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Paladino J, Ritchie C. Meeting the Communication and Care Planning Needs of Patients and Caregivers Affected by Dementia from the Time of Diagnosis. J Palliat Med 2024. [PMID: 38770630 DOI: 10.1089/jpm.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Joanna Paladino
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Ritchie
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Colenda CC, Applegate WB. Gluing Together a Fragmented Healthcare System for Geriatrics Will Be Hard. It's Time for United Action. Am J Geriatr Psychiatry 2024; 32:393-404. [PMID: 38503539 DOI: 10.1016/j.jagp.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
"Gluing" together integrated Geriatric Clinical Service lines (GCSL) within the US healthcare system is a significant challenge. Reasons encompass health professional workforce shortages, inconsistent requirements for geriatric educational competencies among the health professional disciplines, preconceived ageist attitudes about older adults with complex illnesses, and a US healthcare system infrastructure that is not aligned with longitudinal and interdisciplinary care needs for older adults. This review focuses on three major characteristics of the US healthcare system that have impeded widespread dissemination of GCSLs: 1) the US's historical fee for service (FFS) reimbursement system; 2) increasing reliance upon disease specific specialty care services for older patients that have resulted from advances in medicine; and 3) rising consolidation of US healthcare systems over the last 30 years. Three specific options are also provided that might help change the current and future trajectories of GCSLs: 1) local political advocacy to implement health policy legislation; 2) expand geriatric physician and health professional workforce by nontraditional means; and 3) reprioritize expansionist healthcare systems corporate behavior. Each of these interventions will be hard to achieve, but it is time to unite if GCSLs are to thrive as pathways to improve care outcomes for older adults with complex medical, cognitive and neuropsychiatric disorders.
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Affiliation(s)
- Christopher C Colenda
- President Emeritus, West Virginia University Health System, Former Chancellor for Health Sciences, West Virginia University, Adjunct Professor of Gerontology and Geriatrics, Department of Internal Medicine, Wake Forest University School of Medicine (CCC), Morgantown, WV
| | - William B Applegate
- President and Dean Emeritus, Wake Forest University Health Sciences, Professor of Gerontology and Geriatrics, Department of Internal Medicine, Wake Forest University School of Medicine (WBA), Winston-Salem, NC
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Bartels SJ, Reynolds CF. Reverse Innovation, Partnerships, and The Role of Academic Health Systems in Creating a Sustainable Geriatric Health Care System. Am J Geriatr Psychiatry 2024; 32:405-408. [PMID: 38503540 DOI: 10.1016/j.jagp.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Stephen J Bartels
- James J. and Jean H. Mongan Chair in Health Policy and Community Health, Director of Mongan Institute, Massachusetts General Hospital, Professor of Medicine, Harvard Medical School..
| | - Charles F Reynolds
- Distinguished Professor of Psychiatry and UPMC Endowed Professor in Geriatric Psychiatry emeritus, University of Pittsburgh School of Medicine, Editor, American Journal of Geriatric Psychiatry
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Colenda CC, Applegate WB. Gluing together a fragmented healthcare system for geriatrics will be hard. It's time for united action. J Am Geriatr Soc 2024; 72:993-1003. [PMID: 38494999 DOI: 10.1111/jgs.18814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
"Gluing" together integrated Geriatric Clinical Service lines (GCSL) within the US healthcare system is a significant challenge. Reasons encompass health professional workforce shortages, inconsistent requirements for geriatric educational competencies among the health professional disciplines, preconceived ageist attitudes about older adults with complex illnesses, and a US healthcare system infrastructure that is not aligned with longitudinal and interdisciplinary care needs for older adults. This review focuses on three major characteristics of the US healthcare system that have impeded widespread dissemination of GCSLs: (1) the US's historical fee for service (FFS) reimbursement system; (2) increasing reliance upon disease specific specialty care services for older patients that have resulted from advances in medicine; and (3) rising consolidation of US healthcare systems over the last 30 years. Three specific options are also provided that might help change the current and future trajectories of GCSLs: (1) local political advocacy to implement health policy legislation; (2) expand geriatric physician and health professional workforce by nontraditional means; and (3) reprioritize expansionist healthcare systems corporate behavior. Each of these interventions will be hard to achieve, but it is time to unite if GCSLs are to thrive as pathways to improve care outcomes for older adults with complex medical, cognitive and neuropsychiatric disorders.
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Affiliation(s)
- Christopher C Colenda
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - William B Applegate
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Howell BM, Peterson J. Starting a university gerontology research laboratory: Experiences from researchers in public health and psychology. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:166-179. [PMID: 36573691 PMCID: PMC10293468 DOI: 10.1080/02701960.2022.2163245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Although founding and directing an independent research laboratory is often expected of faculty at American universities, there are several barriers to successful completion of this important task. There is little guidance in the literature regarding exactly how to go about starting a research laboratory. The guidance that exists for faculty often focuses on running research labs in the "hard sciences," such as biomedical science and engineering, leaving social and behavioral scientists out of such considerations. Additionally, smaller or teaching-focused universities often have little infrastructure or support for starting a research lab, so faculty at these institutions may not know where to begin. These barriers are significant concerns for junior faculty, who are often unprepared for the realities and challenges of starting a successful research lab while obtaining other milestones required for promotion and tenure. We present two examples of recently-formed gerontology research laboratories begun by junior faculty, one in the psychology department of a research university and one in public health at a teaching-focused university. Our case studies present the reader with specific examples, lessons learned, and guidance for starting their own gerontology research laboratory in higher education, whether as a physical or virtual space, as well as recommendations on maintaining its functioning during a global pandemic.
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Shin H, Lee OE. Who is behind the robot? The role of public social workers in implementing robotic eldercare program in South Korea. SOCIAL WORK IN HEALTH CARE 2024; 63:311-327. [PMID: 38448245 DOI: 10.1080/00981389.2024.2324849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
A companion robot named Hyodol is a digital technology implemented for eldercare in South Korea. Drawing insights from semi-structured interviews with public social workers actively involved in the Hyodol care program, this study explores how social workers contribute to the success of the robotic care program. Throughout the phases of selecting potential users, introducing older adults to the robot, and maintaining the robotic program, the practical wisdom of social workers plays an important role. Despite the increased workload in case management and the emotional labor associated with navigating the care system, these pioneering social workers maintained high morale to adopt the robotic care system. By shedding light on the specific roles of social workers, this study contributes to a deeper understanding of the intricate dynamics that underlie successful robotic eldercare.
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Affiliation(s)
- Heesun Shin
- Graduate School of Science and Technology Policy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Othelia EunKyoung Lee
- School of Social Work, University of North Carolina at Charlotte College of Health and Human Services, Charlotte, North Carolina, USA
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7
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Shabat LB, Itzhaki M. Choosing a nursing specialty: connection to nursing students' personality traits, clinical self-efficacy, adoption of technology changes, and specialty prestige; a cross-sectional study. BMC Nurs 2024; 23:152. [PMID: 38438852 PMCID: PMC10910800 DOI: 10.1186/s12912-024-01813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Choosing a field of specialization within the nursing profession is affected by nurses' personality traits, self-confidence in performing clinical skills, and the field's prestige. A successful choice of area of expertise may improve nurses' job satisfaction and reduce job mobility. This study aims to examine the relationship between personality traits, clinical self-efficacy, perceived prestige, adoption of technological changes, and choice of specialty field among nursing students. METHODS A cross-sectional study was conducted. One-hundred-twenty-seven undergraduate nursing students in their fourth year of studies at a large university in Israel participated in the study. The questionnaire administered was comprised of six parts: demographic data, personality traits, adoption of technological changes, clinical self-efficacy, perceived prestige, and intention to select a field of specialization. RESULTS Acute disciplines were rated more prestigious than chronic disciplines, with intensive care and emergency medicine considered the most prestigious, while mental health and geriatrics were the least prestigious. Students' mean perceived confidence in performing nursing clinical skills was high and more than half considered themselves open to technology changes. Positive correlations were found between prestige and intention to choose a field of expertise (r = 0.41, p < 0.001) and the personality trait of openness and the intention to choose an acute care area (r = 0.26, p < 0.01). CONCLUSIONS Despite the gradual aging of the population and the increase in chronic morbidity, which demand a greater nursing focus on older adults, and notwithstanding the mental health reforms, nursing students perceive geriatrics and mental health as less prestigious fields. A career development path can be applied by developing a tool for occupational guidance designed to rank students' suitability for specialty fields and thus help them choose the area that best suits them.
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Affiliation(s)
- Lilach Ben Shabat
- Nursing Department, School of Health Professions, Faculty of Medical and Health Sciences , Tel Aviv University , Tel Aviv, Israel
| | - Michal Itzhaki
- Nursing Department, School of Health Professions, Faculty of Medical and Health Sciences , Tel Aviv University , Tel Aviv, Israel.
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Park MK, Taylor J, Biernot J, Martin DJ. The Virtual Geriatric Assessment Interdisciplinary Team Project: Interprofessional Geriatric Training Against the Backdrop of COVID-19. J Appl Gerontol 2024:7334648241234496. [PMID: 38379509 DOI: 10.1177/07334648241234496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Interprofessional geriatric education programs enhance trainees' knowledge of older adults, and the valuable contributions health and social care practitioners make to their well-being when specialists work collaboratively. In response to the 2020 COVID-19 pandemic restrictions, in-person geriatric interprofessional education (IPE) programs were redesigned for virtual delivery. Nineteen virtual programs were held between September 2020 and December 2022. Of the 369 health and social care trainees who participated, 67.2% completed both pre- and post-program surveys. Survey instruments included the Interprofessional Collaborative Competency Attainment Survey (ICASS), which measures perceptions associated with patient-centered, team-based, collaborative care. Significant differences were obtained across ICASS domains, including communication, conflict management/resolution, and team functioning, suggesting that virtual programs may enhance attitudes and perceived abilities for interprofessional collaborative practice. Furthermore, participants' perceived understanding of older adult needs improved, as did their interest in geriatrics. Results illustrate that virtual geriatric interprofessional (IP) programs may be viable alternatives to in-person opportunities.
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Affiliation(s)
- Min Kyoung Park
- Department of Gerontology, University of Maryland, Baltimore, MD, USA
| | - Joy Taylor
- Maryland Area Health Education Center (AHEC) West, Cumberland, MD, USA
| | - Julia Biernot
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Diane J Martin
- Graduate School, University of Maryland, Baltimore, MD, USA
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Snowdon DA, Wang YT, Callisaya ML, Collyer TA, Jolliffe L, Johns N, Vincent P, Pragash N, Taylor NF. Staying Active with Multimorbidity In Acute hospital settings (StAMInA) trial: protocol for a feasibility randomised controlled trial of allied health assistant mobility rehabilitation for patients with multimorbidity. BMJ Open 2024; 14:e078843. [PMID: 38216182 PMCID: PMC10806632 DOI: 10.1136/bmjopen-2023-078843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Key to improving outcomes for patients with multimorbidity is increasing mobility through prescription of a physical activity programme, but this can be difficult to achieve in acute hospital settings. One approach that would assist physiotherapists to increase levels of physical activity is delegation of rehabilitation to allied health assistants. We aim to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient mobility rehabilitation for patients with multimorbidity. METHODS AND ANALYSIS Using a parallel group randomised controlled design, participants will be allocated to allied health assistant mobility rehabilitation or physiotherapist mobility rehabilitation. Adult inpatients (n=60) in an acute hospital with a diagnosis of multimorbidity who walked independently preadmission will be included. The experimental group will receive routine mobility rehabilitation, including daily mobilisation, from an allied health assistant under the supervision of a physiotherapist. The comparison group will receive routine rehabilitation from a physiotherapist. Feasibility will be determined using the following areas of focus in Bowen's feasibility framework: Acceptability (patient satisfaction); demand (proportion of patients who participate); implementation (time allied health assistant/physiotherapist spends with participant, occasions of service); and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant rehabilitation will be interviewed to explore their perspectives on feasibility. Secondary outcomes include: Physical activity (daily time spent walking); daily mobilisation (Y/N); discharge destination; hospital readmission; falls; functional activity (Modified Iowa Level of Assistance Scale); and length of stay. Descriptive statistics will be used to describe feasibility. Secondary outcomes will be compared between groups using Poisson or negative binomial regression, Cox proportional hazards regression, survival analysis, linear regression or logistic regression. ETHICS AND DISSEMINATION Ethics approval was obtained from Peninsula Health (HREC/97 431/PH-2023). Findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry ACTRN12623000584639p.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Yi Tian Wang
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Laura Jolliffe
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Nathan Johns
- Department of Rehabilitation Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Peggy Vincent
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Nandhinee Pragash
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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Hayes C, Fitzgerald C, O'Shaughnessy Í, Condon B, Leahy A, O'Connor M, Manning M, Griffin A, Glynn L, Robinson K, Galvin R. Exploring stakeholders' experiences of comprehensive geriatric assessment in the community and out-patient settings: a qualitative evidence synthesis. BMC PRIMARY CARE 2023; 24:274. [PMID: 38093176 PMCID: PMC10717956 DOI: 10.1186/s12875-023-02222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult's biopsychosocial capabilities to create an integrated and co-ordinated plan of care. While quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes has been synthesised, to date qualitative research reporting how older adults and service providers experience CGA has not been synthesised. This study aimed to systematically review and synthesise qualitative studies reporting community-dwelling older adults', caregivers' and healthcare professionals' (HCP) experiences of CGA in the primary care and out-patient (OPD) setting. METHOD We systematically searched five electronic databases including MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Social Sciences Full Text targeting qualitative or mixed methods studies that reported qualitative findings on older adults', caregivers' and HCPs' experiences of CGA in primary care or out-patient settings. There were no language or date restrictions applied to the search. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare's seven-step approach to meta-ethnography, which involves an iterative and inductive process of data synthesis. RESULTS Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and hospital-based OPD settings. Synthesis generated four key themes: (1) CGA is experienced as a holistic process, (2) The home environment enhances CGA, (3) CGA in the community is enabled by a collaborative approach to care, and (4) Divergent experiences of the meaningful involvement of older adults, caregivers and family in the CGA process. CONCLUSION Findings demonstrate that CGA in a home-based or OPD setting allows for a holistic and integrated approach to care for community-dwelling older adults while increasing patient satisfaction and accessibility of healthcare. Healthcare professionals in the community should ensure meaningful involvement of older adults and their families or caregivers in the CGA process. Further robustly designed and well reported trials of different models of community-based CGA informed by the findings of this synthesis are warranted.
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Affiliation(s)
- Christina Hayes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Christine Fitzgerald
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Íde O'Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brian Condon
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland, Discipline of General Practice, School of Medicine, HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Williams E, Tang A, Rice SD, Woodall T, Davis SA, Scott MA. Survey of pharmacy students to assess attitudes toward a career in older adult care. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:1006-1016. [PMID: 37923638 DOI: 10.1016/j.cptl.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/24/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION In the United States, the older adult population is growing faster than the geriatrics-trained healthcare workforce. The primary objective of this study was to determine the top factors that increase or decrease pharmacy student interest in seeking a career in geriatrics. METHODS A 23-item survey was disseminated to 611 first- through fourth-year pharmacy students. Participants were recruited from two public schools of pharmacy in the United States from February through September 2022. Surveys were administered during class or distributed via email and websites for required courses. Participation was voluntary, and responses were anonymous. Descriptive statistics, independent-samples t-tests, Fisher's exact test, and analysis of variance were used for analysis. RESULTS A total of 210 responses were received. Respondents were evenly split between somewhat or extremely interested and somewhat or extremely disinterested in geriatrics. Among those interested, the top factors driving interest were past positive experiences with older adults, interest in deprescribing, and perceived need for geriatrics-trained providers. Among those not interested, the top three factors discouraging interest were emotional impact of death and end-of-life care, disinterest in geriatric syndromes, and perception of inadequate exposure to geriatrics within the curriculum. CONCLUSIONS In order to ensure an adequately trained geriatrics workforce for the aging population, it is crucial to intensify efforts to encourage health profession students to pursue careers in geriatric care. Creating opportunities to increase interest and addressing factors that discourage interest may augment the pipeline of pharmacy students wishing to seek a career specializing in older adult care.
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Affiliation(s)
- Emma Williams
- Mountain Area Health Education Center, 125 Hendersonville Road, Asheville, NC 28803, United States; UNC Eshelman School of Pharmacy, 121 Karpen Hall, 1 University Heights, Asheville, NC 28804, United States.
| | - Angela Tang
- Mountain Area Health Education Center, 125 Hendersonville Road, Asheville, NC 28803, United States
| | - Shannon D Rice
- Baylor Scott & White Medical Center, 100 Medical Parkway, Lakeway, TX 78738, United States
| | - Tasha Woodall
- UNC Eshelman School of Pharmacy, 121 Karpen Hall, 1 University Heights, Asheville, NC 28804, United States; Center for Healthy Aging, Mountain Area Health Education Center, 125 Hendersonville Road, Asheville, NC 28803, United States; UNC School of Medicine and UNC Health Sciences at MAHEC, 125 Hendersonville Road, Asheville, NC 28803, United States.
| | - Scott A Davis
- UNC Eshelman School of Pharmacy, 121 Karpen Hall, 1 University Heights, Asheville, NC 28804, United States.
| | - Mollie Ashe Scott
- Mountain Area Health Education Center, 125 Hendersonville Road, Asheville, NC 28803, United States; UNC Eshelman School of Pharmacy, 121 Karpen Hall, 1 University Heights, Asheville, NC 28804, United States; UNC School of Medicine and UNC Health Sciences at MAHEC, 125 Hendersonville Road, Asheville, NC 28803, United States.
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Arany S, Eliav E, Medina-Walpole A, Caprio TV. Postgraduate dental resident education: A pilot in age-friendly "mentation" training. SPECIAL CARE IN DENTISTRY 2023; 43:765-771. [PMID: 37147183 DOI: 10.1111/scd.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. BACKGROUND Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. MATERIALS AND METHODS We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. RESULTS The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 ± $ \pm \ $ 0.97) and knowledge acquisition (4.36 ± $ \pm \ $ 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care. CONCLUSION Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.
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Affiliation(s)
- Szilvia Arany
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Eli Eliav
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Annette Medina-Walpole
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York, USA
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Wiese LAK, Gibson A, Guest MA, Nelson AR, Weaver R, Gupta A, Carmichael O, Lewis JP, Lindauer A, Loi S, Peterson R, Radford K, Rhodus EK, Wong CG, Zuelsdorff M, Saidi LG, Valdivieso-Mora E, Franzen S, Pope CN, Killian TS, Shrestha HL, Heyn PC, Ng TKS, Prusaczyk B, John S, Kulshreshtha A, Sheffler JL, Besser L, Daniel V, Tolea MI, Miller J, Musyimi C, Corkey J, Yank V, Williams CL, Rahemi Z, Park J, Magzamen S, Newton RL, Harrington C, Flatt JD, Arora S, Walter S, Griffin P, Babulal GM. Global rural health disparities in Alzheimer's disease and related dementias: State of the science. Alzheimers Dement 2023; 19:4204-4225. [PMID: 37218539 PMCID: PMC10524180 DOI: 10.1002/alz.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.
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Affiliation(s)
- Lisa Ann Kirk Wiese
- C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Allison Gibson
- University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Marc Aaron Guest
- Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Amy R Nelson
- Frederick P. Whiddon College of Medicine, Department of Physiology & Cell Biology, University of South Alabama, Mobile, Alabama, USA
| | - Raven Weaver
- Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, Neurology, Alzheimer's Disease Research Center, University of Kansas, Kansas City, Kansas, USA
| | - Owen Carmichael
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Allison Lindauer
- Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Samantha Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Rachel Peterson
- University of Montana School of Public and Community Health Sciences, Missoula, Montana, USA
| | - Kylie Radford
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Elizabeth K Rhodus
- University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
- University of Kentucky Alzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky, USA
- University of Kentucky College of Medicine, for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA
| | - Christina G Wong
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Megan Zuelsdorff
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ladan Ghazi Saidi
- Department of Communication Disorders, Center for Brain Biology and Behavior (CB3), University of Nebraska at Kearney, and Lincoln, Nebraska, USA
| | - Esmeralda Valdivieso-Mora
- Department of Psychology and Public Health, Universidad Centroamericana José Simeón Cañas, El Salvador, El Salvador
| | - Sanne Franzen
- Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Caitlin N Pope
- Department of Health, Behavior, & Society, University of Kentucky, Lexington, Kentucky, USA
| | - Timothy S Killian
- Human Development and Family Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Hom L Shrestha
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Ontario, Canada
| | - Patricia C Heyn
- Center for Optimal Aging, Department of Physical Therapy, Marymount University, Arlington, Virginia, USA
| | - Ted Kheng Siang Ng
- Department of Psychology, Arizona State University, Phoenix, Arizona, USA
| | - Beth Prusaczyk
- Institute for Informatics (I2), Center for Population Health Informatics at I2, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Samantha John
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julia L Sheffler
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Lilah Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Valerie Daniel
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Magdalena I Tolea
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Justin Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Veronica Yank
- Department of Medicine, University of California, San Francisco, USA
| | - Christine L Williams
- C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Zahra Rahemi
- Clemson School of Nursing, Clemson University, Clemson, South Carolina, USA
| | - JuYoung Park
- Sandler School of Social Work, College of Social Work and Criminal Justice, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Robert L Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Jason D Flatt
- School of Public Health, Department of Social & Behavioral Health, University of Nevada, Las Vegas, USA
| | - Sonakshi Arora
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Sarah Walter
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Percy Griffin
- Alzheimer's Therapeutic Research Institute, Alzheimer's Clinical Trials Consortium, University of Southern California, San Diego, California, USA
| | - Ganesh M Babulal
- Scientific Engagement, Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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14
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Kim SK, Jang JW, Hwang YS, Lee OE, Jo HS. Investigating the effectiveness of Socially Assistive Robot on Depression and Cognitive Functions of Community Dwelling Older Adults with Cognitive Impairments. Assist Technol 2023:1-9. [PMID: 37459459 DOI: 10.1080/10400435.2023.2237554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/17/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023] Open
Abstract
We evaluated a socially assistive robot (SAR) named Hyodol during a six-week intervention. This study enrolled 69 older adults with cognitive decline. To screen the eligibility, we have used the following three criteria, namely Korean-Mini-Mental Status Exam score ≤ 26). Clinical Dementia Rating 0.5-2), and Diagnostics and Statistical Manual V. Participants were divided into three groups based on their cognitive function (i.e. very mild cognitive impairment (vMCI), mild cognitive impairment (MCI), and moderate cognitive impairment (MOCI). The groups were instructed to use Hyodol at home for a six-week period. Baseline and post-intervention surveys were performed after six weeks to examine the changes in perceived health, depression, and cognitive function. The vMCI group showed a reduction in the depression score after the intervention (t = -2.447, p = 0.040), in comparison to their peers in the control group. Further, the MCI group showed an improvement in the cognitive function score after the intervention (t = 2.690, p = 0.021). No significant improvement was found among MOCI participants who used the SARs. The significance of this study was to examine whether participants with different levels of cognitive functioning would diverge after a period of intervention using the Hyodol SARs. Moreover, it presented preliminary data for services and policies for home care treatment targeted to cognitive decline in older adults.
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Affiliation(s)
- Su Kyoung Kim
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon University Hospital, Chuncheon, Korea
| | - Yu Seong Hwang
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Othelia EunKyoung Lee
- College of Health and Human Services, The University of North Carolina, Charlotte, North Carolina, US
| | - Heui Sug Jo
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Korea
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15
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Brown B, Kang G, Schwartz A, Rink A, Gallant N, Magpantay-Monroe E, Empleo-Frazier O, Windish D, Marottoli R. Cognition and dementia with Raymond and Brain: Curriculum development and evaluation using interactive animated flipped-classroom modules to impact nursing students' attitude toward dementia care. Nurse Educ Pract 2023; 71:103696. [PMID: 37453370 DOI: 10.1016/j.nepr.2023.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
AIM To design a modular, flipped-classroom curriculum using character animations to improve knowledge and attitudes regarding dementia care among pre-clinical nursing students. BACKGROUND Demographic trends suggest an urgent, unmet need for nurses with interest and adequate training in caring for people with dementia and other disorders of cognition. While flipped classrooms using video show promise, little is known about specific animation techniques to impact knowledge and attitudes in preclinical nursing education. DESIGN A curriculum was developed, implemented and assessed across three nursing schools in series, totaling 223 eligible students in the states of Connecticut and Hawaii, USA from 2019 to 2022. The evaluation included prospective pre-post assessment of knowledge, attitudes and module acceptability, as well as qualitative interpretations of needs assessment data. METHODS The six-step curriculum development process was based on that described by Kern et al., including: 1) general needs assessment in the form of literature review; 2) targeted needs assessment, in the form of faculty stakeholder meetings, a student focus group and baseline surveys; 3) optimization of learning objectives based on needs; 4) development of a pedagogical approach, namely animated, interactive modules informed by previously described best practices in animation development; 5) implementation across three different nursing schools; and 6) assessment of the learners and evaluation of the curriculum, primarily via surveys and engagement metadata. RESULTS Needs assessments confirmed the importance of prior experiences, sense of mission and other affective elements as key factors mitigating learners' baseline receptiveness to training and careers in cognition-related care. Students at all three institutions rated the modules' impact on their dementia-related attitudes highly, however these ratings were statistically significantly lower when both modules were delivered as a single assignment at one site. Knowledge quiz scores significantly increased from baseline at all three sites. Only 2.6% of respondents would have preferred a text-based reading assignment. Acceptability scores, including clarity, relevance, entertainment, attention and complexity, were generally rated highly, but attention and entertainment were rated significantly lower when both modules were administered as a single assignment. CONCLUSION Cognition and Dementia with Raymond and Brain demonstrates the successful blending of animation industry workflows with best practices of curriculum development to create a novel, animated module series that is acceptable and effective in priming nursing students with the attitudes and knowledge to continue learning about cognition and its disorders.
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Affiliation(s)
- Bryan Brown
- Office of Medical Education, University of Hawaii John A. Burns School of Medicine, 651 Ilalo St., MEB 307, Honolulu, HI 96813, USA; The Center for Physician Professional Development and Wellness, The Queen's Medical Center, 1301 Punchbowl St., Honolulu, HI 96813, USA.
| | - Gina Kang
- University of Washington, Department of Medicine, Division of Gerontology and Geriatrics, 325 9th Ave, Box 359755, Seattle, WA 98104, USA
| | - Anna Schwartz
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College St, New Haven, CT 06510, USA
| | - Andrea Rink
- Yale School of Medicine, Department of Internal Medicine, Section of Geriatrics, 333 Cedar Street, New Haven, CT 06520, USA
| | - Noelle Gallant
- Yale New Haven Health System, 20 York Street, New Haven, CT 06520, USA
| | | | | | - Donna Windish
- Yale School of Medicine, Department of Internal Medicine, Section of General Internal Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Richard Marottoli
- Yale School of Medicine, Department of Internal Medicine, Section of Geriatrics, 333 Cedar Street, New Haven, CT 06520, USA
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16
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Takeda S. Factors Related to Turnover and Intention to Leave the Care Working Profession in Japan: A Review. Yonago Acta Med 2023; 66:196-201. [PMID: 37229365 PMCID: PMC10203648 DOI: 10.33160/yam.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023]
Abstract
Globally, the elderly population is growing rapidly. The number of elderly people requiring nursing care is expected to increase along with the elderly population. However, the high turnover rate of care workers has caused a labor shortage, which in turn has encouraged further turnover, creating a vicious cycle. Preventing turnover is an important issue not only for the physical and mental health of care workers but also for the quality of nursing care. In particular, Japan has emerged as the world's first super-aged society, experiencing an increase in the number of elderly people requiring nursing care and a shortage of care workers. This review summarizes the research on factors influencing care worker turnover and intent to leave the profession in Japan. Additionally, workplace interpersonal problems have been shown to be consistently associated with care worker turnover or intention to leave in previous studies that were reviewed.
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Affiliation(s)
- Shinya Takeda
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago 683-8503, Japan
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17
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Attafuah PYA, Everink IH, Lohrmann C, Abuosi A, Schols JM. Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021. Arch Public Health 2023; 81:74. [PMID: 37106445 PMCID: PMC10134515 DOI: 10.1186/s13690-023-01056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.
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Affiliation(s)
- Priscilla Yeye Adumoah Attafuah
- School of Nursing and Midwifery, University of Ghana, Legon, Ghana.
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Irma Hj Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Aaron Abuosi
- Health Services Management Department, University of Ghana Business School, Legon, Ghana
| | - Jos Mga Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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18
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Furlong KR, O'Donnell K, Farrell A, Mercer S, Norman P, Parsons M, Patey C. Older Adults, the "Social Admission," and Nonspecific Complaints in the Emergency Department: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e38246. [PMID: 36920467 PMCID: PMC10132007 DOI: 10.2196/38246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/09/2022] [Accepted: 12/21/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older adults have a higher visit rate and poorer health outcomes in the emergency department (ED) compared to their younger counterparts. Older adults are more likely to require additional resources and hospital admission. The nonspecific, atypical, and complex nature of disease presentation in older adults challenges current ED triage systems. Acute illness in older adults is often missed or commonly disguised in the ED as a social or functional issue. If diagnostic clarity is lacking or safe discharge from the ED is not feasible, then older adults may be labelled a "social admission" (or another synonymous term), often leading to negative health consequences. OBJECTIVE This scoping review aims to describe and synthesize the available evidence on patient characteristics, adverse events, and health outcomes for older adults labelled as "social admission" (and other synonymously used terms), as well as those with nonacute or nonspecific complaints in the ED or hospital setting. METHODS A literature search of MEDLINE, Embase, Scopus, PsycINFO, and CINAHL was completed. Relevant reference lists were screened. Data have been managed using EndNote software and the Covidence web application. Original data have been included if patients are aged ≥65 years and are considered a "social admission" (or other synonymously used term) or if they present to the ED with a nonacute or nonspecific complaint. Two review team members have reviewed titles and abstracts and will review full-text articles. Disagreements are resolved by consensus or in discussion with a third reviewer. This review does not require research ethics approval. RESULTS As of January 2023, we have completed the title and abstract screening and have started the full-text screening. Some remaining full-text articles are being retrieved and/or translated. We are extracting data from included studies. Data will be presented in a narrative and descriptive manner, summarizing key concepts, patient characteristics, and health outcomes of patients labelled as a "social admission" (and other synonymously used terms) and of those with nonacute and nonspecific complaints. We expect the first results for publication in Spring 2023. CONCLUSIONS Acute illness in the older adult is not always easily identified. We hope to better understand patient characteristics, adverse events, and health outcomes of older adults labelled as a "social admission," as well as those with nonacute or nonspecific complaints. We aim to identify priorities for future research and identify knowledge gaps that may inform health care providers caring for these vulnerable patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38246.
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Affiliation(s)
- Kayla Rose Furlong
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
| | - Kathleen O'Donnell
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University Libraries, Memorial University, St John's, NL, Canada
| | - Susan Mercer
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Paul Norman
- Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
| | - Michael Parsons
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
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19
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Naughton C, Hayes N, Ezhova I, Fitzpatrick JM. Evaluation of the feasibility of an Education-Career pathway in Healthcare for Older People (ECHO) for early career nurses. Int J Older People Nurs 2023; 18:e12526. [PMID: 36658469 DOI: 10.1111/opn.12526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply. OBJECTIVES To test the feasibility and acceptability of an Education-Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6-month cycles. METHODS A feasibility study with a pre-post design using a multi-methods evaluation. Twenty-nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6-month (T2, end of intervention) and follow-up at 18 months from baseline (T3). Outcome measures were career intention, self-reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non-parametric tests for paired data and thematic analysis for qualitative data. RESULTS Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self-reported gerontological knowledge, pre 87 (IQR 81-102), post 107 (IQR 98-112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention-a double-edged sword, ECHO logistics, and sustainability. CONCLUSION Education-Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies. IMPLICATIONS FOR PRACTICE Attracting and retaining early-career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership.
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Affiliation(s)
- Corina Naughton
- Clinical Nursing in Older People's Healthcare, School of Nursing and Midwifery, College of Medicine and Health, South SouthWest Hospital Group (SSWHG), Cork, Ireland
| | - Nicky Hayes
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Joanne M Fitzpatrick
- Older People's Healthcare, Care for Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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20
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Mbao M, Keefe B, Almeida J, Hamilton-Mason J. Care Managers in the Aging Network: Increasing Self-Efficacy in Human Service Providers. J Appl Gerontol 2023:7334648231156134. [PMID: 36786301 DOI: 10.1177/07334648231156134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
One in four older adults has Behavioral Health (BH) concerns, and over 63% are not receiving services. Older adults living in the community depend on the aging network for home- and community-based services and care managers are critical providers in this network. However, most care managers' current education and training are inadequate to care for older adults with BH needs. This study evaluated the effectiveness of training on the perceived self-efficacy of care managers working with older adults with BH needs. The study used a quasi-experimental design with a pre- and post-test approach and convenience sampling (n = 90). We found a significant difference in mean self-efficacy scores, from pre-test (M = 62.31, SD = 10.11) to post-test (M = 65.88, SD = 7.40) related to working with clients with mental health problems. In addition, we found a significant difference between the mean pre-test (M = 59.81, SD = 10.68) and post-test score (M = 65.60, SD = 9.85) related to working with clients with substance use problems.
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Affiliation(s)
- Mbita Mbao
- School of Social Work, Salem State University, Salem, MA, USA
| | - Bronwyn Keefe
- School of Social Work, Boston University, Boston, MA, USA
| | - Joanna Almeida
- School of Social Work, Simmons University, Boston, MA, USA
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21
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Takeda S, Fukuzaki T. Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities. Psychogeriatrics 2023; 23:86-93. [PMID: 36332615 DOI: 10.1111/psyg.12906] [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: 05/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study focuses on care workers at elder care facilities to examine what factors (including workplace personal relations) influence turnover intention and to what extent. Based on this analysis, the study discusses the content of workplace personal relations problems in qualitative terms. METHODS The study targeted care workers at elder care facilities. There were 406 participants with no missing data who were analyzed. The survey period ranged from September to November 2021. Questions consisted of basic attributes, turnover intention, problems with workplace personal relations, content of personal relation problems, and psychological distress. RESULTS Female care workers were 2.25 times more likely than male care workers to have turnover intention. Care workers with workplace personal relation problems were 1.97 times more likely than those without these problems to have high turnover intention. Moreover, with regard to psychological distress, the ratio increased to 4.99 times. The following six categories were extracted from the text data on workplace personal relation problems: insufficient communication, bullying, sense of unfair workload, different attitudes to care work, difficulty in guidance for subordinates/new staff, and labelling. CONCLUSIONS Gender, workplace personal relation problems, and psychological distress have shown to affect care workers' turnover intentions. To prevent care worker turnover, future studies should focus on the development and impact of strategies to improve workplace personal relations specific to care workers, targeting the six factors identified in this study.
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Affiliation(s)
- Shinya Takeda
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago, Tottori, Japan
| | - Toshiki Fukuzaki
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago, Tottori, Japan
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22
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Root EZ, Caskie GIL. The Associations between eMental Health Literacy, Barriers to Mental Health Services, and Psychological Distress in Older Adults. J Appl Gerontol 2022; 42:951-961. [PMID: 36541275 DOI: 10.1177/07334648221146775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Building on eHealth literacy and mental health literacy, this cross-sectional survey study examined associations between eMental health literacy (the degree to which individuals obtain, process, and understand basic mental health information online to inform mental health-related decisions), perceived barriers to mental healthcare, and psychological distress. Data were collected online for 247 older adults in the United States. Higher eMental health literacy was associated with fewer perceived barriers to mental healthcare, in models conceptualizing psychological distress as an outcome of eMental health literacy and barriers to care (intrinsic, β = −0.36, p < .001; extrinsic, β = −0.24, p = .002) and as a covariate of eMental health literacy (intrinsic, β = −0.33, p = .001; extrinsic, β = −0.24, p = .003). Continued research and replication of findings are needed to better understand the potential role of eMental health literacy in reducing barriers to mental health services in later life.
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23
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Kokorelias KM, Leung G, Jamshed N, Grosse A, Sinha SK. Identifying the areas of low self-reported confidence of internal medicine residents in geriatrics: a descriptive study of findings from a structured geriatrics skills assessment survey. BMC MEDICAL EDUCATION 2022; 22:870. [PMID: 36522619 PMCID: PMC9756669 DOI: 10.1186/s12909-022-03934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Currently, no standardized methods exist to assess the geriatric skills and training needs of internal medicine trainees to enable them to become confident in caring for older patients. This study aimed to describe the self-reported confidence and training requirements in core geriatric skills amongst internal medicine residents in Toronto, Ontario using a standardized assessment tool. METHODS This study used a novel self-rating instrument, known as the Geriatric Skills Assessment Tool (GSAT), among incoming and current internal medicine residents at the University of Toronto, to describe self-reported confidence in performing, teaching and interest in further training with regard to 15 core geriatric skills previously identified by the American Board of Internal Medicine. RESULTS 190 (75.1%) out of 253 eligible incoming (Year 0) and current internal medicine residents (Years 1-3) completed the GSAT. Year 1-3 internal medicine residents who had completed a geriatric rotation reported being significantly more confident in performing 13/15 (P < 0.001 to P = 0.04) and in teaching 9/15 GSAT skills (P < 0.001 to P = 0.04). Overall, the residents surveyed identified their highest confidence in administering the Mini-Mental Status Examination and lowest confidence in assessing fall risk using a gait and balance tool, and in evaluating and managing chronic pain. CONCLUSION A structured needs assessment like the GSAT can be valuable in identifying the geriatric training needs of internal medicine trainees based on their reported levels of self-confidence. Residents in internal medicine could further benefit from completing a mandatory geriatric rotation early in their training, since this may improve their overall confidence in providing care for the mostly older patients they will work with during their residency and beyond.
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Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada
| | - Grace Leung
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada
| | - Namirah Jamshed
- Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anna Grosse
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada.
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA.
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Tsang M, Gan S, Boscardin J, Wong ML, Walter LC, Smith AK. The epidemiology of preexisting geriatric and palliative conditions in older adults with poor prognosis cancers. J Am Geriatr Soc 2022; 70:3402-3412. [PMID: 36259424 PMCID: PMC9772051 DOI: 10.1111/jgs.18039] [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: 03/23/2022] [Revised: 06/19/2022] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. Because they are not routinely assessed, the prevalence of preexisting geriatric and palliative conditions in this population is unknown. METHODS We used the nationally representative Health and Retirement Study (HRS) linked with Medicare claims (1998-2016) to identify adults aged ≥65 years diagnosed with poor prognosis cancers (cancers with a median survival ≤1 year). Using the HRS interview before the first Medicare cancer claim, we used survey-weighted descriptive statistics and modified Poisson regression analysis to examine the prevalence of the following clinically significant conditions: functional impairment, difficulty with mobility, falls and injurious falls, social support, cognition, advance care planning, use of pain or sleep medications, and presence of pain or breathlessness. RESULTS Of 2105 participants (mean age 76, 53% women, 34% lung cancer, 21% gastrointestinal cancer), the median survival was 9.6 months. Approximately 65% had difficulty climbing stairs (95% CI 63%-67%), 49% had no advance directive (95% CI 45%-54%), 35% lived alone (95% CI 33%-37%), 36% fell in the last 2 years (95% CI 34%-38%), and 32% rated their memory as poor (95% CI 29%-34%). After adjusting for gender, cancer type, and HRS survey time before the first Medicare claim for a poor prognosis cancer, functional impairment and falls were highest among adults aged 85+. Adults aged 65-74 years were less likely to have an advance directive. After adjusting for age, cancer type, and HRS survey time, women had a higher rate of pain and physical impairment. In exploratory analyses, race and socioeconomic status predicted difficulty with mobility and instrumental activities of daily living, living alone, and advance directive completion. CONCLUSIONS Due to a high prevalence across multiple domains, all older adults with poor prognosis cancers should be assessed for geriatric and palliative care conditions.
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Affiliation(s)
- Mazie Tsang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Siqi Gan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Melisa L. Wong
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
| | - Louise C. Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Snowdon DA, King OA, Dennett A, Pinson JA, Shannon MM, Collyer TA, Davis A, Williams CM. Delegation of patient related tasks to allied health assistants: a time motion study. BMC Health Serv Res 2022; 22:1280. [PMID: 36280846 PMCID: PMC9590386 DOI: 10.1186/s12913-022-08642-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Allied health assistants (AHAs) are support staff who complete patient and non-patient related tasks under the delegation of an allied health professional. Delegating patient related tasks to AHAs can benefit patients and allied health professionals. However, it is unclear whether the AHA workforce is utilised optimally in the provision of patient care. The purpose of this study was to determine the proportion of time AHAs spend on patient related tasks during their working day and any differences across level of AHA experience, clinical setting, and profession delegating the task. Methods A time motion study was conducted using a self-report, task predominance work sampling method. AHAs were recruited from four publicly-funded health organisations in Victoria, Australia. AHAs worked with dietitians, occupational therapists, physiotherapists, podiatrists, social workers, speech pathologists, psychologists, and exercise physiologists. The primary outcome was quantity of time spent by AHAs on individual task-categories. Tasks were grouped into two main categories: patient or non-patient related activities. Data were collected from July 2020 to May 2021 using an activity capture proforma specifically designed for this study. Logistic mixed-models were used to investigate the extent to which level of experience, setting, and delegating profession were associated with time spent on patient related tasks. Results Data from 51 AHAs showed that AHAs spent more time on patient related tasks (293 min/day, 64%) than non-patient related tasks (167 min/day, 36%). Time spent in community settings had lower odds of being delegated to patient related tasks than time in the acute hospital setting (OR 0.44, 95%CI 0.28 to 0.69, P < 0.001). Time delegated by exercise physiologists and dietitians was more likely to involve patient related tasks than time delegated by physiotherapists (exercise physiology: OR 3.77, 95% 1.90 to 7.70, P < 0.001; dietetics: OR 2.60, 95%CI 1.40 to 1.90, P = 0.003). Time delegated by other professions (e.g. podiatry, psychology) had lower odds of involving patient related tasks than physiotherapy (OR 0.37, 95%CI 0.16 to 0.85, P = 0.02). Conclusion AHAs may be underutilised in community settings, and by podiatrists and psychologists. These areas may be targeted to understand appropriateness of task delegation to optimise AHAs’ role in providing patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08642-7.
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Affiliation(s)
- David A Snowdon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Olivia A King
- grid.1002.30000 0004 1936 7857Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC Australia ,grid.414257.10000 0004 0540 0062Allied Health Department, Barwon Health, Geelong, VIC Australia
| | - Amy Dennett
- grid.414366.20000 0004 0379 3501Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC Australia ,grid.1018.80000 0001 2342 0938School of Allied Health Human Services and Sport, La Trobe University, Bundoora, VIC Australia
| | - Jo-Anne Pinson
- grid.419789.a0000 0000 9295 3933Medical Imaging Department, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC Australia ,grid.466993.70000 0004 0436 2893Medical Imaging Department, Peninsula Health, Frankston, VIC Australia
| | - Michelle M Shannon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Taya A Collyer
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Annette Davis
- grid.419789.a0000 0000 9295 3933Allied Health Workforce Innovation Strategy Education Research (WISER) unit, Monash Health, Clayton, VIC Australia
| | - Cylie M Williams
- grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,grid.1002.30000 0004 1936 7857School of Primary and Allied Health Care, Monash University, Frankston, VIC Australia
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Little MO, Morley JE. Healthcare for older adults in North America: challenges, successes and opportunities. Age Ageing 2022; 51:6754359. [PMID: 36209783 DOI: 10.1093/ageing/afac216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/07/2022] [Indexed: 01/27/2023] Open
Abstract
Older adults in North America face similar challenges to successful ageing as other adults around the world, including an increased risk of geriatric syndromes and functional decline, limited access to healthcare professionals specialising in geriatrics and constraints on healthcare spending for Long-Term Services and Supports. Geriatrics as a specialty has long been established, along with the creation of a variety of screening tools for early identification of geriatric syndromes. Despite this, workforce shortages in all older adult care service areas have led to significant gaps in care, particularly in community settings. To address these gaps, innovative programs that expand the reach of geriatric specialists and services have been developed. Opportunities exist for further dissemination of these programs and services, as well as for expansion of an ageing capable workforce.
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Affiliation(s)
- Milta O Little
- Department of Medicine, Division of Geriatric Medicine, Durham, NC USA
| | - John E Morley
- Department of Medicine, Division of Geriatric Medicine, St. Louis, MO USA
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Shigli K, Nayak SS, Lagali-Jirge V, Kusurkar RA, Nerali JT, Oginni FO. Inclusion of gerodontology in dental curriculum: An urgent case for India. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:468-481. [PMID: 35422199 DOI: 10.1080/02701960.2022.2058936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.
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Affiliation(s)
- Kamal Shigli
- Department of Prosthodontics, DY Patil Dental School, Pune, India
| | | | - Vasanti Lagali-Jirge
- Department of Oral Medicine and Radiology, KLEVK Institute of Dental Sciences, KAHER Belagavi, India
| | - Rashmi A Kusurkar
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, Boelelaan, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam The Netherlands
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Australian nursing students’ clinical experiences in residential aged care: Reports from nurse academics. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Dang L, Ananthasubramaniam A, Mezuk B. Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions. Clin Interv Aging 2022; 17:1037-1056. [PMID: 35855744 PMCID: PMC9288177 DOI: 10.2147/cia.s336301] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022] Open
Abstract
As a major life transition characterized by changes in social, behavioral, and psychological domains, retirement is associated with numerous risk factors that can contribute to the development of depression in later life. Understanding how these risk factors intersect with overall health and functioning can inform opportunities for mental health promotion during this transition. The objective of this review is to summarize the literature on risk and protective factors for depression during retirement transitions, discuss challenges related to appropriate management of depression in later life, and describe opportunities for prevention and intervention for depression relating to retirement transitions, both within and beyond the health care system. Key implications from this review are that 1) the relationship between depression and retirement is multifaceted; 2) while depression is a common health condition among older adults, this syndrome should not be considered a normative part of aging or of retirement specifically; 3) the existing mental health specialty workforce is insufficient to meet the depression management needs of the aging population, and 4) therefore, there is a need for interprofessional and multidisciplinary intervention efforts for preventing and managing depression among older adults. In sum, both healthcare providers, public health practitioners, and community organizations have meaningful opportunities for promoting the mental health of older adults during such major life transitions.
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Affiliation(s)
- Linh Dang
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Marrs SA, Ansello EF, Slattum PW, Davis K, Parsons PL, Zimmerman K, Coogle CL. Infusing geriatrics expertise in health professions education through interprofessional faculty development. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:429-441. [PMID: 33544659 DOI: 10.1080/02701960.2021.1883599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As the population of older adults continues to grow, the need for health care professionals trained in the delivery of interprofessional care for older adult patients is critical. The purpose of this paper is to detail the outcomes of an interprofessional, geriatrics training program for healthcare professionals with a faculty appointment. Specifically, we gathered outcomes at four levels: reactions/satisfaction, learning, behavioral, and organizational. Our findings suggest that programs structured like the Faculty Development Program (FDP) have the potential to increase the amount of geriatrics content introduced in already existing health professions curricula, as well as to offer faculty needed training in how to provide their students with interprofessional learning experiences.
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Affiliation(s)
- Sarah A Marrs
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Edward F Ansello
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia W Slattum
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kimberly Davis
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pamela L Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kristin Zimmerman
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Constance L Coogle
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
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Rogers WA, Kadylak T, Bayles MA. Maximizing the Benefits of Participatory Design for Human-Robot Interaction Research With Older Adults. HUMAN FACTORS 2022; 64:441-450. [PMID: 34461761 PMCID: PMC10645376 DOI: 10.1177/00187208211037465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We reviewed human-robot interaction (HRI) participatory design (PD) research with older adults. The goal was to identify methods used, determine their value for design of robots with older adults, and provide guidance for best practices. BACKGROUND Assistive robots may promote aging-in-place and quality of life for older adults. However, the robots must be designed to meet older adults' specific needs and preferences. PD and other user-centered methods may be used to engage older adults in the robot development process to accommodate their needs and preferences and to assure usability of emergent assistive robots. METHOD This targeted review of HRI PD studies with older adults draws on a detailed review of 26 articles. Our assessment focused on the HRI methods and their utility for use with older adults who have a range of needs and capabilities. RESULTS Our review highlighted the importance of using mixed methods and including multiple stakeholders throughout the design process. These approaches can encourage mutual learning (to improve design by developers and to increase acceptance by users). We identified key phases used in HRI PD workshops (e.g., initial interview phase, series of focus groups phase, and presentation phase). These approaches can provide inspiration for future efforts. CONCLUSION HRI PD strategies can support designers in developing assistive robots that meet older adults' needs, capabilities, and preferences to promote acceptance. More HRI research is needed to understand potential implications for aging-in-place. PD methods provide a promising approach.
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Washington SE, Malmstrom TK, Bottin E, Cler E, Stallings DT, Berg-Weger M. Perceptions and knowledge of older adults: an analysis of interprofessional education and medically underserved populations. GERONTOLOGY & GERIATRICS EDUCATION 2022:1-15. [PMID: 35437121 DOI: 10.1080/02701960.2022.2067152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study explored an academic Interprofessional Geriatric Case Competition (IGCC) experience with a focus on medically underserved populations. Our aims were to assess: the perceptions of and knowledge of older adult populations; and the overall IPE (Interprofessional Education) experience of the IGCC participants. A multi-method study approach was used, the Facts on Aging Quiz assessed knowledge and the Carolina Opinions on Care of Older Adults (COCOA) assessed perceptions. A qualitative thematic approach was utilized to explore the themes of the IPE experience. There was a moderate correlation (0.37, p < .001) between perception and knowledge data of the respondents (N = 94), current professionals (54%) and enrolled students (46%). The three emerged themes were as follows: interprofessional/holistic practice; culturally responsive/older adult centered practice; and the impact of Covid-19. The implementation of IPE that centers medically underserved populations has the potential to: enhance students learning, influence the quality of care, and provide pathways to working within these specific populations.
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Affiliation(s)
- Selena E Washington
- Department of Occupational Science and Occupational Therapy, Saint Louis University,Doisy College of Health Sciences, St. Louis, Missouri, US
| | - Theodore K Malmstrom
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri, US
| | - Emma Bottin
- Department of Occupational Science and Occupational Therapy, Saint Louis University,Doisy College of Health Sciences, St. Louis, Missouri, US
| | - Emily Cler
- Department of Occupational Science and Occupational Therapy, Saint Louis University,Doisy College of Health Sciences, St. Louis, Missouri, US
| | - Devita T Stallings
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri, US
| | - Marla Berg-Weger
- School of Social Work, Saint Louis University, St. Louis, Missouri, US
- School of Medicine, Geriatric Education Center, St. Louis, Missouri, US
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Huot C, Cruz-Knight W, Jester DJ, Wenders A, Andel R, Hyer K. Impact of establishing a Geriatrics Workforce Enhancement Program clinic on preventive health and Medicare Annual Wellness Visits. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:285-294. [PMID: 33272147 DOI: 10.1080/02701960.2020.1854247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We established a Geriatrics Workforce Enhancement Program (GWEP) clinic to enhance resident training on comprehensive preventive care and chronic disease management, and to increase the number of older patients who received Medicare Annual Wellness Visit (AWV) preventive services. A total of 1,104 patients were tracked at baseline and during the intervention period. Patients were grouped into two categories: Adult (aged 55-64) and Senior (aged 65+). Clinical quality measures were monitored by electronic health record and tracked through monthly reports at baseline (May 2018) and during the intervention period (July 2018-June 2019). In the Senior group, the proportion of patients receiving the Medicare AWV increased after GWEP began (p <.001). Additionally, the Senior group showed significant improvements in the frequency of body mass index assessments (p = .04), colorectal cancer screenings (p < .001), advance directive documentation (p < .001), cognitive screenings (p < .001), and pneumococcal vaccinations (p < .001). In the Adult group, a trending increase was seen in influenza vaccinations (p = .06). Curricular innovations including the establishment of a GWEP clinic in our residency outpatient center, development of new educational materials, and use of a nurse coordinator resulted in significant improvements in the percentage of older adults who received the Medicare AWV benefit and preventive health performance metrics.
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Affiliation(s)
- Charisse Huot
- BayCare Health System, University of South Florida-Morton Plant Mease Family Medicine Residency, Clearwater, Florida, USA
| | - Wanda Cruz-Knight
- BayCare Health System, University of South Florida-Morton Plant Mease Family Medicine Residency, Clearwater, Florida, USA
| | - Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Anna Wenders
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ross Andel
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Ssensamba JT, Nakafeero M, Musana H, Amollo M, Ssennyonjo A, Kiwanuka SN. Primary care provider notions on instituting community-based geriatric support in Uganda. BMC Geriatr 2022; 22:258. [PMID: 35351013 PMCID: PMC8962536 DOI: 10.1186/s12877-022-02897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding of the most economical and sustainable models of providing geriatric care to Africa’s rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda’s resource-limited primary public health care settings. Methods We interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon’s approach to conventional manifest content analysis. Results During analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS. Conclusion Provider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda’s public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02897-9.
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Affiliation(s)
- Jude Thaddeus Ssensamba
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda. .,Health Care Programmes, VIVES University of Applied Sciences, Kortrijk, Belgium. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Mary Nakafeero
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hellen Musana
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mathew Amollo
- School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloysius Ssennyonjo
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzanne N Kiwanuka
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
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Goldberg EM, Lin MP, Burke LG, Jiménez FN, Davoodi NM, Merchant RC. Perspectives on Telehealth for older adults during the COVID-19 pandemic using the quadruple aim: interviews with 48 physicians. BMC Geriatr 2022; 22:188. [PMID: 35260091 PMCID: PMC8903127 DOI: 10.1186/s12877-022-02860-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background Telehealth delivery expanded quickly during the COVID-19 pandemic after the reduction of payment and regulatory barriers, but older adults are the least likely to benefit from this expansion. Little is known about physician experiences initiating telehealth and factors that fostered or discouraged adoption during the COVID-19 pandemic with older adult patients. Therefore, our objective was to understand experiences of frontline physicians caring for older adults via telehealth during the COVID-19 pandemic. Methods We conducted semi-structured interviews from September 2020 to November 2020 with 48 physicians. We recruited a diverse sample of geriatricians (n = 18), primary care (n = 15), and emergency (n = 15) physicians from all United Stated (US) regions, rural-urban settings, and academic-community practices who cared for older adult patients during the pandemic using purposive sampling methods. We completed framework analysis of the transcribed interviews to identify emerging themes and used the Quadruple Aim to organize themes. Results Frontline physicians described telehealth as a more flexible, value-based, and patient-centered mode of health care delivery. Benefits of using telehealth to treat older adults included reducing deferred care and increasing timely care, improving efficiency for physicians, enhancing communication with caregivers and patients, reducing patient travel burdens, and facilitating health outreach and education. Challenges included unequal access for rural, older, or cognitively impaired patients. Physicians noted that payment parity with in-person visits, between video and telephone visits, and relaxation of restrictive regulations would enhance their ability to continue to offer telehealth. Conclusions Frontline physicians who treated older adults during the COVID-19 pandemic were largely in favor of continuing telehealth use beyond the pandemic; however, they noted that sustainability would depend on enacting policies that address access inequities and reimbursement concerns. Our data provide policy insights that if placed into action could facilitate the long-term success of telehealth and encourage a more flexible healthcare delivery system in the US. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02860-8.
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Affiliation(s)
- Elizabeth M Goldberg
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, 55 Claverick Street, Second floor, Providence, RI, 02903, USA. .,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Michelle P Lin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura G Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Roland C Merchant
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Fetherstonhaugh D, Rayner JA, Solly K, Beattie E, Harrington A, Jeon YH, Moyle W, Parker D. Teaching the care of older people in Australian nursing schools: Survey findings. Collegian 2022. [DOI: 10.1016/j.colegn.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baik S, Davitt JK. Factors Associated With Attitudes Toward Older Adults in Social Work Students: A Systematic Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:168-187. [PMID: 34193024 DOI: 10.1080/01634372.2021.1944946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
This systematic review examined the factors associated with social work students' attitudes toward older adults or working with older adults from the literature published in the last decade. Twelve peer-reviewed empirical studies published between 2011 and 2020 were included for review. Results suggest that both direct and indirect exposures to older adults positively changed social work students' attitudes. While infusing exposure to older adults into courses appeared effective in modifying students' attitudes, inconsistent measurement and lack of information across studies made it impossible to compare the effectiveness of interventions across studies. Implications for gerontological social work education are discussed.
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Affiliation(s)
- Sol Baik
- School of Social Work, University of Maryland, Baltimore, Maryland, USA
| | - Joan K Davitt
- School of Social Work, University of Maryland, Baltimore, Maryland, USA
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Davila H, O'Malley KA, Shin MH, Engle RL, Adjognon OL, Sullivan JL. Supporting Veterans with dementia to remain in the community: strategies used in 12 Veterans Health Administration programs. Home Health Care Serv Q 2022; 41:149-164. [PMID: 35068371 DOI: 10.1080/01621424.2022.2027315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Veterans Health Administration (VA) provides services to growing numbers of Veterans with dementIa, individuals at heightened risk for hospitalizations and nursing home placement. Beginning in 2010, the VA funded 12 innovative pilot programs to improve dementia care and help Veterans remain at home. We conducted a retrospective qualitative analysis of program materials and interviews with physicians, nurses, social workers, and other personnel (n = 33) to understand the strategies these programs adopted. Interviews were conducted every 6 months between 2010-2013 (4-5 interviews per program) and focused on factors affecting program design and implementation, challenges, and strategies to reduce hospitalizations and nursing home placements. Programs varied considerably yet shared three overarching strategies to improve dementia care: involving and supporting family caregivers; engaging interdisciplinary teams; and improving coordination with other healthcare providers. Our results highlight the importance of adapting common dementia care strategies based on the local context and needs of individuals served.
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Affiliation(s)
- Heather Davila
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Healthcare System, Iowa City, Iowa, USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Kelly A O'Malley
- Community Living Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,New England Geriatric Research Education Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Ryann L Engle
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Kochar B, Ufere NN, Ritchie CS, Lai JC. The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis. Clin Transl Gastroenterol 2022; 13:e00445. [PMID: 35080513 PMCID: PMC8806384 DOI: 10.14309/ctg.0000000000000445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 12/22/2022] Open
Abstract
The number of Americans 65 years or older in 2060 will be more than double what it was in 2014. Approximately 40% of patients seen in gastroenterology (GI) and hepatology practices in the United States are 60 years or older. Adapting care delivery models, curating data on shifting risk-benefit decisions with geriatric syndromes, understanding appropriate assessments, and focusing on tailored implementation strategies are challenges that are actively confronting us as we provide care for a burgeoning population of older adults. Limited availability of geriatric specialists results in an onus of specialists caring for older adults, such as gastroenterologists, to innovate and develop tailored, comprehensive, and evidence-based care for adults in later life stages. In this article, we present the 5M framework from geriatrics to achieve age-friendly healthcare. The 5Ms are medications, mind, mobility, multicomplexity, and what matters most. We apply the 5M framework to 2 chronic conditions commonly encountered in clinical GI practice: inflammatory bowel diseases and cirrhosis. We highlight knowledge gaps and outline future directions to expand evidence-based care and advance the creation of age-friendly GI care.
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Affiliation(s)
- Bharati Kochar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Boston, Massachusetts, USA
| | - Nneka N. Ufere
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine S. Ritchie
- Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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40
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Rossler KL, Tucker C. Simulation helps equip nursing students to care for patients with dementia. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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41
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Supporting Community Development for Mental Health in the Ageing Population of Hong Kong. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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"I was not able to keep myself away from tending to her immediate needs": Primary Care Physicians' Perspectives of Serious Illness Conversations at Community Health Centers. J Gen Intern Med 2022; 37:130-136. [PMID: 34327652 PMCID: PMC8738823 DOI: 10.1007/s11606-021-06921-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/06/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting. METHODS An initiative to increase SI conversations was implemented at two CHCs in the Bronx, NY. Eleven participating family physicians who together conducted 37 SI conversations underwent semi-structured in-depth interviews. The 11 interviews were analyzed using inductive thematic analysis. RESULTS Eight themes emerged: (1) Structured approaches to SI conversations are useful even in longstanding patient-doctor relationships; (2) Discussion of prognosis is meaningful but difficult; (3) Emotional work is humanizing but draining; (4) Poverty and underinsurance are high priorities; (5) Social context affects patient readiness; (6) Communication barriers take multiple forms; (7) Patient characteristics make it "easier" or "harder" to initiate the SI conversation; (8) Time constraints limit the ability to meet multiple patient needs. CONCLUSIONS Physicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs.
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Ornstein KA, Ankuda CK, Leff B, Rajagopalan S, Siu AL, Harrison KL, Oh A, Reckrey JM, Ritchie CS. Medicare-funded home-based clinical care for community-dwelling persons with dementia: An essential healthcare delivery mechanism. J Am Geriatr Soc 2021; 70:1127-1135. [PMID: 34936087 DOI: 10.1111/jgs.17621] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past decade, medical care has shifted from institutions into home settings-particularly among persons with dementia. Yet it is unknown how home-based clinical services currently support persons with dementia, and what factors shape access. METHODS Using the National Health and Aging Trends Study linked to Medicare claims 2012-2017, we identified 6664 community-dwelling adults age ≥ 70 years enrolled in fee-for-service Medicare. Annual assessment of dementia status was determined via self-report, cognitive interview, and/or proxy assessment. Receipt of four types of home-based clinical care (home-based medical care (HBMC) (i.e., nurse practitioner, physician, or physician assistant visits), skilled home health care (SHHC), podiatry visits, and other types of home-based clinical services (e.g., behavioral health)) was assessed annually. We compared age-adjusted rates of home-based clinical care by dementia status and determined sociodemographic, health, and environmental characteristics associated with utilization of home-based clinical care among persons with dementia. RESULTS Nearly half (44.4%) of persons with dementia received any home-based clinical care annually compared to only 14.4% of those without dementia. Persons with dementia received substantially more of each type of home-based clinical care than those without dementia including a 5-fold increased use of HBMC (95% CI = 3.8-6.2) and double the use of SHHC (95% CI = 2.0-2.5). In adjusted models, Hispanic/Latino persons with dementia were less likely to receive HBMC (OR = 0.32; 95% CI = 0.11-0.93). Use of HBMC, podiatry, and other home-based clinical care was significantly more likely among those living in residential care facilities, in the Northeast and in metropolitan areas. CONCLUSION Although almost half of community-dwelling persons with dementia receive home-based clinical care, there is significant variation in utilization based on race/ethnicity and environmental context. Increased understanding as to how these factors impact utilization is necessary to reduce potential inequities in healthcare delivery among the dementia population.
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Affiliation(s)
- Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Claire K Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, The Center for Transformative Geriatric Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Subashini Rajagopalan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Albert L Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Anna Oh
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA
| | - Jennifer M Reckrey
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
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Stockman TB, Alsane DM, Slattum PW, Falls K, Parsons P, Donohoe KL. Evaluation of students' knowledge, values, and experiences in a geriatrics interprofessional practice-based model. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1683-1689. [PMID: 34895679 DOI: 10.1016/j.cptl.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 07/08/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE The objective was to evaluate (1) students' knowledge in a variety of geriatrics competencies, (2) students' attitudes toward the value of interprofessional practice, and (3) pharmacy students' experiences after an advanced pharmacy practice experience (APPE) in a practice-based interprofessional education (IPE) model. EDUCATIONAL ACTIVITY AND SETTING Nursing, pharmacy, social work, and health sciences programs who participated in the Richmond Health and Wellness Program (RHWP) interprofessional experience received pre- and post-surveys to assess changes in geriatrics knowledge. An adapted Attitude Toward Health Care Teams Scale (ATHCTS) was used to assess changes in students' attitudes toward the value of interprofessional teamwork. Finally, representative quotes were taken from APPE evaluations to illustrate the pharmacy student experience. FINDINGS Seventy-two out of 82 (87.8%) interprofessional students who participated in the practice-based IPE model at RHWP in the fall 2018 participated in this study. Geriatrics knowledge scores significantly increased by 4.03 (P < .001) with a significant change in some knowledge domains: frailty (P = .005) and medication knowledge (P = .017). Attitudes toward the value of interprofessional practice increased with a statistically significant difference in the ATHCTS quality of care subscale (P < .001). Pharmacy students found the interprofessional collaboration to be valuable. SUMMARY A practice-based IPE experience can provide many benefits to health professional students. By working as a team, students learn from each other, leading to increased knowledge on several geriatrics competencies. Students understand the importance of IPE experiences, but their attitudes become more positive through application.
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Affiliation(s)
- Tabbitha B Stockman
- Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, P.O. Box 980533, Richmond, VA 23298-0533, United States.
| | - Danah M Alsane
- Pharmacy Practice, Health Science Center, Kuwait University, Kuwait.
| | - Patricia W Slattum
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, 410 N 12th Street, P.O. Box 980533, Richmond, VA 23298-0533, United States.
| | - Katherine Falls
- Richmond Health and Wellness Program, Virginia Commonwealth University School of Nursing, Richmond, VA, United States.
| | - Pamela Parsons
- Virginia Commonwealth University School of Nursing, P.O. Box 980657, Richmond, VA, United States.
| | - Krista L Donohoe
- Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, P.O. Box 980533, Richmond, VA 23298-0533, United States.
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Huglin J, Whelan L, McLean S, Greer K, Mitchell D, Downie S, Farlie MK. Exploring utilisation of the allied health assistant workforce in the Victorian health, aged care and disability sectors. BMC Health Serv Res 2021; 21:1144. [PMID: 34686210 PMCID: PMC8540135 DOI: 10.1186/s12913-021-07171-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Allied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. Previous studies have indicated that AHAs may be underutilised in some contexts. This study aims to identify factors contributing to the effective utilisation of AHAs across health, aged care and disability sectors and possible pathway elements that may optimise AHA careers in Victoria. Methods Using an interpretive description approach data collection included a workforce survey and semi structured interviews (individual and group). Data analysis included descriptive statistics, independent t-tests and thematic analysis. Participants included allied health assistants, allied health professionals and allied health leaders in the health, aged care or disability sectors; educators, managers or student of allied health assistance training; and consumers of Victorian health, disability or aged care services. Results The literature scan identified numerous potential barriers to and enablers of AHA workforce utilisation. A total of 727 participants completed the survey consisting of AHAs (n = 284), AHPs & allied health leaders (n = 443). Thirteen group and 25 individual interviews were conducted with a total of 119 participants. Thematic analysis of the interview data identified four interrelated factors (system, training, individual and workplace) in pre-employment training and workplace environments. These factors were reported to contribute to effective utilisation of the AHA workforce across health, aged care and disability sectors. Study findings were also used to create a conceptual diagram of potential AHA career pathway elements. Conclusion This study identified pre-employment and workplace factors which may contribute to the optimal utilisation of the AHA workforce across Victorian health, aged care and disability sectors. Further study is needed to investigate the transferability of these findings to national and global contexts, and testing of the conceptual model. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07171-z.
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Affiliation(s)
- J Huglin
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - L Whelan
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - S McLean
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia
| | - K Greer
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - D Mitchell
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - S Downie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia.,Department of Health, Victoria State Government, Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - M K Farlie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia.
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Jester DJ, Hyer K, Wenders A, Andel R. Attitudes toward aging of health professions students: Implications for geriatrics education. GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:589-603. [PMID: 33111652 DOI: 10.1080/02701960.2020.1835657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We compared attitudes toward aging of students from several health professions (N = 1,156: 286 medical, 275 pharmacy, 213 undergraduate nursing, 160 graduate nursing, 139 Internal Medicine residents, 49 physical therapy, and 34 physician assistant), and assessed the construct validity of the Image of Aging Scale. Physical therapy and graduate nursing students reported more positive attitudes toward aging in comparison to all other health professions (all p <.001). Differences in attitudes were not strongly affected by demographic variables, clinical exposure, desire to pursue primary care, or interest in providing care to older adults. The Image of Aging Scale yielded good internal reliability and adequate construct validity for health professions students. Health professions students' attitudes toward aging largely reflect the students' professional training, rather than student characteristics or career goals. The Image of Aging Scale is a robust measure of attitudes toward aging in health professions students and in older adults.
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Affiliation(s)
- Dylan J Jester
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Anna Wenders
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Department of Neurology, Memory Clinic, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Indoor Localization for Personalized Ambient Assisted Living of Multiple Users in Multi-Floor Smart Environments. BIG DATA AND COGNITIVE COMPUTING 2021. [DOI: 10.3390/bdcc5030042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This paper presents a multifunctional interdisciplinary framework that makes four scientific contributions towards the development of personalized ambient assisted living (AAL), with a specific focus to address the different and dynamic needs of the diverse aging population in the future of smart living environments. First, it presents a probabilistic reasoning-based mathematical approach to model all possible forms of user interactions for any activity arising from user diversity of multiple users in such environments. Second, it presents a system that uses this approach with a machine learning method to model individual user-profiles and user-specific user interactions for detecting the dynamic indoor location of each specific user. Third, to address the need to develop highly accurate indoor localization systems for increased trust, reliance, and seamless user acceptance, the framework introduces a novel methodology where two boosting approaches—Gradient Boosting and the AdaBoost algorithm are integrated and used on a decision tree-based learning model to perform indoor localization. Fourth, the framework introduces two novel functionalities to provide semantic context to indoor localization in terms of detecting each user’s floor-specific location as well as tracking whether a specific user was located inside or outside a given spatial region in a multi-floor-based indoor setting. These novel functionalities of the proposed framework were tested on a dataset of localization-related Big Data collected from 18 different users who navigated in 3 buildings consisting of 5 floors and 254 indoor spatial regions, with an to address the limitation in prior works in this field centered around the lack of training data from diverse users. The results show that this approach of indoor localization for personalized AAL that models each specific user always achieves higher accuracy as compared to the traditional approach of modeling an average user. The results further demonstrate that the proposed framework outperforms all prior works in this field in terms of functionalities, performance characteristics, and operational features.
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Triscott JAC, Dobbs B, Charles L, Huang J, Moores D, Tian PGJ. The Care-of-the-Elderly Health Guide. J Prim Care Community Health 2021; 12:21501327211044058. [PMID: 34486428 PMCID: PMC8424605 DOI: 10.1177/21501327211044058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: The Evidence-Based Care of the Elderly Health Guide is a clinical guide with cross-references for care recommendations. This guide is an innovative adaptation of the Rourke Baby Record to support elderly care. In 2003, the guide was published with an endorsement from the Health Care-of-the-Elderly Committee of the College of Family Physicians of Canada. Since then, physicians have used the guide as a checklist and a monitoring tool for care to elderly patients. Objective: We will update the 2003 Care-of-the-Elderly Health Guide with current published evidence-based recommendations. Methods: This was a mixed methods study consisting of (1) the creation of a list of topics and corresponding guidelines or recommendations, (2) two focus group discussions among family physicians (n = 12) to validate the list for relevance to practice, and (3) a modified Delphi technique in a group of ten experts in Care of the Elderly and geriatrics to attain consensus on whether the guidelines/recommendations represent best practice and be included. Results: The initial list contained 43 topics relevant to family practice, citing 49 published guidelines or recommendations. The focus group participants found the list of topics and guidelines potentially useful in clinical practice and emphasized the need for user-friendliness and clinical applicability. In the first online survey of the modified Delphi technique, 93% (63/66) of the references attained consensus that these represented standards of care. The other references (3/66) attained consensus in the second online survey. The final list contained 47 topics, citing 66 references. Conclusion: The Care-of-the-Elderly Health Guide is a quick reference to geriatric care, reviewed for relevance by family physicians and a panel of experts. The Guide is intended to be used in primary care practice.
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Affiliation(s)
- Jean A C Triscott
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Dobbs
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - James Huang
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David Moores
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Guth A, Chou J, Courtin SO, Ford C, Hennawi G, Brandt N. An Interdisciplinary Approach to Implementing the Age-Friendly Health System 4Ms in an Ambulatory Clinical Pathway With a Focus on Medication Safety. J Gerontol Nurs 2021; 46:7-11. [PMID: 32976620 DOI: 10.3928/00989134-20200909-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
MedStar's Center for Successful Aging (CSA) participated in the Age-Friendly Health Systems initiative led by The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States. This initiative focuses on bringing the 4Ms framework-What Matters, Medication, Mentation, and Mobility-to caring for older adults. A quality improvement project was conducted at the CSA to integrate the 4Ms framework into the CSA ambulatory clinical pathway. Our interventions found upward trends in patients receiving 4Ms care during their new patient visits. Positive preliminary feedback was also obtained from providers following the incorporation of the 4Ms framework in the high-risk rounds discussion. A focus on high-risk medications and deprescribing illustrated positive clinical outcomes. This ongoing interprofessional collaboration illustrates the importance of person-centered care and quality improvement to achieve Age-Friendly Health Systems status within an ambulatory practice. [Journal of Gerontological Nursing, 46(10), 7-11.].
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Venditti EM, Steinman LE, Lewis MA, Weiner BJ, Ma J. Seeking a pot of gold with integrated behavior therapy and research to improve health equity: insights from the RAINBOW trial for obesity and depression. Transl Behav Med 2021; 11:1691-1698. [PMID: 34244787 PMCID: PMC8344914 DOI: 10.1093/tbm/ibab069] [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] [Indexed: 11/25/2022] Open
Abstract
More than one third of adults in the United States (U.S.) live with multiple chronic conditions that affect their physical and mental health, functional outcomes, independence, and mortality. The COVID-19 pandemic has exposed not only an increased risk for infection, morbidity, and mortality among those with chronic conditions but long-standing health inequities by age, race, sex, and other social determinants. Obesity plus depression represent one such prevalent comorbidity for which few effective integrated interventions exist, prompting concern about the potential for secondary physical and mental health pandemics post COVID-19. Translational behavioral medicine research can play an important role in studying integrated collaborative healthcare approaches and advancing scientific understanding on how to engage and more effectively treat diverse populations with physical and mental health comorbidities. The RAINBOW (Research Aimed at Improving Both Mood and Weight) clinical trial experience offers a wealth of insights into the potential of collaborative care interventions to advance behavior therapy research and practice. Primary care patients with co-occurring obesity and depression were assigned to either Integrated Coaching for Mood and Weight (I-CARE), which blended Group Lifestyle Balance (GLB) for weight management and the Program to Encourage Active Rewarding Lives (PEARLS) for depression, or usual care, to examine clinical, cost-effectiveness, and implementation outcomes. This commentary highlights the empirical findings of eight RAINBOW research papers and discusses implications for future studies, including their relevance in the U.S. COVID-19 context. Organized by key principles of translational behavioral medicine research, the commentary aims to examine and embrace the heterogeneity of baseline and intervention response differences among those living with multiple chronic conditions. We conclude that to prevent health and healthcare disparities from widening further, tailored engagement, dissemination, and implementation strategies and flexible delivery formats are essential to improve treatment access and outcomes among underrepresented populations.
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Affiliation(s)
- Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | | | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA, USA
| | - Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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