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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kramer BJ, Weintraub NT, Richter-Lagha RA. Infusing geriatrics in Indian Health Service general primary care clinics: extending VA workforce development training. Gerontol Geriatr Educ 2022:1-10. [PMID: 35377832 DOI: 10.1080/02701960.2022.2056735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
As federal partners, the Veterans Health Administration (VA) and the Indian Health Service (IHS) agreed to share resources, such as education. The VA Geriatric Scholars Program, a workforce development program, provides one of its training programs on team-based primary care of elders to clinicians working in IHS and Tribal Health Programs. The practical impact of that training is described. A mixed methods approach was applied to the course's evaluation survey at five clinics in the Northwestern Plains, Southwest, Pacific Coast, and Alaska. Quantitative approaches assessed participants' self-reported intention to improve recognition and assessment of common geriatric syndromes. A qualitative approach applied to open-ended text responses revealed intensions to improve team-based care. Among the 51 respondents in our sample, we found significant improvements in self-reported ability to recognize previously unfamiliar potential risks to elders' health and safety, t(49) = 8.0233, p < .001, as well as increased comfort with conducting geriatric assessments and increased confidence in interprofessional team-based communication. Improvements to team-based care included enhanced clinical skills, organizational factors and the need to train additional employees. This evaluation demonstrates the value of sharing resources among federal partners and its value for participants in IHS and Tribal Health Programs.
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Affiliation(s)
- B Josea Kramer
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, North Hills, USA
- David Geffen School of Medicine, University of California at Los Angeles, Division of Geriatric Medicine, Los Angeles, USA
| | - Nancy T Weintraub
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, North Hills, USA
- David Geffen School of Medicine, University of California at Los Angeles, Division of Geriatric Medicine, Los Angeles, USA
| | - Regina A Richter-Lagha
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, North Hills, USA
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Hathaway JR, Tarini BA, Banerjee S, Smolkin CO, Koos JA, Pati S. Healthcare team communication training in the United States: A scoping review. Health Commun 2022:1-26. [PMID: 35168467 DOI: 10.1080/10410236.2022.2036439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of this literature review was to identify interventions designed to improve healthcare team communication in the United States. We conducted a review of peer-reviewed, English-language articles describing interventions aimed at improving healthcare team communication. We analyzed articles that met pre-specified inclusion and exclusion criteria and characterized who is testing communication interventions, the rationale for testing, and ways of measuring effectiveness. We descriptively categorized the strength and types of study findings. Thirty articles were retained in our analysis. Most assessments were conducted by academic medical centers, the Veterans Health Administration, and teaching hospitals. Interventions sought to improve teamwork, patient safety, clinical outcomes, costs of care, and enhance provider job satisfaction and well-being. Intervention strategies included didactic lectures, simulation, Crew Resource Management, quality improvement, or a combination of these approaches. The vast majority employed a pre-post survey design and measured outcomes using participant feedback. Many assessments failed to utilize a social science theory or communication-specific measures. Interventions with the best training content were conducted at academic medical centers, used a pre-post design, and utilized statistical analysis to analyze results. While interventions for improving healthcare team communication are diverse and have uneven effectiveness, early markers of success merit continued development and assessment.
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Affiliation(s)
- Julia R Hathaway
- Alan Alda Center for Communicating Science®, Stony Brook University
| | - Beth A Tarini
- Center for Translational Research, Children's National Medical Center
| | - Sushmita Banerjee
- Renaissance School of Medicine, Stony Brook University, Stony Brook University
| | - Caroline O Smolkin
- Renaissance School of Medicine, Stony Brook University, Stony Brook University
| | | | - Susmita Pati
- Alan Alda Center for Communicating Science®, Renaissance School of Medicine at Stony Brook University & Stony Brook Children's Hospital, Stony Brook University
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Hoang P, Torbiak L, Goodarzi Z, Schmaltz HN. A Qualitative and Quantitative Analysis of the Geriatrics Update: Clinical Pearls Course. Can Geriatr J 2021; 24:304-311. [PMID: 34912484 PMCID: PMC8629497 DOI: 10.5770/cgj.24.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The University of Calgary Cumming School of Medicine Annual Geriatrics Update: Clinical Pearls Course (Geriatrics Update) is a one-day, continuing medical education (CME) course designed to enhance geriatrics competency for family physicians (FPs), given increasing population age and complexity. We aimed to evaluate how the course meets FPs’ perceived learning needs and identify modifications that may better support FPs. Methods Descriptive data from 2018–2019 course evaluation surveys including demographic data, evaluations, and narrative feedback from participating FPs. Semi-structured phone and video-conferenced interviews with FPs were thematically analyzed each year. Results Evaluation surveys had high response rates of FPs (52 or 61% in 2018; 39 or 58% in 2019). Most FP respondents (84% in 2018 and 82% in 2019) intended to make practice changes. FPs were significantly (p=.001) more confident on course objectives after the course in both years. All interviewees (n=20) described fulfilled perceived and unperceived learning needs and planned to return. The Geriatrics Update course is the primary source of Geriatrics CME for 60% of interviewees. Conclusions Iterative evaluation of Geriatrics Update identified that the course is well received, and often FPs primary source of geriatric CME. Interviews provided additional context and descriptive feedback to improve course delivery and better meet FP learning needs.
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Affiliation(s)
- Peter Hoang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Lindsay Torbiak
- Department of Medicine, University of Manitoba, Winnipeg, MB
| | - Zahra Goodarzi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, AB
| | - Heidi N Schmaltz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.,Seniors' Health, Calgary Zone, Alberta Health Services, Edmonton, AB
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Hintenach A, Raphael O, Hung WW. Training Programs on Geriatrics in Rural Areas: A Review. Curr Geriatr Rep 2019; 8:117-122. [PMID: 31435495 PMCID: PMC6703557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW To understand the current scope of training in geriatrics in rural areas for rural providers and teams, we reviewed current literature to identify training programs which pertain to geriatric education and training of the rural workforce. RECENT FINDINGS Older adults are one of the fastest growing demographics in the United States and represent a higher share of the population in rural areas than in other counties. Older adults in rural areas often have complex health challenges and may benefit from care from healthcare teams with geriatrics training. However, there is a paucity of geriatrics workforce in the country and particularly in rural areas. Geriatric training programs targeting rural practitioners may serve to bridge this gap through providing training and support to rural teams taking care of older adults in rural areas. SUMMARY Ten unique programs were identified which described efforts to introduce geriatrics to rural practitioners. Each used different methods of training at a distance, leveraging the use of telecommunications and the internet, or face to face training methods alone or in combination with distance training. Improvements in clinician knowledge, skills and other impacts were described. Current evidence demonstrates that providing training in geriatrics is feasible and may yield positive impacts on rural clinical teams and potential downstream effects on patient care.
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Affiliation(s)
- Annette Hintenach
- The Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Oren Raphael
- The Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - William W. Hung
- The Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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