.20, 1.43), respectively]. CONCLUSIONS AND IMPLICATIONS Combinations of somatic diseases and high depressive symptoms are associated with greatest accumulation of functional limitations over time in adults ages 65 and older. There is a more rapid growth in functional limitations among individuals from racial/ethnic minority groups. Given the high prevalence of multimorbidity and depressive symptomatology among older adults and the availability of treatment options for depression, these results highlight the importance of screening/treatment for depression, particularly among older adults with socioeconomic vulnerabilities, to slow the progression of functional decline in later life.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA; Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
| | - Miriam R Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ana R Quiñones
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Rezvani F, Pelt M, Härter M, Dirmaier J. Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis. PLoS One 2022; 17:e0273747. [PMID: 36048797 PMCID: PMC9436130 DOI: 10.1371/journal.pone.0273747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Intermittent claudication is the leading symptom of peripheral artery disease (leg pain when walking). The present study investigates the extent to which walking impairment is associated with health-related quality of life, mental health and health risk behavior. Methods A theory-based, cross-sectional path model was empirically examined using pre-intervention baseline data from a multicenter, randomized-controlled trial of patients with intermittent claudication (PAD-TeGeCoach). Data were available from 1 696 patients who completed a battery of questionnaires between April 14, 2018 and March 12, 2019, including measures of walking impairment (Walking Impairment Questionnaire), health-related quality of life (SF-12), mental burden (GAD-7, PHQ-9), nicotine- and alcohol-related risk behavior (Fagerström-Test, AUDIT-C). Sociodemographic characteristics and comorbid conditions were included in the postulated model a priori to minimize confounding effects. Results Walking impairment was associated with an increase in depressive (β = -.36, p < .001) and anxiety symptoms (β = -.24, p < .001). The prevalence of depressive and anxiety symptoms was 48.3% and 35.5%, respectively, with female patients and those of younger age being at greater risk. Depressive symptoms were predictive of an increased tobacco use (β = .21; p < .001). Walking impairment had adverse effects on physical quality of life, both directly (β = .60, p < .001) and indirectly mediated through depressive symptoms (β = -.16, p < .001); and indirectly on mental quality of life mediated through depressive (β = -.43, p < .001) and anxiety symptoms (β = -.35, p < .001). Discussion The findings underscore the need for a comprehensive treatment strategy in patients with intermittent claudication. Measures to improve walking impairment (e.g. exercise training) are key to enhance quality of life and should be the primary treatment. As a key mediator of mental quality of life, depressive and anxiety symptoms should be addressed by rigorously including mental health treatment. Risky health behaviors should be approached by promoting behavior change (e.g. smoking cessation) as a secondary prevention of peripheral artery disease.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Mara Pelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Role of social determinants in anxiety and depression symptoms during COVID-19: A longitudinal study of adults in North Carolina and Massachusetts. Behav Res Ther 2022; 154:104102. [PMID: 35561644 PMCID: PMC9056067 DOI: 10.1016/j.brat.2022.104102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022]
Abstract
Trajectory studies of the COVID-19 pandemic have described patterns of symptoms over time. Yet, few have examined whether social determinants of health predict the progression of depression and anxiety symptoms during COVID-19 or identified which social determinants worsen symptom trajectories. Using a racially, ethnically, and linguistically diverse sample of adults participating in a randomized clinical trial with pre-existing moderate to severe depression and/or anxiety symptoms, we compare symptom patterns before and during COVID-19; characterize symptom trajectories over a 20-week follow-up period; and evaluate whether social determinants are associated with within- and between- person differences in symptom trajectories. Data were collected before and during COVID-19 in Massachusetts and North Carolina. On average, depression and anxiety symptoms did not seem to worsen during the pandemic compared to pre-pandemic. During COVID-19, anxiety scores at follow-up were higher for participants with baseline food insecurity (vs no food insecurity). Depression scores at follow-up were higher for participants with food insecurity and for those with utilities insecurity (vs no insecurity). Participants with child or family care responsibilities at baseline had depression symptoms decreasing at a slower rate than those without these responsibilities. We discuss the important implications of these findings.
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10
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Versluijs Y, Bandell D, Kortlever J, Ring D. The Influence of Symptoms of Anger on Pain Intensity and Activity Intolerance. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09894-5. [PMID: 35750973 DOI: 10.1007/s10880-022-09894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
This study assessed the association of anger, anxiety, and depression, and cognitive bias with pain and activity tolerance among patients with a musculoskeletal illness or injury expected to last more than a month. 102 Patients completed emotional thermometers to quantify symptoms of anger, anxiety, depression; the abbreviated Pain Catastrophizing Scale; a pain intensity scale; Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test; the Spielberger State-Trait Anxiety Inventory and demographic questionnaires. Controlling for potential confounding in multivariable analysis we found greater activity intolerance was associated with retired work-status and greater depressive symptoms, but not with greater symptoms of anger. In addition, greater pain intensity was associated with greater symptoms of depression and greater catastrophic thinking, but not with greater symptoms of anger. Anger emotions do not contribute to symptom intensity and activity intolerance in musculoskeletal illness. Attention can be directed at addressing psychological distress and cognitive bias.
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Affiliation(s)
- Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA.,Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - David Bandell
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA
| | - Joost Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA.
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11
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Demsas F, Joiner MM, Telma K, Flores AM, Teklu S, Ross EG. Disparities in peripheral artery disease care: a review and call for action. Semin Vasc Surg 2022; 35:141-154. [PMID: 35672104 PMCID: PMC9254894 DOI: 10.1053/j.semvascsurg.2022.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
Peripheral artery disease (PAD), the pathophysiologic narrowing of arterial blood vessels of the lower leg due to atherosclerosis, is a highly prevalent disease that affects more than 6 million individuals 40 years and older in the United States, with sharp increases in prevalence with age. Morbidity and mortality rates in patients with PAD range from 30% to 70% during the 5- to 15-year period after diagnosis and PAD is associated with poor health outcomes and reduced functionality and quality of life. Despite advances in medical, endovascular, and open surgical techniques, there is striking variation in care among population subgroups defined by sex, race and ethnicity, and socioeconomic status, with concomitant differences in preoperative medication optimization, amputation risk, and overall health outcomes. We reviewed studies from 1995 to 2021 to provide a comprehensive analysis of the current impact of disparities on the treatment and management of PAD and offer action items that require strategic partnership with primary care providers, researchers, patients, and their communities. With new technologies and collaborative approaches, optimal management across all population subgroups is possible.
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12
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Boustani M, Unützer J, Leykum LK. Design, implement, and diffuse scalable and sustainable solutions for dementia care. J Am Geriatr Soc 2021; 69:1755-1762. [PMID: 34245584 DOI: 10.1111/jgs.17342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022]
Abstract
Most innovations developed to reduce the burden of Alzheimer disease and other related dementias (ADRD) are difficult to implement, diffuse, and scale. The consequences of such challenges in design, implementation, and diffusion are suboptimal care and resulting harm for people living with ADRD and their caregivers. National experts identified four factors that contribute to our limited ability to implement and diffuse of evidence-based services and interventions for people living with ADRD: (1) limited market demand for the implementation and diffusion of effective ADRD interventions; (2) insufficient engagement of persons living with ADRD and those caring for them in the development of potential ADRD services and interventions; (3) limited evidence and experience regarding scalability and sustainability of evidence-based ADRD care services; and (4) difficulties in taking innovations that work in one context and successfully implementing them in other contexts. New investments in the science of human-centered design, implementation, and diffusion are crucial for meeting the goals of the National Plan to Address Alzheimer's Disease under the auspices of the National Alzheimer's Project Act.
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Affiliation(s)
- Malaz Boustani
- Department of Medicine, Indiana University, Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Jürgen Unützer
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Luci K Leykum
- Department of Internal Medicine, South Texas Veterans Healthcare System, Austin, Texas, USA.,Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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13
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Tang VL, Cenzer I, McCulloch CE, Finlayson E, Cooper Z, Silvestrini M, Ngo S, Schmitt EM, Inouye SK. Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery. J Am Geriatr Soc 2020; 68:2814-2821. [PMID: 32898280 PMCID: PMC7744402 DOI: 10.1111/jgs.16781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/24/2020] [Accepted: 07/16/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVES Depression screening and treatment for older adults are recommended in Age-Friendly Health Systems. Few studies have evaluated the association between depressive symptoms and postoperative functioning. We aimed to determine the association between varying levels of depressive symptoms in the preoperative setting with postoperative functional recovery. DESIGN Prospective cohort study. SETTING Two academic hospitals in Boston, Massachusetts. PARTICIPANTS Surgical patients aged 70 and older (N = 560). MEASUREMENTS Participants were assessed preoperatively and 1 year postoperatively. Preoperative evaluation included the 15-item short-form Geriatric Depression Scale (GDS). Results were categorized as low (GDS = 0-1), moderate (2-5), or high (6-15) symptom burden. Primary outcome was 1-year instrumental activities of daily living functional decline. Secondary outcomes included hospital stay longer than 5 days, discharge to post-acute care (PAC) facility, and readmission within 30 days. RESULTS Mean participant age was 76.6 ± 5 years, 58% were women, 81% underwent an orthopedic operation, 13% gastrointestinal, 6% vascular; 13% had functional decline at 1 year after their operation (by symptom burden: low = 5.5%; moderate = 14.8%, and high = 38.6%). After adjusting for age, sex, and comorbidity, those with moderate or high depressive symptoms demonstrated greater odds of functional decline at 1 year compared with those with a low symptom burden (moderate: adjusted odds ratio [AOR] = 2.7; 95% confidence interval [CI] = 1.3-5.3; high: AOR = 9.3; 95% CI = 4.2-20.6), discharge to PAC facility (moderate: AOR = 1.7; 95%CI = 1.2-2.6; high: AOR = 2.7; 95% CI = 1.4-5.1) but demonstrated no significant association with 30-day readmission or hospital length of stay longer than 5 days. CONCLUSION Greater burden of preoperative depressive symptoms is associated with increased likelihood of functional decline at 1 year after surgery and of discharge to PAC facility. Preoperative assessment of the burden of depressive symptoms in older adults undergoing elective surgery may be helpful in identifying patients at high risk of poor outcomes.
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Affiliation(s)
- Victoria L Tang
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
- Phillip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Molly Silvestrini
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Ngo
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eva M Schmitt
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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14
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Heser K, Stein J, Luppa M, Wiese B, Mamone S, Weyerer S, Werle J, König HH, Hajek A, Scherer M, Stark A, Kaduszkiewicz H, Maier W, Riedel-Heller SG, Wagner M. Late-Life Depressive Symptoms Are Associated With Functional Impairment Cross-sectionally and Over Time: Results of the AgeMooDe Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:811-820. [PMID: 29986090 DOI: 10.1093/geronb/gby083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/03/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES This study examines the relationship between late-life depressive symptoms, cognitive and functional impairment in a cohort of very old community-based participants. METHODS A sample of 1,226 primary care patients was assessed at baseline (Mage = 80.6 years). Statistical analyses were conducted using baseline and 12-month follow-up data. RESULTS At baseline, depressed participants showed minor cognitive deficits compared with nondepressed participants, whereas functional deficits were pronounced. Depressive symptoms and global cognition were not associated longitudinally. In contrast, follow-up functional impairment was predicted by baseline level and increase of depressive symptoms between baseline and follow-up. Reversely, follow-up depressive symptoms were predicted by functional decline between baseline and follow-up, whereas baseline functional status was not predictive. DISCUSSION Depressive symptoms and global cognitive function were not associated longitudinally, but level and increase of depressive symptoms over time predicted functional impairment after 1 year. Interventions to reduce depressive symptoms, or to encourage coping strategies might be promising to reduce functional impairment. Elevated follow-up depressive symptoms were only predicted by functional decline, supposedly emphasizing that incident functional impairment might be associated with an acute increase of depressive symptoms. Psychological adjustment processes were not examined, but might be targeted in future.
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Affiliation(s)
- Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Germany
| | - Birgitt Wiese
- Institute of General Practice, Working Group Medical Statistics and IT Infrastructure, Hannover Medical School, Germany
| | - Silke Mamone
- Institute of General Practice, Working Group Medical Statistics and IT Infrastructure, Hannover Medical School, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
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15
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Integrating behavioral health and substance use models for advanced PMHN practice in primary care: Progress made in the 21st century. Arch Psychiatr Nurs 2020; 34:363-369. [PMID: 33032759 PMCID: PMC7529389 DOI: 10.1016/j.apnu.2020.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
The integration of behavioral health and substance use assessment and treatment has advanced in primary care settings in the 21st century yet the roles and practice of nursing remain unclear. This paper focuses on the Institute of Medicine (2011) Report on the "The Future of Nursing: Leading Change, Advancing Health", and to what degree specialty of Psychiatric-Mental Health Nursing has advanced as it pertains to behavioral health integration. Each of the four domains (practice, education, leadership and policy) in the Report will be highlighted with recommendations for how Psychiatric-Mental Health Advanced Practice Nurses can lead the way in 2020 and beyond.
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16
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Wu CY, Rodakowski JL, Terhorst L, Karp JF, Fields B, Skidmore ER. A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults. THE GERONTOLOGIST 2020; 60:e52-e65. [PMID: 31002312 DOI: 10.1093/geront/gnz026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions. RESEARCH DESIGN AND METHODS A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training). RESULTS The range of Cohen's d was -0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = -0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes. DISCUSSION AND IMPLICATIONS Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for "risk of disability" to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.
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Affiliation(s)
- Chao-Yi Wu
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania
| | - Juleen L Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania.,Department of Health and Community Systems, School of Nursing, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, School of Medicine, Pennsylvania.,Department of Anesthesiology, School of Medicine, Pennsylvania
| | - Beth Fields
- Center for Caregiving Research, Education and Policy, Pennsylvania.,Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania.,Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pennsylvania
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17
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John JR, Jani H, Peters K, Agho K, Tannous WK. The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6886. [PMID: 32967161 PMCID: PMC7558011 DOI: 10.3390/ijerph17186886] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD -0.24; 95% CI -0.35, -0.14; I2 = 76%) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21; I2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15; I2 = 51%), self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44; I2 = 83%), and hospital admissions (OR 0.83; 95% CI 0.70, 0.98; I2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26; I2 = 82%). The quality of individual studies ranged from "fair" to "good" by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.
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Affiliation(s)
- James Rufus John
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW 2000, Australia
| | - Hir Jani
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Kingsley Agho
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- School of Science and Health, Western Sydney University, Sydney, NSW 2560, Australia
| | - W. Kathy Tannous
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- School of Business, Western Sydney University, Sydney, NSW 2150, Australia
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18
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Cree RA, Okoro CA, Zack MM, Carbone E. Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics - United States, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1238-1243. [PMID: 32914770 PMCID: PMC7499832 DOI: 10.15585/mmwr.mm6936a2] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Frequent mental distress, defined as 14 or more self-reported mentally unhealthy days in the past 30 days,* is associated with adverse health behaviors, increased use of health services, mental disorders (e.g., diagnosis of major depressive disorder), chronic diseases, and functional limitations (1). Adults with disabilities more often report depression and anxiety (2), reduced health care access (3), and health-related risk behaviors (4) than do adults without disabilities. CDC analyzed 2018 Behavioral Risk Factor Surveillance System (BRFSS) data to compare the prevalence of frequent mental distress among adults with disabilities with that among adults without disabilities and to identify factors associated with mental distress among those with disabilities. Nationwide, an estimated 17.4 million adults with disabilities reported frequent mental distress; the prevalence of reported mental distress among those with disabilities (32.9%) was 4.6 times that of those without disabilities (7.2%). Among adults with disabilities, those with both cognitive and mobility disabilities most frequently reported mental distress (55.6%). Adults with disabilities who reported adverse health-related characteristics (e.g., cigarette smoking, physical inactivity, insufficient sleep, obesity, or depressive disorders) or an unmet health care need because of cost also reported experiencing more mental distress than did those with disabilities who did not have these characteristics. Adults living below the federal poverty level reported mental distress 70% more often than did adults in higher income households. Among states, age-adjusted prevalence of mental distress among adults with disabilities ranged from 25.2% (Alaska) to 42.9% (New Hampshire). Understanding the prevalence of mental distress among adults with disabilities could help health care providers, public health professionals, and policy makers target interventions and inform programs and policies to ensure receipt of mental health screening, care, and support services to reduce mental distress among adults with disabilities.
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19
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Díaz-Venegas C, Wong R. Recovery from physical limitations among older Mexican adults. Arch Gerontol Geriatr 2020; 91:104208. [PMID: 32739714 PMCID: PMC7856256 DOI: 10.1016/j.archger.2020.104208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This paper examines the key determinants of the likelihood of recovery from a physical disability among older adults. METHODS Data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as "same", "worse", "improved" or "died" depending on the number of physical dimensions with a limitation in a 2-year span (2001-2003) and again, separately, in a 3-year span (2012-2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another. FINDINGS Around 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving. CONCLUSIONS Disability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.
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Affiliation(s)
| | - Rebeca Wong
- Senior Fellow, Sealy Center on Aging; Director, WHO/PAHO Collaborating Center on Aging and Health, The University of Texas Medical Branch, United States.
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20
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Reichardt LA, Nederveen FE, van Seben R, Aarden JJ, van der Schaaf M, Engelbert RHH, van der Esch M, Twisk JWR, Bosch JA, Buurman BM. The longitudinal association between depressive symptoms and functional abilities in older patients. J Psychosom Res 2020; 137:110195. [PMID: 32731046 DOI: 10.1016/j.jpsychores.2020.110195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the course of depressive symptoms, and basic and instrumental activities of daily living (collectively described as, (I)ADL functioning) from acute admission until one year post-discharge, the longitudinal association between depressive symptoms and (I)ADL functioning, and to disaggregate between- and within-person effects to examine whether changes in depressive symptoms are associated with changes in (I)ADL functioning. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥70. Data gathered over a one-year period were assessed using validated measures of depressive symptoms (GDS-15) and physical functioning (Katz-ADL index). A Poisson mixed model analysis was used to examine the association between the courses and a hybrid model was used to disentangle between- and within-subject effects. RESULTS The analytic sample included 398 patients (mean age = 79.6 years, SD = 6.6). Results showed an improvement in depressive symptoms and physical functions over time, whereby changes in depressive symptoms were significantly associated with the course of ADL function (rate ratio (RR) = 0.91, p < .001) and IADL function (RR = 0.94, p < .001), even after adjustment for confounding variables. Finally, both between- and within-person effects of depressive symptoms were significantly associated with the course of ADL function (between-person: RR = 0.85, p < .001; within-person: RR = 0.94, p < .001) and IADL function (between-person: RR = 0.87, p < .001; within-person: RR = 0.97, p < .001). CONCLUSION The course of depressive symptoms and physical functions improved over time, whereby changes in depressive symptoms were significantly associated with changes in physical functions, both at group and individual level. These changes in (I)ADL functioning lie mostly above the estimated minimally important change for both scales, implying clinically relevant changes.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Floor E Nederveen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands..
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
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Ortiz D, Meagher AD, Lindroth H, Holler E, Gao S, Khan B, Lasiter S, Boustani M, Zarzaur B. A trauma medical home, evaluating collaborative care for the older injured patient: study protocol for a randomized controlled trial. Trials 2020; 21:655. [PMID: 32678026 PMCID: PMC7364470 DOI: 10.1186/s13063-020-04582-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/04/2020] [Indexed: 04/11/2023] Open
Abstract
Background It is estimated that 55 million adults will be 65 years and older in the USA by 2020. These older adults are at increased risk for injury and their recovery is multi-faceted. A collaborative care model may improve psychological and functional outcomes of the non-neurologically impaired older trauma patient and reduce health care costs. Methods This is a randomized controlled trial of 430 patients aged 50 and older who have suffered a non-neurologic injury and are admitted to a level one trauma center in Indianapolis, IN, or Madison, WI. Participants will be assigned to either the Trauma Medical Home (TMH) intervention or usual care. The TMH intervention is a collaborative care model that includes validated protocols addressing the multi-faceted needs of this population, with the help of care coordination software and a mobile office concept. The primary outcome is self-reported physical recovery at 6- and 12-month follow-up. Secondary outcomes include self-reported psychological recovery, acute health care utilization, and cost-effectiveness of the intervention at 6 and 12 months. The TMH collaborative care model will be delivered by a registered nurse care coordinator. The assessments will be completed by trained blinded research assistants. Discussion The proposed study will evaluate a collaborative care model to help maximize psychological and functional recovery for non-neurologically injured older patients at four level one trauma centers in the Midwest. Trial registration Clinical Trials. NCT03108820. Registered on 11 April 2017. Protocol Version 6: Study # 1612690852. April 12, 2019. Sponsor: Indiana University. Human subjects and IRB contact information: irb@iu.edu Prospectively registered in the WHO ICTRP on 4 June 2017.
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Affiliation(s)
- Damaris Ortiz
- Division of Acute Care Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall, Indianapolis, IN, 46202, USA. .,Sidney & Lois Eskenazi Hospital Smith Level One Trauma Center, 720 Eskenazi Ave, Indianapolis, IN, 46202, USA.
| | - Ashley D Meagher
- Division of Acute Care Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall, Indianapolis, IN, 46202, USA.,Indiana University Health, Methodist Hospital Level One Trauma Center, 1701 Senate Ave, Indianapolis, IN, 46202, USA
| | - Heidi Lindroth
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN, 46202, USA.,Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA.,Indiana University Center of Aging Research, Regenstrief Institute, 1101 W. 10th St., Indianapolis, IN, 46202, USA
| | - Emma Holler
- Sidney & Lois Eskenazi Hospital Smith Level One Trauma Center, 720 Eskenazi Ave, Indianapolis, IN, 46202, USA
| | - Sujuan Gao
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA
| | - Babar Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN, 46202, USA.,Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA.,Indiana University Center of Aging Research, Regenstrief Institute, 1101 W. 10th St., Indianapolis, IN, 46202, USA
| | - Sue Lasiter
- School of Nursing and Health Studies, University of Missouri, 2464 Charlotte St, Kansas City, MO, 64108, USA
| | - Malaz Boustani
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA.,Indiana University Center of Aging Research, Regenstrief Institute, 1101 W. 10th St., Indianapolis, IN, 46202, USA
| | - Ben Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine and Public Health-Madison, 600 Highland Ave., Madison, WI, 53792, USA
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22
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Zucato da Silva C, José Gomes Campos C, Ferraz Martins Jamarim M, Marcondes pimentel de abreu lima G. Experiencias de pacientes con discapacidades funcionales posteriores al tratamiento en la Unidad de Cuidados Intensivos. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Comprender las experiencias de los pacientes con discapacidades funcionales después del tratamiento en la Unidad de Cuidados Intensivos a su regreso a casa. Materiales y métodos: Se trata de un estudio de enfoque cualitativo que utilizó el estudio de caso como método de investigación. La muestra de ocho participantes fue compuesta intencionalmente y cerrada por saturación teórica. La recolección de datos se realizó a través de entrevistas domiciliarias semiestructuradas complementadas con notas y diarios de campo. Los datos fueron analizados mediante el análisis de contenido temático propuesto por Minayo. Resultados: La atención primaria, a través de la atención domiciliaria, fue la principal responsable del seguimiento posterior al alta de los participantes. Del material empírico, surgieron las categorías "sufrimiento emocional y sus repercusiones en la recuperación funcional" y "la pérdida del rol familiar y los conflictos con los cuidadores". Discusión y conclusiones: La recuperación funcional de pacientes con discapacidades funcionales después de pasar por cuidados intensivos puede ser compleja y requiere, además de rehabilitación física, monitoreo psicoemocional adecuado, aclaración de los recuerdos de hospitalización y apoyo profesional a la familia. Se sugiere que la atención primaria reciba capacitación sobre la complejidad de estos pacientes y la creación de estrategias que lo acerquen a la atención hospitalaria, lo que permite una atención compartida y continua.
Como citar este artículo: Silva, Camila Zucato; Campos, Claudinei José Gomes; Jamarim, Michelle Ferraz Martins; Lima, Gerusa Marcondes Pimentel de Abreu. Vivências de pacientes diante de incapacidades funcionais pós-tratamento em Unidade de Terapia Intensiva. Revista Cuidarte. 2020; 11(2): e1018. http://dx.doi.org/10.15649/cuidarte.1018
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Gontijo Guerra S, Berbiche D, Vasiliadis HM. Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults. Disabil Rehabil 2020; 43:3663-3671. [PMID: 32255362 DOI: 10.1080/09638288.2020.1745303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.Aims: To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.Method: A secondary analysis including participants from the Longitudinal Survey on Senior's Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.Results: More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.Conclusions: We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.Implications for RehabilitationBy establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.
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Affiliation(s)
- Samantha Gontijo Guerra
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Longueuil, Longueuil, QC, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
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24
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O'Neill D, Forman DE. The importance of physical function as a clinical outcome: Assessment and enhancement. Clin Cardiol 2020; 43:108-117. [PMID: 31825137 PMCID: PMC7021659 DOI: 10.1002/clc.23311] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.
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Affiliation(s)
| | - Daniel E. Forman
- Professor of MedicineUniversity of Pittsburgh University of Pittsburgh Medical Center and VA Pittsburgh Healthcare SystemPittsburghPennsylvania
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25
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Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial. Am J Geriatr Psychiatry 2019; 27:1299-1313. [PMID: 31494015 PMCID: PMC6842701 DOI: 10.1016/j.jagp.2019.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages. DESIGN Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care. SETTING Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019. PARTICIPANTS English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction. INTERVENTIONS Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care. MEASUREMENTS Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0). RESULTS Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention. CONCLUSIONS PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.
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Abstract
Prevalence of cardiovascular disease (CVD) increases with age and is endemic in the burgeoning population of older adults. Older adults with CVD are susceptible not only to high mortality but also to increased likelihood of disability, dependency, functional decline, and poor quality of life. Cardiac rehabilitation (CR) is a multidimensional and comprehensive treatment program that can potentially address many of the distinctive challenges of older adults with CVD. In this review, the wide range of potential benefits of CR for older adults with CVD is summarized.
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Affiliation(s)
- Deirdre O'Neill
- Department of Medicine and Mazankowski Heart Institute, Division of Cardiology, University of Alberta Hospital, 11220 83 Avenue, Edmonton, AB T6G 2J2, Canada
| | - Daniel E Forman
- Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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27
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Cao C, Liu Q, Yang L, Zheng X, Lan P, Koyanagi A, Vancampfort D, Soysal P, Veronese N, Stubbs B, Firth J, Smith L. Handgrip strength is associated with suicidal thoughts in men: Cross-sectional analyses from NHANES. Scand J Med Sci Sports 2019; 30:92-99. [PMID: 31544270 DOI: 10.1111/sms.13559] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the association between handgrip strength and suicidal thoughts in a representative sample of the US adult population using data from the National Health and Nutrition Examination Survey (NHANES). POPULATION AND METHODS Data from two waves of NHANES (2011-2014) were aggregated. Handgrip strength in kilogram (kg) was defined as the maximum value from the dominant hand. Suicidal thoughts were assessed using one question "Over the last 2 weeks, how often have you been bothered by the following problem: Thoughts that you would be better off dead or of hurting yourself in some way?" and dichotomized to no (not at all) and yes (several days/ more than half the days/ nearly every day). Sex-specific logistic regressions were carried out to analyze associations between handgrip strength and suicidal thoughts. RESULTS Data on total of 8903 adults (mean age 47.4 ± 0.4 years) were analyzed. Each 5kg increase in handgrip strength was associated with a 16% reduced odds of having suicidal thoughts (0.84, 95% CI: 0.74-0.95) among the overall male population. These associations were stronger in male aged 20-39 years (0.83, 95% CI: 0.70-0.98), and 40-64 years (0.73, 95% CI: 0.63-0.85). In contrast, no associations were observed in females of all age groups. CONCLUSIONS Males younger than 65 years old with low handgrip strength are significantly more likely to have suicidal thoughts demonstrating a dose-response relationship. Future research is required to confirm/refute our findings and establish if strength interventions can reduce suicidal thoughts.
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Affiliation(s)
- Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Qinran Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.,Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Lin Yang
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Xiaobin Zheng
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, CIBERSAM, Madrid, Spain
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,KU Leuven, University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
| | - Pinar Soysal
- Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Nicola Veronese
- National Research Council, Aging Branch, Neuroscience Institute, Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Joseph Firth
- School of Science and Health, NICM Health Research Institute, University of Western Sydney, Sydney, NSW, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Abstract
Depression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. The first review outlined an approach to screening and diagnosing depression in primary care. This second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.
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Affiliation(s)
- Parashar Ramanuj
- Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA
- Royal National Orthopaedic Hospital
| | | | - Harold Alan Pincus
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
- RAND Corporation, Pittsburgh, PA, USA
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29
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Kim JH. Effect of grip strength on mental health. J Affect Disord 2019; 245:371-376. [PMID: 30423464 DOI: 10.1016/j.jad.2018.11.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/26/2018] [Accepted: 11/03/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study is to longitudinally investigate the association between grip strength and mental health disorders in middle aged and aged population from the Korean Longitudinal Study of Aging. METHODS Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016 was assessed using longitudinal data analysis and out of the 9279 research subjects gathered 1549 (16.7%) participants were reported as Q1 group and 2074 (22.4%) participants were reported as Q5 group. To analyze the association between grip strength and mental health disorders, generalized estimating equation (GEE) model was used. RESULTS The association between grip strength and cognitive decline was statistically significant, with the following Odds ratio (OR) predicting decreased cognitive decline: OR = 4.99 (p < .0001) for Q1 group vs. Q5 group. The association between grip strength and MMSE and CESD was also statistically significant, with the following estimate (B) predicting decreased MMSE score: B = -0.12 (p < .0001) for Q1 group vs. Q5 group. In terms of CESD, CESD score was higher for Q1 group (B = 0.34, p < .0001) compared to Q5 group. CONCLUSION This study shows a significant association between grip strength and risk of mental illness in Korean middle aged and aged population. Therefore, grip strength should be given more focus in terms of resistance training programs.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea; Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea.
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30
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Gebara MA, DiNapoli EA, Lederer LG, Bramoweth AD, Germain A, Kasckow JW, Karp JF. Brief behavioral treatment for insomnia in older adults with late-life treatment-resistant depression and insomnia: a pilot study. Sleep Biol Rhythms 2019; 17:287-295. [PMID: 31632192 DOI: 10.1007/s41105-019-00211-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective Brief Behavioral Treatment for Insomnia (BBTI) is an efficacious treatment of insomnia in older adults. Behavioral treatments for insomnia can also improve depression. However, it is unknown if BBTI is feasible or has an effect in patients with insomnia and late-life treatment resistant depression (LLTRD). The aims of this study were two-fold, to test: 1) the feasibility (defined by acceptability and retention rates) of BBTI and 2) the therapeutic potency of BBTI on symptoms of insomnia and depression. Methods Eleven older Veterans with LLTRD and insomnia were recruited in a randomized control trial to receive immediate (4-weeks of BBTI followed by 3-weeks of phone call check-ins and a final in-person 8-week assessment) or delayed (3-weeks of treatment as usual [wait-list control] followed by 4-weeks of BBTI and a final in-person 8-week assessment) BBTI. The primary outcome measures included the Patient Health Questionnaire (minus the sleep item) and the Insomnia Severity Index. Results BBTI was found to be feasible in older Veterans with insomnia and LLTRD; all participants recommended BBTI and retention rates were 90.9%. There was no difference in treatment effect between the immediate BBTI and delayed BBTI groups at week 4. After both groups (immediate and delayed) received BBTI, improvements were seen in both insomnia (d = 1.06) and depression (d = 0.54) scores. Conclusions BBTI is a feasible treatment for insomnia in older adults with LLTRD. BBTI may be an effective adjunctive treatment for depression. Larger adequately-powered trials are required to confirm these preliminary findings.
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Affiliation(s)
- Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; USA.,Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA; USA
| | - Elizabeth A DiNapoli
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA; USA
| | - Lisa G Lederer
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA; USA
| | - Adam D Bramoweth
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA; USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA; USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; USA
| | - John W Kasckow
- VA Beckley Healthcare System, Beckley, West Virginia; USA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; USA
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Using Patient-reported Outcomes Measurement Information System Measures to Understand the Relationship Between Improvement in Physical Function and Depressive Symptoms. J Am Acad Orthop Surg 2018; 26:e511-e518. [PMID: 30216242 PMCID: PMC6289818 DOI: 10.5435/jaaos-d-17-00039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This investigation determined whether improved physical function and decreased pain would reduce depressive symptoms using the Patient-reported Outcomes Measurement Information System (PROMIS). METHODS This cohort study analyzed PROMIS Depression, Physical Function, and Pain Interference CAT scores from 3,339 patients presenting to a tertiary orthopaedic center. Patients demonstrating at least a-five point (effect size, 0.5) improvement in PROMIS Physical Function between consecutive visits were eligible for inclusion. RESULTS Patients presented, on average, with Physical Function and Pain Interference scores nearly one SD worse than population averages and Depression scores that approximated the normal population. Improved Physical Function and Pain Interference scores demonstrated no correlation with change in Depression scores (r = -0.13; r = 0.25). CONCLUSION Substantial early improvement in PROMIS Physical Function scores is not associated with change in PROMIS Depression scores. PROMIS Depression scores likely reflect underlying mental health rather than situational depressive symptoms. LEVEL OF EVIDENCE Prognostic, level III.
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Woodson TT, Gunn R, Clark KD, Balasubramanian BA, Jetelina KK, Muller B, Miller BF, Burdick TE, Cohen DJ. Designing health information technology tools for behavioral health clinicians integrated within a primary care team. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:158-168. [PMID: 30398459 PMCID: PMC6779316 DOI: 10.14236/jhi.v25i3.998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/27/2018] [Accepted: 06/08/2018] [Indexed: 01/11/2023] Open
Abstract
Background Electronic health records (EHRs) are a key tool for primary care practice. However, the EHR functionality is not keeping pace with the evolving informational and decision-support needs of behavioural health clinicians (BHCs) working on integrated teams. Objective Describe the workflows and tasks of integrated BHCs working with adult patients identify their health information technology (health IT) needs and develop EHR tools to address them. Method A mixed-methods, comparative case study of six community health centres (CHCs) in Oregon, each with at least one BHC integrated into their primary care team. We observed clinical work and conducted interviews to understand workflows and clinical tasks, aiming to identify how effectively current EHRs supported integrated care delivery, including transitions, documentation, information sharing and decision-making. We analysed these data and employed a user-centred design process to develop EHR tools addressing the identified needs. Results BHCs used the primary care EHR for documentation and communication with other team members, but the EHR lacked the functionality to fully support integrated care. Needs include the ability to: (1) automate and track paper-based screening; (2) document behavioural health history; (3) access patient social and medical history relevant to behavioural health issues and (4) rapidly document and track progress on goals. To meet these needs, we engaged users and developed a set of EHR tools called the Behavioural Health e-Suite (BH e-Suite). Conclusion US-based integrated primary care teams, and particularly BHCs working with adult populations, have unique information needs, workflows and tasks. These needs can be met and supported by the EHR with a moderate level of modification.
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Affiliation(s)
- Tanisha Tate Woodson
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Rose Gunn
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Khaya D Clark
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health-Dallas Campus, Dallas, TX, USA.
| | - Katelyn K Jetelina
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health-Dallas Campus, Dallas, TX, USA.
| | - Brianna Muller
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA.
| | - Timothy E Burdick
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Medical Informatics & Clinical Epidemiology, OHSU School of Medicine, Portland, OR.
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
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Clarifying Values and Preferences for Care Near the End of Life: The Role of a New Lay Workforce. J Community Health 2018; 42:926-934. [PMID: 28353007 DOI: 10.1007/s10900-017-0336-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community health workers (CHWs) can engage elderly persons in advance care planning (ACP) conversations. We report how trained CHWs used Go Wish cards (GW R cards) to identify patients' highest priority preferences and evaluated whether engaging in ACP conversations was associated with subsequent health care utilization. A one-year long, pre-post longitudinal design was used to evaluate our educational intervention using mixed-methods. 392 patients (mean of 73.3 years, 82% women, 48% African American, 43% Caucasian) enrolled in the Aging Brain Care (ABC) program and participated in ACP discussions with CHWs. We expanded the role of the ABC's CHW, who work directly with individuals and caregivers during home visits to monitor bio-psycho-social needs, to include ACP conversations. The CHWs received ACP training, practice with tools such as GW R cards, and support from an electronic health record (EHR) clinical decision support tool. Quantitative measures of patients' ACP preferences and health care utilization were abstracted from the EHR. Qualitative data about patients' perceptions of CHWs in facilitating ACP discussions was obtained through semi-structured interviews. Eighty-six patients' data indicated that they had engaged in a preferences-for-care process using GW R cards. The top-three card choices by patients was attending to spirituality and religious concerns, preparing for end of life, and maintaining personal wholeness. CHWs were able to effectively engage in ACP conversations with patients and GW R cards were a positive way to stimulate discussion of issues previously undiscussed.
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Smith L, White S, Stubbs B, Hu L, Veronese N, Vancampfort D, Hamer M, Gardner B, Yang L. Depressive symptoms, handgrip strength, and weight status in US older adults. J Affect Disord 2018; 238:305-310. [PMID: 29902734 DOI: 10.1016/j.jad.2018.06.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Handgrip strength is a valid indicator of broader physical functioning. Handgrip strength and weight status have been independently associated with depressive symptoms in older adults, but no study has yet investigated the relationships between all three in older US adults. This study investigated the relationship between physical function and depressive symptoms by weight status in older US adults. METHODS Cross-sectional data were analysed from the National Health and Nutrition Examination Survey waves 2011 to 2012 and 2013 to 2014. Physical function was assessed using a grip strength dynamometer. Depressive symptoms were assessed using the self-reported Patient Health Questionnaire-9. Weight status was assessed using Body Mass Index (BMI) and participants were categorised as normal weight (< 25 kg/m2), overweight (25 to < 30 kg/m2), and obese (≥ 30.0 kg/m2). Associations between depressive symptoms and hand grip strength were estimated by gender-specific multiple linear regressions and BMI stratified multivariable linear regression. RESULTS A total of 2,812 adults (54% female, mean age 69.2 years, mean BMI 29.2 kg/m2) were included. Women with moderate to severe depressive symptoms had 1.60 kg (95% CI: 0.91 to 2.30) lower hand grip strength compared to women with minimal or no depressive symptoms. No such association was observed in men. Among those with obesity, men (-3.72 kg, 95% CI: -7.00 to -0.43) and women (-1.83 kg, 95% CI: -2.87 to -0.78) with moderate to severe depressive symptoms both had lower handgrip strength. CONCLUSION Among older US adults, women and people who are obese and depressed are at the greatest risk of decline in physical function.
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Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom.
| | - Stephanie White
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Liang Hu
- Department of Sport Science, Zhejiang University, Hangzhou, China
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Davy Vancampfort
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
| | - Mark Hamer
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; National Institute for Health Research Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, United Kingdom
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addison House, Guy's Campus, London, SE1 1UL, United Kingdom
| | - Lin Yang
- Department of Epidemiology, Medical University of Vienna, Austria.
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Elrashidi MY, Mohammed K, Bora PR, Haydour Q, Farah W, DeJesus R, Murad MH, Ebbert JO. Co-located specialty care within primary care practice settings: A systematic review and meta-analysis. Healthcare (Basel) 2018; 6:52-66. [DOI: 10.1016/j.hjdsi.2017.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/26/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022] Open
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Gebara MA, DiNapoli EA, Kasckow J, Karp JF, Blumberger DM, Lenze EJ, Mulsant BH, Reynolds CF. Specific depressive symptoms predict remission to aripiprazole augmentation in late-life treatment resistant depression. Int J Geriatr Psychiatry 2018; 33:e330-e335. [PMID: 28975710 PMCID: PMC5773368 DOI: 10.1002/gps.4813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To identify which specific depressive symptoms predict remission to aripiprazole augmentation in late-life treatment resistant depression. METHODS This is a secondary analysis of data from a late-life treatment resistant depression trial examining the safety and efficacy of aripiprazole augmentation. Participants aged 60 and above were randomized to aripiprazole augmentation (N = 91) versus placebo (N = 90). The main outcome was depression remission. Clinical predictors included individual Montgomery-Asberg Depression Rating Scale (MADRS) item scores categorized as symptomatic (scores >2) or nonsymptomatic (scores ≤2). RESULTS Three MADRS items predicted depression remission with aripiprazole augmentation: symptomatic scores on sleep disturbance and nonsymptomatic scores on apparent sadness and inability to feel. The 2-way and 3-way interaction terms of these MADRS items were not significant predictors of remission; therefore, the models' ability to predict remission was not improved by combining the significant MADRS items. CONCLUSIONS The identification of specific depressive symptoms, which can be clinically assessed, can be used to inform treatment decisions. Older adults with treatment resistant depression that present with sleep disturbances, lack of apparent sadness, or lack of inability to feel should be considered for aripiprazole augmentation.
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Affiliation(s)
- Marie Anne Gebara
- University of Pittsburgh School of Medicine, Pittsburgh, PA,Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Elizabeth A. DiNapoli
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - John Kasckow
- VA Beckley Healthcare System, Beckley, West Virginia
| | - Jordan F. Karp
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Daniel M. Blumberger
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric J. Lenze
- Washington University School of Medicine, St. Louis, MO
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Charles F. Reynolds
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Bingham KS, Kumar S, Dawson DR, Mulsant BH, Flint AJ. A Systematic Review of the Measurement of Function in Late-Life Depression. Am J Geriatr Psychiatry 2018; 26:54-72. [PMID: 29050912 DOI: 10.1016/j.jagp.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/17/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
Recovery of everyday premorbid function is a primary goal in the treatment of depression. Measurement of function is an important part of achieving this goal. A multitude of scales have been used to measure function in depression, reflecting the complex, multifaceted nature of functioning. Currently, however, there are no evidence-based guidelines to assist the researcher or clinician in deciding which instruments are best suited to measure function in late-life depression (LLD). Thus, the aims of this study are to 1) systematically review and identify the instrumental activities of daily living and social functioning assessment instruments used in the LLD literature; 2) identify and appraise the measurement properties of these instruments; and 3) suggest factors for LLD researchers and clinicians to consider when selecting functional assessment instruments and make pertinent recommendations. We performed a systematic review of MEDLINE and CINAHL to identify studies that i) incorporated subjects aged 60 years and older with a depressive disorder, and ii) measured instrumental activities of daily living and/or social functioning. Our search yielded 21 functional assessment instruments. Only two of these instruments, the 36-Item Short Form Survey and the Performance Assessment of Self-Care Skills, have formal validation data in LLD. Four additional instruments, although not formally validated, have relevant data regarding their measurement properties. The primary finding of this study is that very few functional assessment instruments have been validated in LLD, and the available measurement property data are mixed; there is a need for further instrument validation in late-life depression. With this caveat in mind, we provide evidence-based suggestions for researchers and clinicians assessing functioning in LLD patients.
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Affiliation(s)
- Kathleen S Bingham
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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Luan S, Wan H, Zhang L, Zhao H. Efficacy, acceptability, and safety of adjunctive aripiprazole in treatment-resistant depression: a meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat 2018; 14:467-477. [PMID: 29445284 PMCID: PMC5810518 DOI: 10.2147/ndt.s156619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) is common and potentially life-threatening in adults, and the benefits and risks of adjunctive aripiprazole in these patients remain controversial. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy, acceptability, safety, and quality of life of adjunctive aripiprazole in patients with TRD. METHODS RCTs published in PubMed, Web of Science, and Embase were systematically reviewed to evaluate the efficacy and safety profiles of TRD patients who were treated with adjunctive aripiprazole. The main outcome measures included response rate, remission rate, changes from baseline in Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impression-severity (CGI-S), Clinical Global Impression-improvement (CGI-I), 17-Item Hamilton Rating Scale for Depression (HAM-D17), Sheehan Disability scale (SDS), and Inventory of Depressive Symptomatology Self-Report Scale (IDS-SR), discontinuation due to adverse events, and adverse events. Risk ratio (RR) or weight mean difference with 95% confidence intervals (CIs) were pooled using a fixed-effects or random-effects model according to the heterogeneity among studies. RESULTS A total of 8 RCTs involving 2,260 patients were included in this meta-analysis. Adjunctive aripiprazole was associated with a significantly higher remission rate (RR =1.64, 95% CI: 1.42 to 1.89; P<0.001) and response rate (RR =1.45, 95% CI: 1.13 to 1.87; P=0.004) than other treatments. Moreover, adjunctive aripiprazole had greater changes in MADRS score, CGI-S score, CGI-I score, HAM-D17 score, SDS score, and IDS-SR score. There were more patients treated with adjunctive aripiprazole who discontinued their treatments due to adverse events. The incidence of adverse events was significantly higher in the adjunctive aripiprazole group than in other treatment groups. CONCLUSION The adjunctive aripiprazole showed benefits in improving the response rate, remission rate, and the quality of life in patients with TRD. However, clinicians should interpret these findings with caution due to the evidence of potential treatment-related side effects.
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Affiliation(s)
- Shuxin Luan
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun, China.,Department of Mental Health, The First Hospital of Jilin University, Changchun, China
| | - Hongquan Wan
- Department of Mental Health, The First Hospital of Jilin University, Changchun, China
| | - Lei Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Hua Zhao
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun, China.,Neuroscience Research Center, The First Hospital of Jilin University, Changchun, China
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Gebara MA, Kasckow J, Smagula SF, DiNapoli EA, Karp JF, Lenze EJ, Mulsant BH, Reynolds CF. The role of late life depressive symptoms on the trajectories of insomnia symptoms during antidepressant treatment. J Psychiatr Res 2018; 96:162-166. [PMID: 29069615 PMCID: PMC5698156 DOI: 10.1016/j.jpsychires.2017.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/13/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Sleep disturbances are common in late life depression; however, changes in insomnia symptoms during antidepressant treatment need to be characterized further. The objective of this study was two-fold: 1) to describe longitudinal trajectories of insomnia symptoms in older adults receiving antidepressant treatment and 2) to examine whether baseline depressive symptoms were associated with trajectories of sleep over time. METHODS Data was obtained from 680 older adults (aged ≥ 60) with major depression who participated in one of two protocolized open-label antidepressant treatment clinical trials (Maintenance Therapies in Late Life Depression [MTLD-3]; Incomplete Response in Late Life Depression: Getting to Remission [IRL-GRey]). Depression (total score minus sleep items) and sleep (sum of sleep items) outcomes were derived from the Hamilton Depression Rating Scale in the MLTD-3 and Montgomery-Asberg Depression Rating Scale in the IRL-GRey. RESULTS Both datasets identified 5 possible trajectories of insomnia symptoms with about half of the older adults having clinically significant baseline sleep disturbances and minimal improvement following a course of antidepressant treatment (i.e., sub-optimal sleep trajectory). Furthermore, across both datasets, worse baseline depression severity was associated with sub-optimal sleep trajectories. CONCLUSION In older adults receiving antidepressant treatment, those with clinically significant baseline sleep disturbances and greater depression severity may require adjunctive sleep-focused treatment to ameliorate sleep symptoms.
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Affiliation(s)
- Marie Anne Gebara
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - John Kasckow
- Beckley Health Care System, Behavioral Health, Beckley, WV
| | - Stephen F. Smagula
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elizabeth A. DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Pittsburgh, PA
| | - Jordan F. Karp
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Pittsburgh, PA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | | | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Cheung G, Edwards S, Sundram F. Death wishes among older people assessed for home support and long-term aged residential care. Int J Geriatr Psychiatry 2017; 32:1371-1380. [PMID: 27859762 DOI: 10.1002/gps.4624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/08/2016] [Accepted: 10/19/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. METHODS Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. RESULTS Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. CONCLUSIONS Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Siobhan Edwards
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Determine the prevalence of clinician-diagnosed posttraumatic stress disorder (PTSD) in primary care patients• Identify the prevalence of questionnaire-ascertained PTSD symptoms in primary care patients OBJECTIVE: Determine the prevalence of clinician-diagnosed PTSD and questionnaire-ascertained PTSD symptoms in primary care patients. METHODS A systematic review of the literature using the PRISMA method, searching MEDLINE, CINAHL, Cochrane Database, PsycINFO, EMBASE, Google Scholar, and relevant book chapter bibliographies. Studies that reported on the prevalence, including point or lifetime prevalence, of PTSD ascertained using diagnostic interviews or self-report questionnaires, or from administrative data, among patients seen in primary care were deemed eligible for inclusion. We abstracted data on the PTSD assessment tool, the mean questionnaire scores/cutoff scores, the time period of PTSD symptoms, and PTSD prevalence reported. RESULTS Of 10,614 titles screened, 41 studies were eligible for inclusion. The included studies assessed PTSD in a total of 7,256,826 primary care patients. The median point prevalence of PTSD across studies was 12.5%. The median point prevalence in the civilian population was 11.1%; in the special-risk population, 12.5%; and in veterans, 24.5%. The point prevalence of diagnostic interview-ascertained PTSD ranged from 2% to 32.5%, and the point prevalence of questionnaire-based substantial PTSD symptoms ranged from 2.9% to 39.1%. Lifetime prevalence of diagnostic interview-ascertained PTSD ranged from 14.5% to 48.8%. The prevalence of PTSD in administrative data-based studies ranged from 3.5% to 29.2%. CONCLUSIONS PTSD is common in primary care settings. Additional research on effective and generalizable interventions for PTSD in primary care is needed.
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Hummel J, Weisbrod C, Boesch L, Himpler K, Hauer K, Hautzinger M, Gaebel A, Zieschang T, Fickelscherer A, Diener S, Dutzi I, Krumm B, Oster P, Kopf D. AIDE-Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial. J Am Med Dir Assoc 2016; 18:341-349. [PMID: 27956074 DOI: 10.1016/j.jamda.2016.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. OBJECTIVES To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. DESIGN Randomized controlled trial with waiting list control group. SETTING Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients' homes. PARTICIPANTS A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. INTERVENTION Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. MEASUREMENTS HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. RESULTS The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. CONCLUSIONS CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. CLINICAL TRIAL REGISTRATION www.germanctr.de German Trial Register DRKS 00004728.
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Affiliation(s)
- Jana Hummel
- Geriatric and Gerontopsychotherapeutic Practice, Mannheim, Germany.
| | | | | | | | - Klaus Hauer
- Geriatric Center Bethanien, Heidelberg, Germany
| | | | | | | | | | | | - Ilona Dutzi
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Bertram Krumm
- Central Institute of Mental Health, Mannheim, Germany
| | - Peter Oster
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Daniel Kopf
- Department of Geriatrics, Marien Hospital, Hamburg, Germany
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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Nieves-Lugo K, del Rio-Gonzalez AM, Reisen C, Poppen P, Oursler KK, Zea MC. Greater Depressive Symptoms and Higher Viral Load Are Associated with Poor Physical Function among Latino Men Living with HIV. J Int Assoc Provid AIDS Care 2016; 16:30-36. [PMID: 27029892 PMCID: PMC5375101 DOI: 10.1177/2325957416640363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Physical function limitations have been associated with poor health outcomes, which have a negative impact on quality of life of older individuals. This study examined the association between depression, viral load, and acculturation with physical function among Latino men living with HIV. A secondary data analysis was performed using a cross-sectional data of 146 Latino immigrant men living with HIV in New York City and Washington, DC. Physical function was measured using the Short-Form Health Survey (SF-12). Uncontrolled HIV infection and depression were associated with worse physical function, thus implying the importance of adequate health care to address these conditions. Preserving physical function should start during middle adulthood, particularly among people living with HIV because of their greater risk of developing age-related challenges such as depression, diabetes, cardiovascular diseases among others. This study informs future interventions to preserve physical function and achieve the goal of successful aging.
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Affiliation(s)
- Karen Nieves-Lugo
- Department of Psychology, George Washington University, Washington, DC, USA
| | | | - Carol Reisen
- Department of Psychology, George Washington University, Washington, DC, USA
| | - Paul Poppen
- Department of Psychology, George Washington University, Washington, DC, USA
| | - Krisann K. Oursler
- Salem Veterans Affairs Medical Center, Salem, VA, USA
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Virginia Tech Research Institute, Roanoke, VA, USA
| | - Maria Cecilia Zea
- Department of Psychology, George Washington University, Washington, DC, USA
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Caban ME, Freeman JL, Zhang DD, Jansen C, Ostir G, Hatch SS, Goodwin JS. The relationship between depressive symptoms and shoulder mobility among older women: assessment at one year after breast cancer diagnosis. Clin Rehabil 2016; 20:513-22. [PMID: 16892933 DOI: 10.1191/0269215506cr966oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the association between depressive symptoms and shoulder range of motion at one year after breast cancer diagnosis, controlling for patient characteristics, tumour stage and cancer therapy (surgery, axillary node dissection and radiation). Design: Prospective trial of nurse case management involving 187 older women with complete data, age 60 years and older, newly diagnosed with breast cancer, from 1 November, 1993 to 31 October, 1996 in south-eastern Texas. Depressive symptoms, sociodemographic characteristics and breast cancer treatment were measured at two months and shoulder range of motion at 12 months. The relationship among the variables was evaluated with bivariate chi-square statistics and logistic regression analysis. All logistic models also included a variable indicating whether or not the woman received nurse case management, to control for intervention status. Results: Increasing depressive symptoms at baseline were associated with lower arm mobility at 12 months following breast cancer diagnosis. Each unit increase in depressive symptoms at baseline was associated with an 8% decreased odds of having full range of motion of the shoulder (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87, 0.97), after controlling for relevant patient and treatment factors. Conclusion(s): Older women with depressive symptoms have an elevated risk of not fully recovering shoulder mobility after being treated for breast cancer. Future studies are needed to assess benefits from early intervention with psychological and or physical interventions in the presence of depressive symptoms on shoulder mobility.
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Affiliation(s)
- Mabel E Caban
- Department of Orthopedics and Rehabilitation, Route 0165, University of Texas Medical Branch, Galveston, TX 77555, USA.
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Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning. Palliat Support Care 2016; 14:641-651. [PMID: 27320687 DOI: 10.1017/s1478951516000353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. METHOD Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. RESULTS Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. SIGNIFICANCE OF RESULTS Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for "sustaining hope" (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers.
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Kaneriya SH, Robbins-Welty GA, Smagula SF, Karp JF, Butters MA, Lenze EJ, Mulsant BH, Blumberger D, Anderson SJ, Dew MA, Lotrich F, Aizenstein HJ, Diniz BS, Reynolds CF. Predictors and Moderators of Remission With Aripiprazole Augmentation in Treatment-Resistant Late-Life Depression: An Analysis of the IRL-GRey Randomized Clinical Trial. JAMA Psychiatry 2016; 73:329-36. [PMID: 26963689 PMCID: PMC4823175 DOI: 10.1001/jamapsychiatry.2015.3447] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Safe, efficacious, second-line pharmacological treatment options exist for the large portion of older adults with major depressive disorder who do not respond to first-line pharmacotherapy. However, limited evidence exists to aid clinical decision making regarding which patients will benefit from which second-line treatments. OBJECTIVE To test the moderating role of pretreatment executive function, severity of anxiety, and severity of medical comorbidity in remission of treatment-resistant late-life depression after aripiprazole augmentation. DESIGN, SETTING, AND PARTICIPANTS As follow-up to a 12-week randomized clinical trial of aripiprazole augmentation for first-line treatment-resistant late-life depression (Incomplete Response in Late-Life Depression: Getting to Remission [IRL-GRey]), we evaluated the effects of the following potential moderators and their interactions with treatment: baseline assessments of executive function (set shifting measured by the Trail Making Test) and response inhibition control (measured by a Color-Word Interference task), anxiety symptoms, and medical comorbidity. Analyses were conducted in May and June 2015. INTERVENTIONS Aripiprazole or placebo tablets were started at 2 mg daily and titrated as tolerated, to a maximal dose of 15 mg daily. MAIN OUTCOMES AND MEASURES Remission of treatment-resistant late-life depression (defined as a Montgomery-Åsberg Depression Rating Scale score of ≤10 at both of the last 2 consecutive visits). RESULTS Of 181 trial participants (103 female [56.9%]) who were 60 years of age or older and whose major depression had failed to remit with venlafaxine hydrochloride monotherapy, 91 received aripiprazole and 90 received placebo. Remission occurred in 40 (43%) who received aripiprazole and 26 (29%) who received placebo. Baseline set shifting moderated the efficacy of aripiprazole augmentation (odds ratio [OR], 1.66 [95% CI, 1.05-2.62]; P = .03 for interaction with treatment). Among participants with a Trail Making Test scaled score of 7 or higher, the odds of remission were significantly higher with aripiprazole than with placebo (53% vs 28%; number needed to treat, 4; OR, 4.11 [95% CI, 1.83-9.20]). Among participants with a Trail Making Test scaled score of less than 7, aripiprazole and placebo were equally efficacious (OR, 0.64 [95% CI, 0.15-2.80]). Greater severity of anxiety at baseline predicted a lower remission rate but did not moderate aripiprazole efficacy; each standard deviation greater anxiety severity was associated with 50% reduced odds of remission in both aripiprazole and placebo arms. Medical comorbidity and Color-Word Interference test performance were neither general predictors nor treatment-moderating factors. CONCLUSIONS AND RELEVANCE Set-shifting performance indicates which older adults with treatment-resistant depression may respond favorably to augmentation with aripiprazole and thus may help to personalize treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00892047.
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Affiliation(s)
| | | | - Stephen F. Smagula
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jordan F. Karp
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Meryl A. Butters
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric J. Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Blumberger
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Stewart J Anderson
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Amanda Dew
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Departments of Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Francis Lotrich
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Howard J. Aizenstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Breno S. Diniz
- Department of Mental Health, Federal University of Minas Gerais School of Medicine, Belo Horizonte, MG, Brazil,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles F. Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Millstein RA, Celano CM, Beale EE, Beach SR, Suarez L, Belcher AM, Januzzi JL, Huffman JC. The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome. Gen Hosp Psychiatry 2016; 43:17-22. [PMID: 27796252 PMCID: PMC6894170 DOI: 10.1016/j.genhosppsych.2016.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study examined the effects of optimism and gratitude on self-reported health behavior adherence, physical functioning and emotional well-being after an acute coronary syndrome (ACS). METHODS Among 156 patients, we examined associations between optimism and gratitude measured 2 weeks post-ACS and 6-month outcomes: adherence to medical recommendations, mental and physical health-related quality of life (HRQoL), physical functioning, depressive symptoms and anxiety. Multivariable linear regression models were used, controlling for increasing levels of adjustment. RESULTS Optimism [β=.11, standard error (S.E.)=.05, P=.038] and gratitude (β=.10, S.E.=.05, P=.027) at 2 weeks were associated with subsequent self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) at 6 months in fully adjusted models. Two-week optimism and gratitude were associated with improvements in mental HRQoL (optimism: β=.44, S.E.=.13, P=.001; gratitude: β=.33, S.E.=.12, P=.005) and reductions in symptoms of depression (optimism: β=-.11, S.E.=.05, P=.039; gratitude: β=-.10, S.E.=.05, P=.028) and anxiety (optimism: β=-.15, S.E.=.05, P=.004; gratitude: β=-.10, S.E.=.05, P=.034) at 6 months. CONCLUSION Optimism and gratitude at 2 weeks post-ACS were associated with higher self-reported adherence and improved emotional well-being 6 months later, independent of negative emotional states. Optimism and gratitude may help recovery from an ACS. Interventions promoting these positive constructs could help improve adherence and well-being.
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Affiliation(s)
- Rachel A. Millstein
- Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA,Corresponding author at: Massachusetts General Hospital, 55 Fruit Street/Warren 1220, Boston, MA 02114, USA. Tel.: +1 617 724 2047; fax: +1 617 724 9150. (R.A. Millstein)
| | - Christopher M. Celano
- Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | | | - Scott R. Beach
- Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Laura Suarez
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Arianna M. Belcher
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - James L. Januzzi
- Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA,Department of Medicine, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Jeff C. Huffman
- Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA,Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
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Zarzaur BL, Bell T. Trajectory subtypes after injury and patient-centered outcomes. J Surg Res 2015; 202:103-10. [PMID: 27083954 DOI: 10.1016/j.jss.2015.12.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/02/2015] [Accepted: 12/22/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND The recent focus on patient-centered outcomes highlights the need to better describe recovery trajectories after injury. The purpose of this study was to characterize recovery trajectory subtypes that exist after non-neurologic injury. MATERIALS AND METHODS A prospective, observational cohort of 500 adults with an Injury Severity Score > 10 but without traumatic brain or spinal cord injury from 2009 to 2011 was formed. The Short Form-36 was administered at admission and repeated at 1, 2, 4, and 12 mo after injury. Group-based trajectory modeling was used to determine the number and shape of physical composite score (PCS) and mental composite score (MCS) trajectories. RESULTS Three PCS trajectories and five MCS trajectories were identified. For PCS, trajectory 1 (10.4%) has low baseline scores, followed by no improvement over time. Trajectory 2 (65.6%) declines 1 mo after injury then improves over time. Trajectory 3 (24.1%) has a sharp decline followed by rapid recovery. For MCS, trajectory 1 (9.4%) is low at baseline and remains low. Trajectory 2 (14.4%) has a large decrease after injury and does not recover over the next 12 mo. Trajectory 3 (22.7%) has an initial decrease in MCS early, followed by continuous recovery. Trajectory 4 (19.1%) has a steady decline over the study period. Trajectory 5 (34.3%) stays consistently high at all time points. CONCLUSIONS Recovery after injury is complex and results in multiple recovery trajectories. This has implications for patient-centered clinical trial design and in development of patient-specific interventions to improve outcomes.
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Affiliation(s)
- Ben L Zarzaur
- Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Teresa Bell
- Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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