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Centeno JG, Obler LK, Collins L, Wallace G, Fleming VB, Guendouzi J. Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States. Am J Speech Lang Pathol 2023:1-11. [PMID: 37099740 DOI: 10.1044/2023_ajslp-22-00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. METHOD We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. RESULTS The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. CONCLUSION Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.
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Affiliation(s)
- José G Centeno
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Loraine K Obler
- Department of Speech-Language-Hearing Sciences, City University of New York, New York
| | - Linda Collins
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond
| | - Gloriajean Wallace
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA
| | - Valarie B Fleming
- Department of Communication Disorders, Texas State University, San Marcos
| | - Jacqueline Guendouzi
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond
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Meza E, Peterson R, Gilsanz P, George KM, Miles SJ, Eng CW, Mungas DM, Mayeda ER, Glymour MM, Whitmer RA. Perceived Discrimination, Nativity, and Cognitive Performance in a Multi-ethnic Study of Older Adults: Findings from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study. J Gerontol A Biol Sci Med Sci 2021; 77:e65-e73. [PMID: 34125189 PMCID: PMC8824601 DOI: 10.1093/gerona/glab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite growing research on the association between discrimination and disparities in cognitive aging, an evidence gap remains on how the association varies by racial/ethnic group. This study evaluates the associations of experiences of discrimination with cognitive function and whether these associations varied by race/ethnicity and nativity. METHODS Using the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) cohort (N=1,712) with approximately equal groups of Black, White, Latino, and Asian community-dwelling older adults aged 65 years and older, we evaluated the associations between self-reported experiences of everyday and major lifetime discrimination with overall cognitive performance and domain-specific cognition (verbal episodic memory, semantic memory and executive functioning) across race/ethnicity and nativity. Linear regression models examined the cross-sectional association between self-reported experiences of everyday and major lifetime discrimination with z-standardized coefficients for cognition. We tested for effect modification by race and nativity. All models controlled for age, sex and education. RESULTS Among KHANDLE participants (mean age: 76 years; standard deviation: 6.8), everyday discrimination was not associated with cognitive scores. Major lifetime discrimination was associated with better average cognitive scores among Black participants but not among other racial/ethnic groups. Major lifetime discrimination was associated with better average cognitive scores among US-born but not among non-US born individuals. CONCLUSION Our findings do not imply that discrimination improves cognition, but rather suggest that future research should include more detailed measures on discrimination and unfair treatment that could help disentangle the extent to which relationships are causal or reflect some other underlying factor.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA
| | - Rachel Peterson
- Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis, Davis, CA
| | - Sunita J Miles
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chloe W Eng
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dan M Mungas
- Department of Neurology, University of California, Davis, Davis, CA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco, CA
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis, Davis, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Hooker K, Phibbs S, Irvin VL, Mendez-Luck CA, Doan LN, Li T, Turner S, Choun S. Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity. Gerontologist 2020; 59:886-891. [PMID: 30561600 DOI: 10.1093/geront/gny159] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups. RESEARCH DESIGN AND METHODS Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations. RESULTS Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites. DISCUSSION AND IMPLICATIONS Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.
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Affiliation(s)
- Karen Hooker
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Sandi Phibbs
- Department of Health Science and Recreation, College of Health and Human Sciences, San Jose State University, California
| | - Veronica L Irvin
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Carolyn A Mendez-Luck
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Lan N Doan
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Tao Li
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Shelbie Turner
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Soyoung Choun
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
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Abstract
This study examined public stigma associated with Alzheimer's disease (AD) among Korean Americans and identified factors affecting their public stigma. Data used in the study were collected using a cross-sectional survey with 268 Korean Americans. Guided by attribution theory, different domains of public stigma were assessed: pity, antipathy, and social distance. Hierarchical regression analyses were conducted to examine the effects of sociodemographic characteristics, exposure to AD, social networking, and AD knowledge on each stigma domain. The influence of emotional attributions (pity and antipathy) on behavioral attributions (social distance) in the stigma process suggested in attribution theory was also examined. Results show that pity is most prevalent followed by social distance and antipathy. Being more proficient in English, knowing fewer relatives/friends with AD, and knowing less about AD risk factors are associated with having more pity stigma. Being less socially engaged and knowing less about AD risk factors are related to having more antipathy stigma. Being younger and more proficient in English and having stronger antipathy stigma are associated with having more social distance stigma. Findings reveal multifaceted nature of public stigma associated with AD in Korean Americans and suggest that we need to work on both positive and negative sides of public stigma for stigma change. Findings of different factors associated with each public stigma domain can be considered when trying to foster and/or reduce certain stigmatic beliefs and behaviors associated with AD.
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Affiliation(s)
- Sang E Lee
- School of Social Work, San Jose State University, CA, USA
| | - Michin Hong
- School of Social Work, Indiana University, IN, USA
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Roth AR, Canedo A, Balabanova R, Chauhan V. My Life, My Way: A Quality Improvement Program to Increase Advance Care Planning in a Racially and Ethnically Diverse Patient Population. J Pain Symptom Manage 2020; 59:147-151. [PMID: 31655191 DOI: 10.1016/j.jpainsymman.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A multilevel quality improvement program was implemented at an urban community hospital, serving a racially and ethnically pluralistic patient population, to increase participation in advance care planning (ACP). MEASURES Number of eligible patients who completed an ACP form. INTERVENTION Projects were implemented over the course of two years that targeted patients, health care providers, the organization, and the community. OUTCOMES The intervention resulted in increased completion of four unique ACP forms. Completion of the Living Will increased by 60%, Health Care Proxy increased by 9%, Medical Orders for Life-Sustaining Treatment increased by 5%, and Do-Not-Resuscitate/Do-Not-Intubate orders increased by 3%. CONCLUSION Multilevel interventions can increase ACP participation in a racially and ethnically pluralistic patient population.
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Affiliation(s)
- Alan R Roth
- Jamaica Hospital Medical Center, Richmond Hill, New York, USA.
| | - Angelo Canedo
- Jamaica Hospital Medical Center, Richmond Hill, New York, USA
| | | | - Vandana Chauhan
- Jamaica Hospital Medical Center, Richmond Hill, New York, USA
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Bilbrey AC, Humber MB, Plowey ED, Garcia I, Chennapragada L, Desai K, Rosen A, Askari N, Gallagher-Thompson D. The Impact of Latino Values and Cultural Beliefs on Brain Donation: Results of a Pilot Study to Develop Culturally Appropriate Materials and Methods to Increase Rates of Brain Donation in this Under-Studied Patient Group. Clin Gerontol 2018; 41:237-248. [PMID: 29227743 PMCID: PMC5962259 DOI: 10.1080/07317115.2017.1373178] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Increasing the number of Latino persons with dementia who consent to brain donation (BD) upon death is an important public health goal that has not yet been realized. This study identified the need for culturally sensitive materials to answer questions and support the decision-making process for the family. METHODS Information about existing rates of BD was obtained from the Alzheimer's Disease Centers. Several methods of data collection (query NACC database, contacting Centers, focus groups, online survey, assessing current protocol and materials) were used to give the needed background to create culturally appropriate BD materials. RESULTS A decision was made that a brochure for undecided enrollees would be beneficial to discuss BD with family members. For those needing further details, a step-by-step handout would provide additional information. CONCLUSIONS Through team collaboration and engagement of others in the community who work with Latinos with dementia, we believe this process allowed us to successfully create culturally appropriate informational materials that address a sensitive topic for Hispanic/Latino families. CLINICAL IMPLICATIONS Brain tissue is needed to further knowledge about underlying biological mechanism of neurodegenerative diseases, however it is a sensitive topic. Materials assist with family discussion and facilitate the family's follow-through with BD.
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Affiliation(s)
- Ann Choryan Bilbrey
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
- c Department of Psychiatry and Behavioral Sciences , Stanford University , Palo Alto , California , USA
| | - Marika B Humber
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
- f Palo Alto University , Palo Alto , California , USA
| | - Edward D Plowey
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
- b Department of Neurology , Stanford University , Palo Alto , California , USA
| | - Iliana Garcia
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
- d Nuestra Casa , East Palo Alto , California, USA
| | - Lakshmi Chennapragada
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
| | - Kanchi Desai
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
| | - Allyson Rosen
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
- e Veterans Affairs Medical Center , Palo Alto , California , USA
| | - Nusha Askari
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
| | - Dolores Gallagher-Thompson
- a Stanford Alzheimer's Disease Research Center , Stanford University , Palo Alto , California , USA
- c Department of Psychiatry and Behavioral Sciences , Stanford University , Palo Alto , California , USA
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Njeru JW, Boehm DH, Jacobson DJ, Guzman-Corrales LM, Fan C, Shimotsu S, Wieland ML. Diabetes Outcome and Process Measures Among Patients Who Require Language Interpreter Services in Minnesota Primary Care Practices. J Community Health 2018; 42:819-825. [PMID: 28229264 DOI: 10.1007/s10900-017-0323-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Immigrants and refugees are less likely to meet diabetes management goals than the general US population. Those with limited English proficiency (LEP) and who need interpreter services (IS) for health care encounters, maybe at higher risk for encountering barriers to optimal diabetes management, and while most receive diabetes care in primary care settings, little is known about the association between IS need and diabetes outcomes. This study aims to determine adherence with diabetes process and outcomes measures among LEP patients in primary care settings, and is a retrospective cohort study of patients with type II diabetes at two large primary care networks in Minnesota from January 1, 2012 through December 31, 2013. Diabetes outcome measure goals were defined as hemoglobin A1C <8%, LDL-C <100 mg/dL, and blood pressure <140/90 mmHg. Process measure goals were defined as hemoglobin A1C measured within the previous 6 months and LDL cholesterol (LDL-C) measured within the previous 12 months. Compared to non-IS patients (N = 11,970), IS patients (N = 1486) were more likely to meet guideline outcome recommendations for blood pressure (Adjusted odds ratio [OR] 2.02; 95% confidence interval [CI] 1.70, 2.40), hemoglobin A1C (OR 1.23; 95% CI 1.08, 1.40), and LDL-C (OR 1.40; 95% CI 1.2, 1.62). Older IS patients and male IS patients were less likely to meet recommendations for hemoglobin A1C (OR 0.70; 95% CI 0.48, 1.02; OR 0.66; CI 0.54, 0.79; respectively) and LDL-C (OR 0.81; 95% CI 0.55, 1.17; OR 0.47; CI 0.39, 0.57; respectively). Healthcare system solutions need to bridge gaps from process to outcomes among LEP patients who require IS in primary care settings.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Deborah H Boehm
- Hennepin County Medical Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura M Guzman-Corrales
- Hennepin County Medical Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Scott Shimotsu
- Analytics Center of Excellence, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Mehta KM, Yeo GW. Systematic review of dementia prevalence and incidence in United States race/ethnic populations. Alzheimers Dement 2017; 13:72-83. [PMID: 27599209 DOI: 10.1016/j.jalz.2016.06.2360] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 05/27/2016] [Accepted: 06/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify incidence and prevalence of dementia in racial and ethnic populations in the United States. METHODS A systematic review of literature. RESULTS A total of 1215 studies were reviewed; 114 were included. Dementia prevalence rates reported for age 65+ years from a low of 6.3% in Japanese Americans, 12.9% in Caribbean Hispanic Americans, 12.2% in Guamanian Chamorro and ranged widely in African Americans from 7.2% to 20.9%. Dementia annual incidence for African American (mean = 2.6%; SD = 1%; range, 1.4%-5.5%) and Caribbean Hispanic populations were significantly higher (mean, 3.6%; SD, 1.2%; range, 2.3%-5.3%) than Mexican American and Japanese Americans and non-Latino white populations (0.8%-2.7%), P < .001. CONCLUSIONS Data are needed for American Indian, most Asian, and Pacific Islander populations. Disaggregation of large race/ethnic classifications is warranted due to within-population heterogeneity in incidence and prevalence. African American and Caribbean Hispanic studies showed higher incidence of dementia. A nationwide approach is needed to identify communities at high risk and to tailor culturally appropriate services accordingly.
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Njeru JW, St Sauver JL, Jacobson DJ, Ebbert JO, Takahashi PY, Fan C, Wieland ML. Emergency department and inpatient health care utilization among patients who require interpreter services. BMC Health Serv Res 2015; 15:214. [PMID: 26022227 PMCID: PMC4448538 DOI: 10.1186/s12913-015-0874-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited English proficiency is associated with health disparities and suboptimal health outcomes. Although Limited English proficiency is a barrier to effective health care, its association with inpatient health care utilization is unclear. The aim of this study was to examine the association between patients with limited English proficiency, and emergency department visits and hospital admissions. METHODS We compared emergency department visits and hospitalizations in 2012 between patients requiring interpreter services and age-matched English-proficient patients (who did not require interpreters), in a retrospective cohort study of adult patients actively empanelled to a large primary health care network in a medium-sized United States city (n = 3,784). RESULTS Patients who required interpreter services had significantly more Emergency Department visits (841 vs 620; P ≤ .001) and hospitalizations (408 vs 343; P ≤ .001) than patients who did not require interpreter services. On regression analysis the risk of a first Emergency Department visit was 60% higher for patients requiring interpreter services than those who did not (unadjusted hazard ratio [HR], 1.6; 95% confidence interval (CI), 1.4-1.9; P < .05), while that of a first hospitalization was 50% higher (unadjusted HR, 1.5; 95% CI, 1.2-1.8; P < .05). These findings remained significant after adjusting for age, sex, medical complexity, residency and outpatient health care utilization. CONCLUSIONS Patients who required interpreter services had higher rates of inpatient health care utilization compared with patients who did not require an interpreter. Further research is required to understand factors associated with this utilization and to develop sociolinguistically tailored interventions to facilitate appropriate health care provision for this population.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Abstract
This article discusses the increased diversity of older adults expected to be treated in intensive care units over the next 10 years. The importance of the integration of an ethnogeriatric assessment to include ethnicity, level of acculturation, religion/spirituality, preferred interaction pattern, facilitation of communication, and physical examination constraints due to ethnicity are discussed.
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Affiliation(s)
- Sonya R Hardin
- East Carolina University, College of Nursing, 600 Moye Boulevard, Greenville, NC 27858, USA.
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Karter AJ, Laiteerapong N, Chin MH, Moffet HH, Parker MM, Sudore R, Adams AS, Schillinger D, Adler NS, Whitmer RA, Piette JD, Huang ES. Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study. J Aging Health 2015; 27:894-918. [PMID: 25659747 DOI: 10.1177/0898264315569455] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. METHOD An observational study was conducted among 115,538 diabetes patients, aged ≥60, in an integrated health care system with uniform access to care. RESULTS Compared with Whites, Asians and Filipinos were more likely to be underweight but had substantively lower prevalence of falls, urinary incontinence, polypharmacy, depression, and chronic pain, and were least likely of all groups to have at least one geriatric condition. African Americans had significantly lower prevalence of incontinence and falls, but higher prevalence of dementia; Latinos had a lower prevalence of falls. Except for end-stage renal disease (ESRD), Whites tended to have the highest rates of prevalent diabetic complications. DISCUSSION Among these insured older adults, ethnic health patterns varied substantially; differences were frequently small and rates were often better among select minority groups, suggesting progress toward the Healthy People 2020 objective to reduce health disparities.
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Affiliation(s)
| | | | | | | | | | | | - Alyce S Adams
- Kaiser Permanente Division of Research, Oakland, CA, USA
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Lee SE, Casado BL. Assessment of Alzheimer's disease symptom recognition in Korean Americans and psychometric analysis of Alzheimer's Disease Symptom Recognition Scale (ADSRS). J Gerontol Soc Work 2015; 58:289-305. [PMID: 25602359 DOI: 10.1080/01634372.2015.1005785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 01/06/2015] [Indexed: 06/04/2023]
Abstract
This study examined recognition of Alzheimer's disease symptoms among Korean Americans (KAs) and assessed psychometric properties of the Alzheimer's Disease Symptom Recognition Scale (ADSRS). A cross-sectional survey collected data from 209 KAs, using a self-administered questionnaire. Results show that KAs recognized symptoms related to memory and cognitive functioning well, but had very limited recognition of neuropsychiatric symptoms. Psychometric analysis of ADSRS identified 4 factors in their symptom recognition. Findings suggest a need to raise awareness of Alzheimer's symptoms over the course of the disease. Assessment using ADSRS can be incorporated in communication in the practice context and public outreach.
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Affiliation(s)
- Sang E Lee
- a School of Social Work , San Jose State University , San Jose , California , USA
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Kim H, Woods DL, Phillips LR, Ruiz ME, Salem B, Jeffers-Skrine K, Salem N. Nursing Assistants’ Communication Styles in Korean American Older Adults With Dementia. J Transcult Nurs 2014; 26:185-92. [DOI: 10.1177/1043659614547200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As ethnic diversity increases in the United States with the anticipated increase in dementia, it is critical to understand the implications of dementia and culturally appropriate communication for ethnic minority older adults with dementia. Utilizing the Ethno-Cultural Gerontological Nursing model and the Progressively Lowered Stress Threshold model, this article describes the relationship between nursing assistants’ communication style and behavioral symptoms of dementia, focused on Korean American older adults with dementia residing in nursing homes. The discussion includes reviewing currently available studies, nursing implications, and suggestions for future studies.
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Affiliation(s)
- Haesook Kim
- University of California, Los Angeles, CA, USA
| | | | | | | | | | | | - Nancy Salem
- University of California, Los Angeles, CA, USA
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Kim H, Woods DL, Mentes JC, Martin JL, Moon A, Phillips LR. The nursing assistants' communication style and the behavioral symptoms of dementia in Korean-American nursing home residents. Geriatr Nurs 2014; 35:S11-6. [DOI: 10.1016/j.gerinurse.2014.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Hong S, Cagle J. Factors associated with perceptions of the cancer care system: a multilevel modeling approach. J Psychosoc Oncol 2013; 31:642-58. [PMID: 24175900 DOI: 10.1080/07347332.2013.835020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Perceptions about the health care system are a key driver of disparities and utilization. This study examined individual and contextual factors related to care and noncare dimensions and their relationship to perceptions of the cancer care system. A national sample of 877 cases was modeled using a multilevel modeling approach. Insurance complaints, number of treatments, and advocacy impact were negatively associated with satisfaction with the cancer care system at the individual level. Also, respondents in states where more Christians resided and lower hospital capacity were more likely to indicate satisfaction. Findings suggest implications for practitioners and health policy makers.
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Affiliation(s)
- Seokho Hong
- a School of Social Work , University of Maryland , Baltimore , MD , USA
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Ahalt C, Walter LC, Yourman L, Eng C, Pérez-Stable EJ, Smith AK. "Knowing is better": preferences of diverse older adults for discussing prognosis. J Gen Intern Med 2012; 27:568-75. [PMID: 22127798 PMCID: PMC3326105 DOI: 10.1007/s11606-011-1933-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/27/2011] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis. OBJECTIVE To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability. DESIGN & PARTICIPANTS We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco's On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory. KEY RESULTS Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had <5 years to live and 75% if the estimate was <1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged. CONCLUSIONS Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.
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Affiliation(s)
- Cyrus Ahalt
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
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Eisenstein DH. Anticoagulation management in the ambulatory surgical setting. AORN J 2012; 95:510-21 examination 522-4. [PMID: 22464623 DOI: 10.1016/j.aorn.2012.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 09/02/2011] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.
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King J, Yourman L, Ahalt C, Eng C, Knight SJ, Pérez-Stable EJ, Smith AK. Quality of life in late-life disability: "I don't feel bitter because I am in a wheelchair". J Am Geriatr Soc 2012; 60:569-76. [PMID: 22288767 DOI: 10.1111/j.1532-5415.2011.03844.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine perceived quality of life in a diverse population of elderly adults with late-life disability. DESIGN Qualitative cross-sectional study. SETTING Community-dwelling participants were recruited from San Francisco's On Lok Lifeways program, the first Program of All-inclusive Care for the Elderly. On Lok enrollees meet Medicaid criteria for nursing home placement. PARTICIPANTS Sixty-two elderly adults with a mean age of 78 and a mean 2.4 activity of daily living dependencies and 6.6 instrumental activity of daily living dependencies were interviewed. Respondents were 63% female, 24% white, 19% black, 18% Latino, 32% Chinese American, and 6% other race. MEASUREMENTS Elderly adults who scored higher than 17 points on the Mini-Mental State Examination were interviewed. Interviews were conducted in English, Spanish, and Cantonese. Respondents were asked to rate their overall quality of life on a 5-point scale. Open-ended questions explored positive and negative aspects of participants' daily experiences. Interviews were analyzed using modified grounded theory and digital coding software. RESULTS Eighty-seven percent of respondents rated their quality of life in the middle range of the quality-of-life spectrum (fair to very good). Themes were similar across ethnic groups. Most themes could be grouped into four domains that dependent elderly adults considered important to their quality of life: physical (e.g., pain), psychological (e.g., depression), spiritual or religious (e.g., religious coping), and social (e.g., life-space). Dignity and a sense of control were identified as themes that are the most closely tied to overall quality of life. CONCLUSION Factors that influence quality of life in late-life disability were similar across ethnic groups. As the number of elderly adults from diverse backgrounds with late life disability increases in the United States, interventions should be targeted to maximize daily sense of control and dignity.
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Affiliation(s)
- Jennifer King
- School of Medicine, University of California at San Francisco, San Francisco, California 94121, USA
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Jerant A, Sohler N, Fiscella K, Franks B, Franks P. Tailored interactive multimedia computer programs to reduce health disparities: opportunities and challenges. Patient Educ Couns 2011; 85:323-330. [PMID: 21146950 PMCID: PMC3070866 DOI: 10.1016/j.pec.2010.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/10/2010] [Accepted: 11/21/2010] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To review the theory and research evidence suggesting that tailored interactive multimedia computer programs (IMCPs) aimed at optimizing patient health behaviors could lessen socio-demographic health disparities. METHODS Selective critical review of research regarding IMCPs tailored to psychological mediators of behavior and their effects on health behavior and outcomes among socio-demographically disadvantaged patients. RESULTS Tailored IMCPs can address patient factors (e.g. language barriers, low self-efficacy) and buffer provider (e.g. cognitive bias) and health system (e.g. office visit time constraints) factors that contribute to poor provider-patient communication and, thereby, suboptimal health behaviors. Research indicates disadvantaged individuals' interactions with providers are disproportionately affected by such factors, and that their behaviors respond favorably to tailored information, thus suggesting tailored IMCPs could mitigate disparities. However, no randomized controlled trials (RCTs) have examined this question. The optimal design and deployment of tailored IMCPs for disadvantaged patients also requires further study. CONCLUSION Preliminary research suggests tailored IMCPs have the potential to reduce health disparities. RCTs designed expressly to examine this issue are warranted. PRACTICE IMPLICATIONS Many socio-demographic health disparities exist, and there is a dearth of proven disparity-reducing interventions. Thus, if tailored IMCPs were shown to lessen disparities, the public health implications would be considerable.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
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Yeboah-Korang A, Kleppinger A, Fortinsky RH. Racial and ethnic group variations in service use in a national sample of Medicare home health care patients with type 2 diabetes mellitus. J Am Geriatr Soc 2011; 59:1123-9. [PMID: 21649625 DOI: 10.1111/j.1532-5415.2011.03424.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Type 2 diabetes mellitus is known to affect adults in racial and ethnic minority groups disproportionately. When diabetes mellitus-related symptoms lead to the need for skilled care in the community-dwelling Medicare population, physicians can order the Medicare home health care (HHC) benefit, and Medicare-certified home health agencies can deliver it. Little is known about the extent to which racial and ethnic disparities exist in types and patterns of HHC services delivered to Medicare beneficiaries with diabetes mellitus when they are approved for the Medicare HHC benefit. This was examined by comparing racial and ethnic groups in terms of measures of HHC service use in a nationally representative sample of Medicare HHC beneficiaries with a primary diagnosis of type 2 diabetes mellitus. Uniform clinical data from the Outcome and Assessment Information Set were linked with Medicare HHC claims for beneficiaries who received a complete episode of HHC in 2002. In the study sample (n=9,838), 62% of participants self-identified as white, 22% African American, 12% Hispanic, and 3% Asian. Nearly all (99%) participants in all racial and ethnic groups received skilled nursing services. Controlling for numerous sociodemographic and health-related covariates and geographic region of the country, African-American participants received fewer nurse visits per week and fewer visits per week from all clinical disciplines combined than whites (both P<.001), and Hispanic participants were less likely than whites to receive physical therapy (adjusted odds ratio (AOR)=0.640, 95% confidence interval (CI)=0.543-0.754, P<.001) or home health aide (AOR=0.716, 95% CI=0.582-0.880, P=.002) services. Lower use of skilled nursing and rehabilitation services by African Americans and of rehabilitation services by Hispanics warrant further clinical and research attention.
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Affiliation(s)
- Amoah Yeboah-Korang
- School of Medicine, University of Connecticut, Farmington, Connecticut 06030, USA
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Abstract
Objective: This study examined the characteristics of individuals in hospice care by racial/ethnic groups. Methods: A total of 22,936 patients served by a hospice in Central Florida during a four-year period, from 2002 to 2006, were included. Of these, 80.6% were White, 9.6% were Black/African-American, 9.3% were Hispanic and 0.5% were Asian American/Pacific Islander. We examined the associations between the characteristics of hospice users and race/ethnicity, and change of hospice user characteristics over time using chi-square and ANOVA tests. Results: More females than males were represented. Spouse caregivers were most common for Whites (35%) and Asian/Pacific Islanders (36%). However, “other” (41%) caregivers were most frequent for African Americans and daughters (33%) were most often caregivers for Hispanics. Cancer was the primary diagnosis across the four groups. Racial/ethnic minorities were more likely to rely on Medicaid than Whites (10-70% vs. 4%) and African Americans were most likely to be transferred from hospital (57%), whereas Whites were referred from assisted living/nursing homes more frequently than others(16% vs. 7-10%). Conclusion: As the hospice settings become more racially/ethnically diverse, it is essential to attend to the different circumstances and needs of the various groups in providing optimal care.
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Affiliation(s)
| | - Nan Sook Park
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Beom S. Lee
- School of Social Work, University of South Florida, Tampa, FL, USA
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Abstract
To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.
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Affiliation(s)
- Sang E Lee
- School of Social Work, San Jose State University, San Jose, California 95192–0124, USA.
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Abstract
In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for "new" PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations.
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Affiliation(s)
| | - Eugene C. Rich
- Mathematica Policy Research, 600 Maryland Avenue SW, Suite 550, Washington, DC 20024 USA
- Creighton University, Omaha, NE USA
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